UNICAEN, CHU de Caen Normandie Department of Neurology, MS Expert Center, Normandie University, Caen 14000, France; Réseau Bas-Normand Pour la Prise en Charge de la SEP, Caen, France.
UNICAEN, CHU de Caen, INSERM U1086 ANTICIPE, Pôle de Recherche, Normandie University, Caen 14000, France.
Mult Scler Relat Disord. 2020 May;40:101930. doi: 10.1016/j.msard.2020.101930. Epub 2020 Jan 7.
Little is known about the association between the socioeconomic status (SES) and disability risk of patients with Multiple Sclerosis (MS).
The aim of this study was to assess the influence of low SES, otherwise known as socioeconomic deprivation, on the disability risk of MS patients.
4498 patients with a relapsing MS disease onset between 1982 and 2017 were included from the databases of three MS expert centres (Caen, Rouen, Lille) of the French Observatory for MS (OFSEP). Sociodemographic and clinical data of 3641 patients were used for the analysis. The EDI (European Deprivation Index), an ecological and composite indicator was used to assess the level of socioeconomic deprivation. Comparisons of time to reach EDSS 4 and EDSS 6, chosen as disability milestones, according to EDI quintiles were performed by Kaplan-Meier analysis. Cox proportional hazard models were also conducted to assess the risk according to EDI quintiles with adjustment to sex, MS type and age at disease onset.
In the study population (n = 3641), most patients were women (71.9%; n = 2664). The mean age at disease onset was 32.2 years (SD =9.7). 1684 (46%) patients reached EDSS 4 and 1005 (28%) reached EDSS 6. The risk of reaching EDSS 4 and EDSS 6 in more socioeconomically deprived patients (EDI Q5) was independently higher than in the less socioeconomically deprived patients (EDI Q1) (HR=1.37 95%CI [1.15-1.64]) to reach EDSS 4 and (HR=1.42 95%CI [1.13-1.75]) to reach EDSS 6.
In this study, socioeconomic deprivation was significantly associated to the disability risk in MS patients. Better knowledge of socioeconomic disparities in MS may help adapt care to settings and improve the quality of care given to patients in the future.
人们对社会经济地位（SES）与多发性硬化症（MS）患者残疾风险之间的关系知之甚少。
本研究旨在评估低 SES（也称为社会经济剥夺）对 MS 患者残疾风险的影响。
从法国多发性硬化症观察站（OFSEP）的三个 MS 专家中心（卡昂、鲁昂、里尔）的数据库中纳入了 1982 年至 2017 年间发病的 4498 例复发性 MS 患者。对 3641 例患者的社会人口统计学和临床数据进行了分析。使用 EDI（欧洲剥夺指数）作为评估社会经济剥夺程度的生态和综合指标。通过 Kaplan-Meier 分析比较了根据 EDI 五分位数达到 EDSS 4 和 EDSS 6（选择为残疾里程碑）的时间。还进行了 Cox 比例风险模型分析，以根据 EDI 五分位数评估风险，调整性别、MS 类型和发病年龄。
在研究人群（n=3641）中，大多数患者为女性（71.9%；n=2664）。疾病发病时的平均年龄为 32.2 岁（SD=9.7）。1684 例（46%）患者达到 EDSS 4，1005 例（28%）达到 EDSS 6。社会经济地位较低（EDI Q1）的患者达到 EDSS 4 和 EDSS 6 的风险明显高于社会经济地位较高（EDI Q5）的患者（达到 EDSS 4 的 HR=1.37，95%CI [1.15-1.64]）和达到 EDSS 6 的 HR=1.42，95%CI [1.13-1.75]）。
在这项研究中，社会经济剥夺与 MS 患者的残疾风险显著相关。更好地了解 MS 中的社会经济差异可能有助于根据环境调整护理，并改善未来患者的护理质量。
