A new study suggests that predisease education, income, and marital status are all linked to severity of future multiple sclerosis disability and symptom severity, and they should be considered in risk stratification. The findings suggest that socio-economic status may reflect both structural and individual determinants of health in MS.

MS severity may be informed by predisease socio-demographic factors. Researchers, led by the Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden, wanted to know whether predisease education, income, and marital status are linked to future MS disability and symptom severity, independent of treatment, in a universal healthcare context. 

The study examined data from the Swedish MS Registry linked to national population registries from 2000 to 2020. There were 4,557 patients with socio-demographic data from one-year preonset of MS. Participants included people with MS onset from 2005 to 2015 and of working age (23 to 59 years old) one and five years preceding disease onset. Repeated measures of Expanded Disability Status Scale scores and patient-reported Multiple Sclerosis Impact Scale scores were used. Models were adjusted for age, sex, relapses, disease duration, and treatment exposure. Secondary analyses further adjusted for comorbidity. All analyses were stratified by disease course (relapse onset and progressive onset).

In this study of working-age adults with MS, predisease income, education, and marital status correlated with disability and symptom severity in relapse onset and progressive-onset MS, independent of treatment. In relapse-onset MS, higher predisease income and education were linked to lower disability, physical symptoms, and psychological symptoms. Marital separation was linked to adverse outcomes. In progressive-onset MS, higher income was linked to lower EDSS, whereas education was linked to lower physical and psychological symptoms. Estimates for five-years preonset were comparable with one-year preonset, as were the comorbidity-adjusted findings.

The findings were published in JAMA Network Open.