In an observational cohort study, factors such as education, income, and marital status correlated with MS severity outcomes.
For reasons not fully understood, MS severity drastically varies among patients. Aspects of the disease or treatment approaches cannot fully explain these differences, and this has led researchers to increasingly consider the influence of social determinants on MS severity.
The influence of sociodemographic factors on disease severity has become an increasingly important topic across medical studies—especially in MS. These analyses have typically focused on financial, educational, environmental, and behavioral factors, as well as obstacles that may bar access to quality care. In addition to socioeconomic considerations, studies have turned their attention to the impact of ecological factors. For example, the authors of the current study note that previous studies have associated one’s relationship status with health outcomes—physical and psychological. To expand on this growing body of literature, the researchers investigated associations between premorbid education, incomes, and marital status with MS severity.
Between 2000 and 2020, data were gathered from the Swedish MS Registry to identify patients with MS at indexes of 1 and 5 years before the onset of their disease. Thus, individuals whose MS began between 2005 and 2015 were included. Disease severity was measured according to the Expanded Disability Status Scale (EDSS), where lower scores indicate less severe disability, and the self-reported Multiple Sclerosis Impact Scale (MSIS-29), where higher percentages indicate more severe physical and psychological symptoms.
In total, 4557 patients were included. This group had a mean age of 37.5 years and 92.1% of them had relapse-onset MS while the remaining had progressive-onset MS.
Of the individuals with relapse-onset MS, more education and income were linked with more favorable outcomes. Higher degrees of education were associated with lower levels of disability (secondary and tertiary education: EDSS, 0.30 and 0.47 fewer points), milder physical symptoms (secondary and tertiary: MSIS-29, 18% and 43% less severity), and psychological symptoms (tertiary: 25% less severity) compared with individuals who did not complete secondary schooling. The authors noted that this trend continued for those in higher income quartiles—compared with the quartile below—across all fields.
For the relapse-onset MS group, no differences were observed between patients who were single compared with those who were partnered. However, those who experienced divorce exhibited higher EDSS and MSIS-29 scores compared with single participants (scores increased by 0.34 points and 35%).
In the progressive-onset MS group, assessments on clinical disability (EDSS) followed a similar trajectory as the relapse-onset MS group. Higher education levels correlated with less severe physical (secondary: MSIS-29 lower by 34%) and psychological symptoms (secondary and tertiary: MSIS-29 lower by 29% and 33%). No statistically significant relationships were found between education and marital status. Additionally, higher income levels were linked to lower clinical disability; for each quartile above the lowest income class, EDSS dropped by 0.30).
The authors added that the estimations for individuals at the 5-year index prior to MS onset followed the same pattern in the relapse-onset MS group; however, no significant associations were seen in the progressive-onset MS group.
The researchers’ findings indicate that a myriad of factors outside of treatment could contribute to MS severity. By taking these factors into account, clinicians may be better able to anticipate the course of a patient’s MS.
He A, Manouchehrinia A, Glaser A, et al. Premorbid sociodemographic status and multiple sclerosis outcomes in a universal health care context. JAMA Netw Open. 2023;6(9):e2334675. doi:10.1001/jamanetworkopen.2023.34675