Socioeconomic Disparities Associated With Retinal Neurodegeneration in Multiple Sclerosis

Socioeconomic differences can be associated with quicker neurodegeneration in patients with multiple sclerosis (MS), according to research published in the December issue of Brain.

“Disease course in multiple sclerosis is notably heterogeneous, and few prognostic indicators have been consistently associated with multiple sclerosis severity. In the general population, socioeconomic disparity is associated with multimorbidity and may contribute to worse disease outcomes in multiple sclerosis,” wrote Eleni S Vasileiou, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA, and coresearchers.

Vasileiou et al aimed to assess if indicators of socioeconomic factors in patients with MS are associated with the progression of their disease course.

A total of 789 patients with MS with longitudinal optical coherence tomography and low contrast acuity, and available socioeconomic status indicators (determined by their postal codes ≤10 years of multiple sclerosis onset) were included to determine if socioeconomic indicators are related with disease progression and to find if differential MS management or comorbidity impacted socioeconomic status-associated effects.

A total of 552 patients with available socioeconomic status indicators ≤3 years of multiple sclerosis symptom onset were included in sensitivity analyses.

“Neighbourhood-level indicators included state and national area deprivation indices, median household income and the Agency for Healthcare Research and Quality (AHRQ) Socioeconomic Status Index. Participant-level indicators included education level,” wrote Dr Vasileiou et al.

Researchers segmented biannual optical coherence tomography scans to quantify thickness of the composite macular ganglion cell and inner plexiform (GCIPL) layer.

GCIPL atrophy and low contrast letter acuity loss were compared to socioeconomic status indicators.

Researchers found that faster retinal atrophy was associated with disadvantaged neighborhood-level indicators in addition to patient-level socioeconomic factors.

The least disadvantaged patients were found to have lower rates of GCIPL atrophy.

Additionally, patients with lower socioeconomic status were at a higher risk for incident comorbidity at follow-up and faster rates of therapy escalation.

“In conclusion, socioeconomic disparity is associated with faster retinal neurodegeneration in multiple sclerosis. As low socioeconomic status was associated with a higher risk of incident comorbidities that may adversely affect multiple sclerosis outcomes, comorbidity prevention may mitigate some of the unfavourable socioeconomic status-associated consequences,” wrote Dr Vasileiou et al of the findings.

Vasileiou ES, et al. Socioeconomic disparity is associated with faster retinal neurodegeneration in multiple sclerosis, Brain, Volume 144, Issue 12, December 2021, Pages 3664–3673, https://doi.org/10.1093/brain/awab342