Socioeconomic status and disability progression in multiple sclerosis

Neurology ◽  
2019 ◽  
Vol 92 (13) ◽  
pp. e1497-e1506 ◽  
Author(s):  
Katharine E. Harding ◽  
Mark Wardle ◽  
Robert Carruthers ◽  
Neil Robertson ◽  
Feng Zhu ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Socioeconomic Status ◽  
Drug Exposure ◽  
Proportional Hazards ◽  
Meta Analysis ◽  
Random Effect ◽  
Cox Proportional Hazards ◽  
Disability Progression ◽  
Cox Proportional Hazards Models ◽  
Neighborhood Level

ObjectiveTo examine the association between socioeconomic status (SES) and disability outcomes and progression in multiple sclerosis (MS).MethodsHealth administrative and MS clinical data were linked for 2 cohorts of patients with MS in British Columbia (Canada) and South East Wales (UK). SES was measured at MS symptom onset (±3 years) based on neighborhood-level average income. The association between SES at MS onset and sustained and confirmed Expanded Disability Status Scale (EDSS) 6.0 and 4.0 and onset of secondary progression of MS (SPMS) were assessed using Cox proportional hazards models. EDSS scores were also examined via linear regression, using generalized estimating equations (GEE) with an exchangeable working correlation. Models were adjusted for onset age, sex, initial disease course, and disease-modifying drug exposure. Random effect models (meta-analysis) were used to combine results from the 2 cohorts.ResultsA total of 3,113 patients with MS were included (2,069 from Canada; 1,044 from Wales). A higher SES was associated with a lower hazard of reaching EDSS 6.0 (adjusted hazard ratio [aHR] 0.90, 95% confidence interval [CI] 0.89–0.91), EDSS 4.0 (aHR 0.93, 0.88–0.98), and SPMS (aHR 0.94, 0.88–0.99). The direction of findings was similar when all EDSS scores were included (GEE: β = −0.13, −0.18 to −0.08).ConclusionsLower neighborhood-level SES was associated with a higher risk of disability progression. Reasons for this association are likely to be complex but could include factors amenable to modification, such as lifestyle or comorbidity. Our findings are relevant for planning and development of MS services.

scholarly journals Childhood body mass index and multiple sclerosis risk: a long-term cohort study

2013 ◽  
Vol 19 (10) ◽  
pp. 1323-1329 ◽  
Author(s):  
Kassandra L Munger ◽  
Joan Bentzen ◽  
Bjarne Laursen ◽  
Egon Stenager ◽  
Nils Koch-Henriksen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Body Mass Index ◽  
Body Mass ◽  
School Health ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Z Score ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Unit Increase

Background: Obesity in late adolescence has been associated with an increased risk of multiple sclerosis (MS); however, it is not known if body size in childhood is associated with MS risk. Methods: Using a prospective design we examined whether body mass index (BMI) at ages 7–13 years was associated with MS risk among 302,043 individuals in the Copenhagen School Health Records Register (CSHRR). Linking the CSHRR with the Danish MS registry yielded 774 MS cases (501 girls, 273 boys). We used Cox proportional hazards models to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Among girls, at each age 7–13 years, a one-unit increase in BMI z-score was associated with an increased risk of MS (HRage 7=1.20, 95% CI: 1.10–1.30; HRage 13=1.18, 95% CI: 1.08–1.28). Girls who were ≥95th percentile for BMI had a 1.61–1.95-fold increased risk of MS as compared to girls <85th percentile. The associations were attenuated in boys. The pooled HR for a one-unit increase in BMI z-score at age 7 years was 1.17 (95% CI: 1.09–1.26) and at age 13 years was 1.15 (95% CI: 1.07–1.24). Conclusion: Having a high BMI in early life is a risk factor for MS, but the mechanisms underlying the association remain to be elucidated.

