Original article
Socioeconomic status and race are correlated with affective symptoms in multiple sclerosis

https://doi.org/10.1016/j.msard.2020.102010Get rights and content

Highlights

  • We investigated the relationship between socioeconomic status and race with affective symptoms in MS.

  • Markers of lower socioeconomic status were correlated with worse affective symptoms.

  • Effects of socioeconomic status on affective symptoms differed by race.

Abstract

Objective: Investigate the relationship between socioeconomic status (SES) and race with self-reported fatigue, depression, and anxiety levels in multiple sclerosis (MS).

Methods: Cross-sectional review of the MS Partners Advancing Technology and Health Solutions (MS PATHS) database for adults with MS in the United States. We evaluated race and socioeconomic status (available markers: insurance, employment status, or level of education) as predictors of fatigue, depression, and anxiety sub-scores of the Neuro-QoL (Quality of life in neurological disorders), with particular interest between Caucasians/whites (CA) and African Americans/blacks (AA). Multivariate linear regression models included as covariates age, sex, disability status, smoking status, body mass index, and disease-modifying therapy.

Results: 7,430 individuals were included; compared to CA, AA tended to be younger, more female-predominant, and had a higher level of disability. AA had completed slightly less education, had a higher level of Medicaid coverage or uninsured status, and had higher rates of unemployed or disabled status. In the univariate model, markers of lower SES, by whichever definition we used, correlated with worse affective symptoms. In the multivariate model stratified by race, CA showed similar trends. In contrast, in AA, only lower SES by employment status was correlated with worse affective symptoms. In both CA and AA, moderate and severe level of disability correlated with worse affective symptoms.

Conclusion: SES and race may influence affective symptoms reported by individuals with MS. The reasons for the correlation are likely multifactorial. Longitudinal studies should strive to identify factors associated with risk of affective symptoms in MS that may be modifiable.

Introduction

Socioeconomic status (SES) is a measure of an individual's social standing in relation to others, which includes access to resources, opportunity, privilege, amongst others. (Galobardes et al., 2006) Studies have linked lower SES to the development of various health conditions and with increased disability and mortality. (Isaacs and Schroeder, 2004) Similar to the effects of lower SES, African American race has been associated with increased mortality and higher level of chronic diseases. (Cunningham et al., 2017) Disentangling the effects of SES and race is difficult in the United States (US). (Sohn, 2017; Williams et al., 2016; Williams et al., 2010) How SES and race, alone or in combination, may affect health outcomes is important to consider when working toward addressing healthcare disparities. (Williams et al., 2016; Williams et al., 2010)

The effect of SES on outcomes in multiple sclerosis (MS) is also gaining interest. Recent studies have demonstrated that lower SES is associated with higher risk of disability progression in the UK and Canada (Harding et al., 2019) and a single-center, US cohort. (Briggs et al., 2019) A prior study in MS (Marrie et al., 2006) showed that accounting for SES might explain some of differing outcomes between Caucasians and African Americans. Most prior studies have focused upon physical disability and associated outcomes. (Briggs et al., 2019; Marrie et al., 2006; Kister et al., 2010; Weinstock-Guttman et al., 2003; Kaufman et al., 2003) Affective symptoms are important to study, as mental comorbidities are common in MS (Marrie et al., 2009) and associated with worse outcomes, including greater long-term disability and mortality. (Marrie et al., 2008; Mohr et al., 1997; Feinstein, 2002; McKay et al., 2018)

There is a lack of studies evaluating how race and SES relate to patient-reported outcomes encompassing affective symptoms in MS. Thus, we aimed to investigate the relationship between markers of SES and race, and self-reported measures of affective disorders in a large population of US-based people with MS.

Section snippets

Standard protocol approvals, registrations, and patient consents

Institutional Review Board approval was granted by all US sites including Johns Hopkins University School of Medicine. Participants provided informed consent or an authorization to use their data when an institution granted a waiver of written informed consent.

Design

Cross-sectional observational study of individuals with MS in the US.

Study population

This study utilized data available from the Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS) network, which is a network of seven MS

Results

A total of 11,878 individuals were enrolled in MS PATHS across US and Europe as of September 14, 2018, 9309 (78%) of whom were residing in the US. Based on the abovementioned inclusion criteria, 7430 (80%) individuals with MS in the US were included in this study, 5504 (74%) of whom were female (Table 1). Age range was 18–85 years old, with a mean of 48 years old (SD: 12.68 years). The majority of participants were CA (79%), and the largest minority group was AA (12%).

Relative to CA

Discussion and conclusions

This study demonstrates that markers of lower SES are correlated with worse self-reported scores in fatigue, depression, and anxiety in US-based individuals with MS treated at tertiary MS centers. We also demonstrate that there are race-based differences in these outcomes, and that the effects of SES differ between CA and AA.

In the univariate model, prior to stratification by race, disabled or unemployed status and Medicaid or uninsured status are correlated with worse self-reported levels of

Role of funding source

Study funding: The MS PATHS study is funded by Biogen. Biogen did not have a role in this analysis.

Declaration of Competing Interest

None.

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