The impact of socioeconomic status on subsequent neurological outcomes in multiple sclerosis.
The impact of socioeconomic status on subsequent neurological outcomes in multiple sclerosis.
复制标题
DOI：
10.1016/j.msard.2022.103994
复制
发表时间：
2022-09
影响因子：
4
通讯作者：
Xia, Zongqi
中科院分区：
文献类型：
--
作者：
Boorgu, Devi Sai Sri Kavya;Venkatesh, Shruthi;Lakhani, Chirag M.;Walker, Elizabeth;Aguerre, Ines M.;Riley, Claire;Patel, Chirag J.;De Jager, Philip L.;Xia, Zongqi
关键词：
研究低社区水平和个人水平的社会经济地位（SES）指标是否与MS患者随后更严重的神经功能障碍（pwMS）相关。在一项多中心研究中，我们前瞻性地收集了来自发现队列（匹兹堡大学，N=1316）和重复队列（哥伦比亚大学，N=488）的数据，基于参与者入组时的住所，我们计算了一个社区SES指标，即区域剥夺指数（ADI），并基于参与者的家庭收入推导了一个个人SES指标。患者报告的神经系统结果包括2018年至2020年的多发性硬化症评定量表修订（MSRS-R）、患者确定的疾病步骤（PDDS）和患者报告的结果测量信息系统（PROMIS）身体功能评分。我们对每个队列进行协变量调整回归分析，然后进行随机效应荟萃分析。2015年较高的ADI（较低的SES）与随后2018-2020年较差的神经预后相关（发现：MSRS-R， β=0.62, 95%CI [0.36,0.89], p<0.001； PDDS, β=0.11, 95%CI [0.21,0.72], p<0.001； PDDS, β=0.12, 95%CI [0.03,0.21], p=0.009， PROMIS, β= - 0.60, 95%CI [- 1.12, - 0.08], p=0.025）。接受过大学教育的社区比例较低（MSRS-R, β= - 7.31, 95%CI [- 8.99, - 5.64], p<0.001； PDDS, β= - 1.62, 95%CI [- 2.20, - 1.05], p<0.001； PROMIS, β=9.31, 95%CI [5.73,12.89], p<0.001），社区家庭收入中位数（MSRS-R, β= - 3.80e-05, 95%CI [- 5.05e-05, - 2.56e-05], p<0.001； PDDS, β= - 8.58e-06, 95%CI [- 1.28 -05, - 4.32 -06], p<0.001； PROMIS, β=2.55e-05, 95%CI [5.96e-07,5.05e-05], p=0.045），社区房屋价值中位数(MSRS-R, β= - 6.50e-06, 95%CI [- 8.16e-06, - 4.84e-06], p<0.001；e-06广泛性成长障碍,β=−1.54,95%可信区间(−2.11 e-06−9.65 e-07], p < 0.001;PROMIS, β=4.98e-06, 95%CI [1.81e-06,8.14e-06], p=0.002)驱动较高的ADI与随后更严重的神经功能障碍之间的关联（在联合分析中）。拥有医疗补助（但不包括私人保险）的社区人口百分比显著调节了观察到的协变量调整关联。较高的个人水平家庭收入水平与较好的神经预后相关（MSRS-R: R= - 0.39, p<0.001; PDDS: R= - 0.35, p<0.001; PROMIS: R=0.37, p<0.001），与ADI无关。较低的邻域SES与随后较差的pwMS神经预后相关。未来有必要通过改善社会经济地位的公共政策来测试有针对性的干预措施。
To examine whether lower neighborhood-level and individual-level indicators of socioeconomic status (SES) are associated with subsequently worse neurological disability in people with MS (pwMS). In a multi-center study using prospectively collected data from discovery cohorts (University of Pittsburgh, N=1316) and replication cohorts (Columbia University, N=488), we calculated a neighborhood SES indicator, area deprivation index (ADI), based on participants’ residence at enrollment, and we derived an individual SES indicator based on participants’ household income. Patient-reported neurological outcomes included the Multiple Sclerosis Rating Scale–Revised (MSRS-R), Patient-Determined Disease Steps (PDDS), and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function scores from 2018 to 2020. We performed covariate-adjusted regression analyses in each cohort and then random-effects meta-analyses. Higher ADI (lower SES) in 2015 was associated with subsequently worse neurological outcomes during 2018–2020 (discovery: MSRS-R, β=0.62, 95%CI [0.36,0.89], p<0.001; PDDS, β=0.11, 95%CI [0.02,0.20], p=0.02 | replication: MSRS-R, β=0.46, 95%CI [0.21,0.72], p<0.001; PDDS, β=0.12, 95%CI [0.03,0.21], p=0.009, PROMIS, β=−0.60, 95%CI [−1.12,−0.08], p=0.025). Lower neighborhood percent with college education (MSRS-R, β=−7.31, 95%CI [−8.99,−5.64], p<0.001; PDDS, β=−1.62, 95%CI [−2.20,−1.05], p<0.001; PROMIS, β=9.31, 95%CI [5.73,12.89], p<0.001), neighborhood median household income (MSRS-R, β=−3.80e-05, 95%CI [−5.05e-05,−2.56e-05], p<0.001; PDDS, β=−8.58e-06, 95%CI [−1.28e-05,−4.32e-06], p<0.001; PROMIS, β=2.55e-05, 95%CI [5.96e-07,5.05e-05], p=0.045), and neighborhood median home value (MSRS-R, β=−6.50e-06, 95%CI [−8.16e-06,−4.84e-06], p<0.001; PDDS, β=−1.54e-06, 95%CI [−2.11e-06,−9.65e-07], p<0.001; PROMIS, β=4.98e-06, 95%CI [1.81e-06,8.14e-06], p=0.002) drove the association between higher ADI and subsequently worse neurological disability (in joint analyses). Neighborhood percent of population with Medicaid (but not private insurance) significantly mediated the observed covariate-adjusted associations. Higher individual-level household income bracket was associated with better neurological outcomes (MSRS-R: R=−0.39, p<0.001; PDDS: R=−0.35, p<0.001; PROMIS: R=0.37, p<0.001), independent of ADI. Lower neighborhood SES is associated with subsequently worse neurological outcomes in pwMS. Future testing of targeted intervention through public policies that improve SES are warranted.
登录
查看更多内容
影响因子：
2.4
作者：
Goldschmidt C;McGinley MP
通讯作者：
McGinley MP
影响因子：
3.7
作者：
Bove, Riley;Secor, Elizabeth;De Jager, Philip L.
通讯作者：
De Jager, Philip L.
影响因子：
5.6
作者：
Jennum, Pout;Wanscher, Benedikte;Kjellberg, Jakob
通讯作者：
Kjellberg, Jakob
影响因子：
3.5
作者：
D'hooghe, M. B.;Haentjens, P.;Nagels, G.
通讯作者：
Nagels, G.
影响因子：
4
作者：
Kever A;Walker ELS;Riley CS;Heyman RA;Xia Z;Leavitt VM
通讯作者：
Leavitt VM