Goulden R, Ibrahim T, Wolfson C
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada; Newcastle Medical School, Newcastle University, Newcastle, UK.
Eur J Neurol. 2015 Jun;22(6):899-911. doi: 10.1111/ene.12586. Epub 2014 Nov 5.
High socioeconomic status (SES) is generally associated with better health outcomes, but some research has linked it with an increased risk of multiple sclerosis (MS). The evidence for this association is inconsistent and has not previously been systematically reviewed. A systematic review of cohort and case-control studies in any language was conducted looking at the association between MS and SES. MEDLINE and EMBASE were searched for articles in all languages published up until 23 August 2013. Twenty-one studies from 13 countries were included in the review. Heterogeneity of study settings precluded carrying out a meta-analysis, and a qualitative synthesis was performed instead. Five studies, all from more unequal countries, reported an association between high SES and MS. Thirteen studies reported no evidence of an association, and three studies reported an association with low SES. These 16 studies largely came from more egalitarian countries. The evidence for an association between high SES and increased MS risk is inconsistent but with some indication of a stronger effect in countries and time periods with higher inequality. Firm conclusions are hampered by the failure of most studies to control for other important risk factors for MS.
高社会经济地位（SES）通常与更好的健康结果相关，但一些研究将其与多发性硬化症（MS）风险增加联系起来。这种关联的证据并不一致，且此前尚未进行系统综述。我们对队列研究和病例对照研究进行了系统综述，考察MS与SES之间的关联，研究语言不限。检索了MEDLINE和EMBASE数据库，查找截至2013年8月23日发表的所有语言的文章。该综述纳入了来自13个国家的21项研究。研究背景的异质性使得无法进行荟萃分析，因此改为进行定性综合分析。五项研究均来自不平等程度更高的国家，报告了高SES与MS之间的关联。十三项研究报告没有关联证据，三项研究报告与低SES有关联。这16项研究大多来自更平等的国家。高SES与MS风险增加之间存在关联的证据并不一致，但有迹象表明，在不平等程度较高的国家和时期，这种效应更强。大多数研究未能控制MS的其他重要风险因素，这妨碍了得出确凿结论。
