Disability progression in multiple sclerosis linked to income, education

Neighbourhood income and education level is associated with risk of disability progression in patients with multiple sclerosis, suggests new research from the University of British Columbia.

North Vancouver resident Marilyn Lenzen, who was diagnosed with MS nearly two decades ago, hopes that everyone with MS, regardless of their socio-economic status, has access to the same lifestyle opportunities to slow the progression of their disease. Courtesy Marilyn Lenzen

Emily Wight, Djavad Mowafaghian Centre for Brain Health, University of British Columbia February 22, 2019

UBC researchers, along with colleagues in Wales, compared population health data across several measures of socio-economic status, and found that lower neighbourhood-level income and educational attainment was associated with an increased likelihood of reaching key physical disability milestones, such as difficulties with walking.

The findings — published online today in Neurology®, the medical journal of the American Academy of Neurology — paint a clearer picture of the way that wealth and education might affect patients with MS.

“This study is the first of its kind,” says the study’s senior author Helen Tremlett, professor in the division of neurology at UBC and the Canada Research Chair in neuroepidemiology and multiple sclerosis. “Previous studies have looked at the relationship between socio-economic status and risk of developing MS. Here, we were able to show a relationship between socio-economic status and subsequent risk of disability progression.”

MS is a chronic inflammatory disease that occurs when the body’s immune system attacks myelin, the fatty material that insulates neurons to enable rapid transmission of electrical signals. When myelin or neurons are damaged, communication between the brain and other parts of the body is disrupted leading to impaired ability including vision problems, muscle weakness, difficulty with balance and coordination, and cognitive decline. Most people who live with MS will experience some form of reduced ability.

Helen Tremlett, University of British Columbia

Comparing population health data between two countries
As the Welsh and Canadian systems for tracking population health data are similar, the team was able to access comparable information for the two groups of patients. For the Canadian patients, the team determined socio-economic status based on census data, which links postal codes with neighbourhood-level income. Clinical information from a provincial MS database was linked with population-based provincial health administrative data. The Welsh patients were assessed by linking similar datasets, including National Health Service information, postal code-related income data and educational attainment.

A key component of this study was that the data on socio-economic status were captured before MS onset, therefore predating any possible effect of the disease itself on socio-economic status.

The researchers did not look at specific factors that might explain the relationship between lower socio-economic status and higher risk of disability progression, but they suggest that modifiable lifestyle factors, such as diet and exercise, could be involved.

“If that is the case, the risk may be amenable to change,” says Tremlett. “One of the next steps is to understand why this relationship exists.”

Findings no surprise to patient
North Vancouver resident Marilyn Lenzen, who was diagnosed with MS nearly two decades ago, says she wasn’t surprised to learn that researchers have now established a clear link between socio-economic status and disability progression in patients with MS.

“I’m glad to see that there is now research that backs up what I and many in the MS community have been experiencing for years,” says Lenzen. “Someone who has the financial means to buy healthier food or afford to participate in yoga, pilates or specialized exercise to rebuild their strength after a relapse doesn’t experience the same progression of disabling symptoms as others who can’t afford to access the same healthy lifestyle choices.”

After her diagnosis, Lenzen, now 59, could no longer keep up with the long hours and extensive travel required by her corporate job. When she gave up her job, however, she also lost her extended health benefits and experienced a significant decline in household income.

“When I was first diagnosed, I remember having to crawl on my knees up the stairs to get to bed every night,” she recalls. “But I was determined to exercise and to keep my muscles strong. I took up cycling and with the assistance of an e-bike, cycled 3,000 kilometres last year.

“I do still have occasional relapses but the relapses are not as bad and I have the strength in my body to rebuild again. I wish that everyone with MS, regardless of their socio-economic status, has the same lifestyle opportunities to slow the progression of their disease.”

Socio-economic status important to consider for future research
The researchers hope that future MS studies will consider the socio-economic status of participants, especially if multiple study sites are involved and findings are compared across regions, as their socio-economic status could be an important factor in disability progression.
The study was co-authored by Dr. Katharine Harding (first author), Elaine Kingwell and colleagues at UBC and Southeast Wales. Harding was funded by an MS of Society Canada Fellowship award for this research. Patient Marilyn Lenzen is available for media interviews upon request.

