Brain damage in MS children linked to lower socioeconomic status
Children from poorer families found to have more brain tissue loss: US study
Children with multiple sclerosis (MS) who come from poorer families or other disadvantageous circumstances tend to have more inflammation and irreversible brain tissue loss, a new study reports.
“Our findings suggest that social disadvantage in childhood can have lasting effects on MS severity,” Kimberly A. O’Neill, MD, study coauthor at New York University Grossman School of Medicine, said in a news story.
The data showed that having public health insurance — and not private insurance, which was far more common for children growing up in more advantaged neighborhoods — was the strongest predictor of a child having a greater amount of inflammation and tissue loss in the brain.
“Childhood is a critical time for exposure to environmental factors associated with increased susceptibility to MS, such as passive smoke, pollution and low sunlight exposure,” O’Neill said, adding that “more studies are needed to understand which and how factors in disadvantaged neighborhoods increase the risk for MS severity in young people.”
The study, titled “Association of Social Determinants of Health With Brain MRI Outcomes in Individuals With Pediatric Onset Multiple Sclerosis” and led by O’Neill and Ruby Ross, MD, also from NYU’s Grossman School of Medicine, was published in the journal Neurology.
Little data exist on impact of socioeconomic status on children with MS
MS is an inflammatory disorder that causes damage to the brain and spinal cord. MS-related damage is visible on MRI scans as lesions — areas where brain tissue has become scarred — and a loss of brain volume. Lesions are usually signs of brain inflammation, but when tissue becomes irreversibly lost, those regions will appear on MRI scans as black holes.
Although MS most commonly develops in adults ages 20-40, the disease can, in rare cases, occur in children and adolescents — this is called pediatric-onset MS or POMS.
While studies in adults with MS have shown that patients with poorer socioeconomic status tend to have worse health outcomes, there isn’t much data on whether this also applies to children with POMS.
To learn more, a team of U.S. researchers analyzed MRI scans from 138 children and adolescents with POMS. At the time scans were collected, the average patient age was 19.9 years, and most of the children and teens had been living with POMS for about three years or longer.
The researchers didn’t have access to data on individual household income, but they did have each patient’s address, so they used that as a proxy for socioeconomic status, with patients living in poorer neighborhoods assumed to be of lower socioeconomic status.
Race and ethnicity were also examined, along with insurance type. In the U.S., the public health insurance program Medicaid is available to low-income families, so patients on public health insurance were assumed to have lower familial incomes.
Statistical models using these data indicated that patients with poorer socioeconomic status tended to have more inflammation and brain damage, with greater lesion volume and also a larger black-hole volume.
Black race and Hispanic ethnicity also were associated with more brain damage.
Importantly, however, being on public health insurance was the strongest predictor of brain damage in the statistical models, the data showed.
“While these are associations and not causes, many of these groups have historically been underrepresented in MS research,” O’Neill said.
Having public health insurance ID’d as greatest predictor of more severe MS
Taking all these data collectively, the models suggested that poor socioeconomic status explained 25.8% of the variance in total lesion volume and 23.4% of the variance in black hole volume.
The researchers noted that the impact of socioeconomic status appeared to be independent of healthcare factors, such as how quickly patients were seen by neurologists, or how soon they started MS treatments.
“This suggests that access to health care does not explain the more severe disease burden shown in the brain scans of people in disadvantaged groups in our study,” O’Neill said.
Our study showed associations between social determinants of health and POMS disease severity as seen on [MRI scans]. … More research is needed to address modifiable risk factors and identify public policies to improve outcomes in these patients.
Altogether, these data indicate that socioeconomic factors likely influence the trajectory of disease for children with POMS — which implies that economic and social support for less well-off families may lead to better health outcomes for their children.
“Our study showed associations between social determinants of health and POMS disease severity as seen on [MRI scans],” the researchers concluded. “More research is needed to address modifiable risk factors and identify public policies to improve outcomes in these patients.”
Added O’Neill: “Our work here is just beginning.”
About the Author
