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PostPosted: Sat Oct 05, 2013 6:46 pm    Post subject: (ECTRIMS)Neighborhood socioeconomic status & MS... Reply with quote

Presented at the annual ECTRIMS conference in Copenhagen, October 2-5, 2013:

Quote:
Epidemiology

Thursday, October 03, 2013, 15:45 - 17:00

Neighbourhood socioeconomic status and multiple sclerosis: the impact of area level deprivation on multiple sclerosis risk frequency and disease progression

P. Moore, K.E. Harding, M. Wardle, T. Pickersgill, N.P. Robertson (Liverpool, Cardiff, GB)

Objectives:

This study investigated possible associations between neighbourhood socioeconomic status (SES) measured by area level deprivation and MS risk frequency and disease progression.

Methods:

The study area comprised a population of 1.32 million people in South East Wales, UK. Neighbourhood SES was determined using the Welsh Index of Multiple Deprivations (WIMD). Small geographical areas (LSOAs) encompassing approximately 1500 people are assessed on multiple socioeconomic indicators that are combined and areas are rank ordered from least to most deprived. LSOAs for the study area were rank ordered according to deprivation level and divided into 3 equal sized groups representing low, medium and high SES.

MS patients were allocated to SES groups using address data. MS risk frequency was determined by the number of current MS cases per population in the 3 SES groups.

Disability progression was determined by time taken to reach key disability milestones.

Results:

1489 MS patients were alive and resident within the geographical boundaries of the study area. The number of MS cases per 100,000 population observed in the high SES (least deprived) group was 135.9 compared to 106.5 in the medium SES group and 92.5 in the low SES (most deprived) group.

The difference in risk frequencies was highly significant (X2 = 38.75, p <0.001). Cox regression analyses were calculated to compare time to disability milestones between SES groups controlling for effects of disease duration, gender and age at onset. Median time in years to EDSS 4 (95% CI) for the high SES group was 18.0 (16.0 19.7), compared to 13.9 (12.0 15.5)(HR 1.21, 1.03-1.42, p=.02) for the medium and 13.8 (11.7 15.9)(HR 1.20, 1.02-1.42, p=.03) for the low SES group. Median time to EDSS 6 (95% CI) was 23.0 (21.0 26.5) for the high SES, compared to 18.5 (17.0 21.0)(HR 1.21, 1.01-1.46, p=.04) for the medium and 18.1 (16.0 -21.0)(HR 1.37, 1.13-1.66, p<0.01) for the low SES group.

Conclusions:

This study demonstrates the substantial significance of area level socioeconomic status in moderating MS risk and disability progression.

Our findings demonstrate that poverty, in the form of lower socioeconomic status, is associated with health inequalities in MS outcomes in terms of more rapid disease progression over time. The findings have important social, political and clinical implications including the possible role of SES in MS prognosis and the need to consider SES in therapeutic clinical trials.

__________________
P. Moore has nothing to disclose. K.E. Harding has nothing to disclose. M. Wardle has nothing to disclose. T. Pickersgill has nothing to disclose. N.P. Robertson has nothing to disclose.
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