Original articleSocioeconomic status and race are correlated with affective symptoms in multiple sclerosis
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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2022, Multiple Sclerosis and Related DisordersCitation Excerpt :Many prior studies used individual components of SES rather than a composite indicator such as ADI (Bjørnevik et al., 2016a, 2016b; Briggs et al., 2015, 2019; D'hooghe et al., 2016; Goulden et al., 2016). Further, most studies assessed the risk of developing MS (Berg-Hansen and Celius, 2015; Bjørnevik et al., 2016a, 2016b; Briggs et al., 2015, 2014; Dobson et al., 2020; Goulden et al., 2015; Nielsen et al., 2013; Wändell et al., 2020), while others did not directly assess neurological function (Minden et al., 2008; Reyes et al., 2020; Wang et al., 2020). Few studies have examined the temporal association between a composite measure of SES and subsequent MS outcomes using clinically relevant PROs of neurological and physical dysfunction, particularly within the context of the socioeconomic and healthcare environment in the United States (Briggs et al., 2019).
The impact of socioeconomic status on mental health and health-seeking behavior across race and ethnicity in a large multiple sclerosis cohort
2022, Multiple Sclerosis and Related DisordersCitation Excerpt :Low SES itself has been associated with greater burden of comorbidities with MS, disparities in symptom management, and potentially greater risk for disability progression (Harding et al., 2019; Marrie et al., 2008; Marrie et al., 2007a(Marrie et al., 2007b)). Some studies also suggest indicators of SES may modify the association between race, cognition, and psychiatric symptoms in people with MS (Amezcua et al., 2020; Wang et al., 2020). Thus, a critical step forward is to examine the psychiatric needs of individuals belonging to historically underrepresented groups living with MS and their mental health needs.