Source University of British Columbia
via EurekAlert! American Association for the Advancement of Science AAAS

Socioeconomic status and disability progression in multiple sclerosis, Katharine E. Harding, Mark Wardle, Robert Carruthers, Neil Robertson, Feng Zhu, Elaine Kingwell, Helen Tremlett. Neurology Feb 2019, 10.1212/WNL.0000000000007190; DOI: 10.1212/WNL.0000000000007190
  Further reading
A multi-national study of socioeconomic status and disability progression in multiple sclerosis, K Harding, M Wardle, R Carruthers, N Robertson, F Zhu, E Kingwell, H Tremlett. ECTRIMS Online Library. Oct 12, 2018; 228839

A population-based study comparing multiple sclerosis clinic users and non-users in British Columbia, Canada, McKay KA, Tremlett H, Zhu F, Kastrukoff L, Marrie RA, Kingwell E. Eur J Neurol. 2016 Jun;23(6):1093-100. doi: 10.1111/ene.12990. Epub 2016 Mar 15. Full text

Clinical Outcomes of Escalation vs Early Intensive Disease-Modifying Therapy in Patients With Multiple Sclerosis, Harding K, Williams O, Willis M, Hrastelj J, Rimmer A, Joseph F, Tomassini V, Wardle M, Pickersgill T, Robertson N, Tallantyre E. JAMA Neurol. 2019 Feb 18. doi: 10.1001/jamaneurol.2018.4905. [Epub ahead of print]

Examining the effects of comorbidities on disease-modifying therapy use in multiple sclerosis, Zhang T, Tremlett H, Leung S, Zhu F, Kingwell E, Fisk JD, Bhan V, Campbell TL, Stadnyk K, Yu BN, Marrie RA; CIHR Team in the Epidemiology and Impact of Comorbidity on Multiple Sclerosis. Neurology. 2016 Apr 5;86(14):1287-95. doi: 10.1212/WNL.0000000000002543. Epub 2016 Mar 4. Full text

Is high socioeconomic status a risk factor for multiple sclerosis? A systematic review, Goulden R, Ibrahim T, Wolfson C. Eur J Neurol. 2015 Jun;22(6):899-911. doi: 10.1111/ene.12586. Epub 2014 Nov 5. Review.

High incidence and increasing prevalence of multiple sclerosis in British Columbia, Canada: findings from over two decades (1991-2010), Kingwell E, Zhu F, Marrie RA, Fisk JD, Wolfson C, Warren S, Profetto-McGrath J, Svenson LW, Jette N, Bhan V, Yu BN, Elliott L, Tremlett H. J Neurol. 2015 Oct;262(10):2352-63. doi: 10.1007/s00415-015-7842-0. Epub 2015 Jul 24.

Modelling the natural history of primary progressive multiple sclerosis, Harding KE, Wardle M, Moore P, Tomassini V, Pickersgill T, Ben-Shlomo Y, Robertson NP. J Neurol Neurosurg Psychiatry. 2015 Jan;86(1):13-9. doi: 10.1136/jnnp-2014-307791. Epub 2014 May 14.

Relative mortality and survival in multiple sclerosis: findings from British Columbia, Canada, Kingwell E, van der Kop M, Zhao Y, Shirani A, Zhu F, Oger J, Tremlett H. J Neurol Neurosurg Psychiatry. 2012 Jan;83(1):61-6. doi: 10.1136/jnnp-2011-300616. Epub 2011 Aug 23.

Also see
Differences between MS clinic and non-clinic users indicate knowledge gaps and more in Djavad Mowafaghian Centre for Brain Health UBC
Trio of papers offers new data on MS prevalence in the US in Djavad Mowafaghian Centre for Brain Health UBC
Teresa Bambrick has multiple sclerosis and has been getting a monthly infusion since late June 2009. This has allowed her to walk without her cane or having to use her wheelchair in The Calgary Herald
Helping people with Multiple sclerosis effectively manage fatigue in Dalhousie University

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