Delaying start of DMTs in RRMS tied to low educational attainment
Study showcases importance of supporting risk groups' health literacy in clinic
Relapsing-remitting multiple sclerosis (RRMS) patients with low educational attainment are more likely to delay the start of disease-modifying therapies (DMTs) after a diagnosis than those with a high educational status, a Danish study suggests.
Educational status wasn’t significantly associated with diagnostic delays after the onset of symptoms, however.
“Our results from a Danish context with a publicly funded healthcare system and near-complete nationwide registry data support an educational gradient in access to DMT in patients with RRMS,” the researchers wrote. “Targeted interventions are, therefore, needed to address educational disparities in healthcare access and treatment initiation.”
The study, “The impact of educational attainment on diagnostic and treatment delays in multiple sclerosis: a nationwide cohort study in Denmark,” was published in Therapeutic Advances in Neurological Disorders.
Social determinants of health such as income, food, housing, healthcare access, social support systems, and educational attainment are nonmedical factors that can influence health outcomes. Education has been linked to outcomes in multiple sclerosis (MS), although it’s not clear how education might affect brain health.
Improved health literacy could help patients make more informed decisions and better navigate the healthcare system, allowing for earlier diagnoses and easier access to DMTs. But studies evaluating this have had conflicting results, with some reporting a link between a higher educational status and better DMT access and others failing to see an association.
Linking treatment delays, education levels
To learn more, two researchers in Denmark examined clinical data from RRMS patients housed in the Danish Multiple Sclerosis Registry, linking the information to other nationwide registries that contain data about educational attainment.
Educational status was determined based on international classification guidelines. Patients were categorized as having a low (primary or lower secondary school), medium (upper secondary and postsecondary school), or high (first- and second-stage tertiary) education level.
A first analysis sought to determine if educational status influenced how long it took to be diagnosed after having the first clinical signs of MS (clinical onset). It included 4,344 RRMS patients with a clinical onset at age 20 or older, and in the year 2012 or later.
Among them, 17.2%, 44.4%, and 38.4% had low, medium, and high educational attainment, respectively. The patients were divided into four groups based on the length of their diagnostic delay, with 25% of patients each considered to have a very short, short, medium, or long delay.
The results showed no differences in diagnostic delays between educational groups.
A second analysis, involving 5,402 RRMS patients diagnosed between 2012-2022 at age 20 or older, was designed to assess how educational attainment influenced the delay between a diagnosis and starting DMTs.
In this group, 16.7%, 43.7%, and 39.6% of patients had low, medium, and high educational attainment, respectively. The patients were grouped based on the delay between their diagnosis and the start of DMTs: concurrent (within a week of diagnosis), short duration (8-28 days), medium duration (29-75 days), and long duration (76 or more days).
Statistical analyses adjusted for age, sex, migration background, and calendar year of clinical onset or diagnosis, showed that patients with low education attainment were significantly more likely, by 48%, to have a longer treatment delay than those with more education.
A total of 314 patients didn’t initiate a DMT during the analysis period. These patients were significantly older (47.1 vs. 38.7 years) and more likely to have a low educational attainment relative to those who did start DMTs (21.3% vs. 16.4%).
Given that the timely initiation of DMTs is associated with better outcomes for patients, the researchers emphasized the need for interventions that would facilitate access to DMTs regardless of educational status. They said educational attainment is often established in adolescence or early adulthood and isn’t easy to change later. Low educational attainment also precedes and influences other social determinants of health, such as income or working conditions.
“Identifying high-risk groups … with a low educational attainment and supporting their health literacy during clinical visits in the MS clinic,” could be a way to address these disparities, wrote the researchers, who identified limitations in their analysis, including a lack of information on other potentially influential factors such as income or health-related behaviors like smoking and diet. Such factors should be included in future studies aimed at better understanding the link between education and MS outcomes, they said.
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