Greater income, education before diagnosis linked to less severe MS

Socioeconomic levels ID'd as risk factors for MS severity in new study

Margarida Maia, PhD avatar

by Margarida Maia, PhD |

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Socioeconomic factors, specifically income and education levels, and marital status, were identified as risk factors for multiple sclerosis (MS) severity in a new study in Sweden.

In fact, the study found that earning a higher income and having more years of education before being diagnosed with MS are associated with less severe disability and milder symptoms over the disease course.

Conversely, people with relapsing MS who were divorced tended to have more severe disability and worse physical and psychological symptoms than did patients who were single.

“Education, income, and marital status are associated with severity of future disability and symptom severity, and they should be considered in risk stratification,” the researchers wrote, noting that greater pre-diagnosis “educational attainment and income were associated with up to 47% milder subsequent disability and patient-reported symptoms.”

The study, “Premorbid Sociodemographic Status and Multiple Sclerosis Outcomes in a Universal Health Care Context,” was published in the journal JAMA Network Open.

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Investigating socioeconomic, marital status as potential risk factors in MS

MS causes a wide range of symptoms, from vision loss and cognitive issues to problems with movement, sensation, and balance. Over time, patients experience an accumulating disability which comes with a significant psychological burden.

The neurodegenerative disorder is highly variable from patient to patient, but disease features and treatment can only partially explain the variation in MS outcomes. This has sparked a growing interest in socioeconomic factors and whether they can affect how severe MS can become.

While a few studies have demonstrated an association between some of these factors and MS severity, most measures of socioeconomic status were assessed at or after diagnosis, which makes it impossible to know for sure whether these measures impacted disease outcomes or the other way around.

Also, previous studies have not examined whether having a partner, which for some individuals may mitigate some of the psychological burden of the disease, also had an effect on disability accumulation and symptom severity.

Now, researchers in Sweden set out to understand if income, education, and marital status at one year before a diagnosis of MS are linked to future disability and symptom severity, regardless of treatment. The overarching goal was to better identify potential risk factors for MS severity.

The team examined data from 4,557 patients included in the Swedish MS Registry and two patient databases from Sweden. The mean age of these patients was 37.5, ranging from 23 to 59 years —”working age,” according to the researchers.

More than two-thirds (68.8%) of the patients were women and most (92.1%) had relapsing forms of MS. On average, the patients were followed for 8.5 years.

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Worse disease severity found for patients with marital separation

The results supported socioeconomic factors as potential predictors for a patient’s risk of worse MS in both relapse-onset and progressive-onset disease.

Among people with relapsing MS, those who earned a higher income or had attained more years of education one year before their diagnosis were found to experience less disability, as assessed with the Expanded Disability Status Scale (EDSS). These individuals also self-reported fewer physical and psychological symptoms on the MS Impact Scale (MSIS-29). 

In turn, those with relapsing MS who were divorced or separated experienced worse outcomes compared with those who were single — but there were no differences between single patients and those who were with a partner.

According to researchers, “this could suggest that the worse prognosis may be attributable to the stress of separation more than the fact of being unmarried.”

Indeed, the team noted that “marital separation was associated with up to 35% higher disease severity in relapse-onset disease.”

“Our results suggest that being separated or divorced prior to disease onset was a negative prognostic factor in relapse-onset MS,” they wrote.

These results suggest that individual or contextual factors linked to sociodemographic status may inform MS severity.

Similar patterns were observed when looking at patients’ socioeconomic status five years before the diagnosis of MS.

For those with progressive MS, a higher income was associated with less severe disability. Higher education was linked to less severe physical and psychological symptoms.

No significant associations were observed regarding marital status among these individuals, though the team noted that the lack of statistical significance may be due to the low number of patients with progressive MS included in the analysis.

In all, greater education and income were linked to milder subsequent disability and patient-reported symptoms, up to 47%, after adjusting for individual treatment, the researchers noted.

“These results suggest that individual or contextual factors linked to sociodemographic status may inform MS severity,” they concluded.