Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
Department of Neurology, Royal London Hospital, London, UK.
Nat Rev Neurol. 2022 Dec;18(12):723-734. doi: 10.1038/s41582-022-00735-5. Epub 2022 Nov 11.
Social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are the non-medical factors that influence health outcomes. Evidence indicates that health behaviours, comorbidities and disease-modifying therapies all contribute to multiple sclerosis (MS) outcomes; however, our knowledge of the effects of social determinants - that is, the 'risks of risks' - on health has not yet changed our approach to MS. Assessing and addressing social determinants of health could fundamentally improve health and health care in MS; this approach has already been successful in improving outcomes in other chronic diseases. In this narrative Review, we identify and discuss the body of evidence supporting an effect of many social determinants of health, including racial background, employment and social support, on MS outcomes. It must be noted that many of the published studies were subject to bias, and screening tools and/or practical interventions that address these social determinants are, for the most part, lacking. The existing work does not fully explore the potential bidirectional and complex relationships between social determinants of health and MS, and the interpretation of findings is complicated by the interactions and intersections among many of the identified determinants. On the basis of the reviewed literature, we consider that, if effective interventions targeting social determinants of health were available, they could have substantial effects on MS outcomes. Therefore, funding for and focused design of studies to evaluate and address social determinants of health are urgently needed.
社会决定因素是人们出生、成长、生活、工作和衰老的环境。这些环境是非医疗因素，会影响健康结果。有证据表明，健康行为、合并症和疾病修正疗法都对多发性硬化症 (MS) 结局有影响；然而，我们对社会决定因素（即“风险的风险”）对健康的影响的认识尚未改变我们对 MS 的治疗方法。评估和解决健康的社会决定因素可以从根本上改善 MS 患者的健康和医疗服务；这种方法已经在改善其他慢性疾病的结局方面取得了成功。在这篇叙述性综述中，我们确定并讨论了支持许多健康社会决定因素（包括种族背景、就业和社会支持）对 MS 结局有影响的证据。必须指出的是，许多已发表的研究都存在偏倚，而且针对这些社会决定因素的筛查工具和/或实际干预措施在很大程度上是缺乏的。现有研究并未充分探讨健康的社会决定因素与 MS 之间潜在的双向和复杂关系，而且由于所确定的许多决定因素之间的相互作用和交叉，对研究结果的解释变得复杂。基于综述文献，我们认为，如果有针对健康的社会决定因素的有效干预措施，它们可能会对 MS 结局产生重大影响。因此，迫切需要为评估和解决健康的社会决定因素提供资金并进行有针对性的研究设计。
