Socioeconomic status and disability progression in multiple sclerosis A multinational study
Socioeconomic status and disability progression in multiple sclerosis A multinational study
复制标题
DOI：
10.1212/wnl.0000000000007190
复制
发表时间：
2019-03-26
期刊：
影响因子：
9.9
通讯作者：
Tremlett, Helen
中科院分区：
文献类型：
--
作者：
Harding, Katharine E.;Wardle, Mark;Tremlett, Helen
目的 研究社会经济地位 (SES) 与残疾结果和多发性硬化症 (MS) 进展之间的关联。方法 将不列颠哥伦比亚省（加拿大）和东南威尔士（英国）的 2 组 MS 患者的健康管理和 MS 临床数据联系起来。 SES 是在 MS 症状发作时（+/- 3 年）根据社区平均收入进行测量的。使用 Cox 比例风险模型评估 MS 发病时的 SES 与持续和确认的扩展残疾状态量表 (EDSS) 6.0 和 4.0 以及 MS 继发进展 (SPMS) 发病之间的关联。还使用具有可交换工作相关性的广义估计方程 (GEE) 通过线性回归检查 EDSS 分数。模型根据发病年龄、性别、初始病程和缓解疾病的药物暴露进行了调整。使用随机效应模型（荟萃分析）来合并两个队列的结果。结果 总共纳入了 3,113 名 MS 患者（2,069 名来自加拿大；1,044 名来自威尔士）。较高的 SES 与达到 EDSS 6.0（调整后风险比 [aHR] 0.90，95% 置信区间 [CI] 0.89-0.91）、EDSS 4.0（aHR 0.93、0.88-0.98）和 SPMS（aHR 0.94、0.88-0.99）的风险较低相关。当包含所有 EDSS 分数时，结果的方向相似（GEE：beta = -0.13、-0.18 至 -0.08）。结论 较低的社区社会经济地位与较高的残疾进展风险相关。这种关联的原因可能很复杂，但可能包括可以改变的因素，例如生活方式或合并症。我们的研究结果与 MS 服务的规划和开发相关。
Objective To examine the association between socioeconomic status (SES) and disability outcomes and progression in multiple sclerosis (MS). Methods Health administrative and MS clinical data were linked for 2 cohorts of patients with MS in British Columbia (Canada) and South East Wales (UK). SES was measured at MS symptom onset (+/- 3 years) based on neighborhood-level average income. The association between SES at MS onset and sustained and confirmed Expanded Disability Status Scale (EDSS) 6.0 and 4.0 and onset of secondary progression of MS (SPMS) were assessed using Cox proportional hazards models. EDSS scores were also examined via linear regression, using generalized estimating equations (GEE) with an exchangeable working correlation. Models were adjusted for onset age, sex, initial disease course, and disease-modifying drug exposure. Random effect models (meta-analysis) were used to combine results from the 2 cohorts. Results A total of 3,113 patients with MS were included (2,069 from Canada; 1,044 from Wales). A higher SES was associated with a lower hazard of reaching EDSS 6.0 (adjusted hazard ratio [aHR] 0.90, 95% confidence interval [CI] 0.89-0.91), EDSS 4.0 (aHR 0.93, 0.88-0.98), and SPMS (aHR 0.94, 0.88-0.99). The direction of findings was similar when all EDSS scores were included (GEE: beta = -0.13, -0.18 to -0.08). Conclusions Lower neighborhood-level SES was associated with a higher risk of disability progression. Reasons for this association are likely to be complex but could include factors amenable to modification, such as lifestyle or comorbidity. Our findings are relevant for planning and development of MS services.