Lower Socioeconomic Status Is Linked to Worse Disability in Persons with Multiple Sclerosis (P2.197)

Objective: To identify whether lower socioeconomic status (SES) is linked to worse physical disability within two independent samples of multiple sclerosis (MS) patients. Background: Disability is prevalent but variable across MS patients, even among patients with comparable disease burden. It is therefore difficult to identify patients at greatest risk for disability, which hinders early treatment decisions (e.g., choice of disease-modifying therapies, which differ in aggressiveness). Herein we examine the link between SES and physician-assessed physical disability. Methods: Disability was assessed with the Expanded Disability Status Scale (EDSS) within independent samples of 377 Italian MS patients and 58 treatment-naïve Serbian MS patients. SES was estimated with education, classified as lower (less than secondary education), medial (secondary education), and higher (more than secondary education). MRI was used to quantify disease burden (cerebral atrophy, T2 lesion volume). ANCOVAs within each sample investigated differences in disability (EDSS) across levels of SES, controlling for demographics and disease burden. Logistic regressions investigated the link between SES and need for assistive gait devices (EDSS≥6.0), an important disability milestone. Results: Italian MS patients with lower SES had worse disability (EDSS; 3.78, [95[percnt] CI: 3.49-4.06]) than patients with medial (3.15 [2.88-3.42], p=.002) or higher (2.98 [2.65-3.32], p=.001) SES. Relative to patients with lower SES, risk for gait disturbance (need for assistive devices) was lower among patients with higher (Odds Ratio: 0.36 [95[percnt] CI: 0.16-0.80], p=.012) and medial (0.42 [0.22-0.80], p=.009) SES. These findings were replicated within the sample of treatment-naïve Serbian MS patients. Conclusions: We identify lower SES (easily estimated with education) as a risk factor for disability in MS patients. Findings may (a) aid early identification of patients at greatest risk for disability, which may guide early treatment decisions, and (b) stimulate research on potentially modifiable mechanisms (e.g., health behaviors) mediating the link between SES and differential disability.