WED 167 Socioeconomic status and progression of disability in ms

2018 ◽  
Vol 89 (10) ◽  
pp. A21.1-A21
Author(s):  
Katharine Harding ◽  
Elaine Kingwell ◽  
Mark Wardle ◽  
Feng Zhu ◽  
Neil Robertson ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Proportional Hazards ◽  
Meta Analysis ◽  
Age At Onset ◽  
Cox Proportional Hazards ◽  
Proportional Hazards Regression ◽  
Working Correlation ◽  
Long Term Prognosis ◽  
Generalised Estimating Equations

There is evidence that socioeconomic status (SES) is associated with multiple sclerosis (MS) incidence; however it is less clear whether there is also an association with long-term prognosis.3113 patients were selected from the MS registries of British Columbia, Canada (n=2069), and Cardiff, Wales (n=1044). SES, based on neighbourhood-level average income, was measured at onset of MS. Cox proportional hazards regression was used to analyse the association of SES with time to sustained and confirmed EDSS 6.0 and EDSS 4.0. The association between SES and EDSS scores was assessed longitudinally by a linear regression model fitted using generalised estimating equations (GEE) with an exchangeable working correlation structure. All models were adjusted for age at onset, sex, year of onset, initial course and DMT. The cohorts were analysed individually and results combined using meta-analysis.SES was associated with hazard of reaching EDSS 6.0 (adjusted hazard ratio [aHR]=0.90, 95% CI 0.89–0.91), and 4.0 (aHR=0.93, 0.88–0.98). GEE modelling confirmed association of SES with EDSS (β=−0.13, [−0.18- −0.08], p<0.001). We found evidence that lower SES is associated with poorer outcomes. Reasons for this are complex but may include lifestyle or comorbidity. Our findings are relevant for planning and development of MS services.

scholarly journals Risk of schizophrenia and bipolar disorder in patients with multiple sclerosis: record-linkage studies

2019 ◽  
Author(s):  
Ute-Christiane Meier ◽  
Sreeram V Ramagopalan ◽  
Michael J Goldacre ◽  
Raph Goldacre
Keyword(s):  
Multiple Sclerosis ◽  
Bipolar Disorder ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Primary Reason ◽  
Hospital Record ◽  
Cox Proportional Hazards Models ◽  
Hazard Ratios ◽  
Potential Association ◽  
Shared Risk

AbstractBackgroundThe epidemiology of psychiatric comorbidity in multiple sclerosis (MS) remains poorly understood.ObjectiveWe aimed to determine the risk of schizophrenia and bipolar disorder in MS patients.Material and MethodsRetrospective cohort analyses were performed using an all-England national linked Hospital Episode Statistics (HES) dataset (1999-2016) and to determine whether schizophrenia or bipolar disorder are more commonly diagnosed subsequently in people with MS (n=128,194), and whether MS is more commonly diagnosed subsequently in people with schizophrenia (n=384,188) or bipolar disorder (n=203,592), than would be expected when compared with a reference cohort (∼15 million people) after adjusting for age and other factors. Adjusted hazard ratios (aHRs) were calculated using Cox proportional hazards models.ResultsFindings were dependent on whether the index and subsequent diagnoses were selected as the primary reason for hospital admission or were taken from anywhere on the hospital record. When searching for diagnoses anywhere on the hospital record, there was a significantly elevated risk of subsequent schizophrenia (aHR 1.51, 95% confidence interval (CI) 1.40 to 1.60) and of bipolar disorder (aHR 1.14, 95% CI 1.04 to 1.24) in people with prior-recorded MS and of subsequent MS in people with prior-recorded schizophrenia (aHR 1.26, 1.15-1.37) or bipolar disorder (aHR 1.73, 1.57-1.91), but most of these associations were reduced to null when analyses were confined to diagnoses recorded as the primary reason for admission.ConclusionFurther research is needed to investigate the potential association between MS and schizophrenia and/or bipolar disorder as it may shed light on underlying pathophysiology and help identify potential shared risk factors.

scholarly journals Long-term disability progression of pediatric-onset multiple sclerosis

Neurology ◽  
2019 ◽  
Vol 92 (24) ◽  
pp. e2764-e2773 ◽  
Author(s):  
Kyla A. McKay ◽  
Jan Hillert ◽  
Ali Manouchehrinia
Keyword(s):  
Multiple Sclerosis ◽  
Proportional Hazards ◽  
Clinical Information ◽  
Cox Proportional Hazards ◽  
Disability Progression ◽  
Kaplan Meier ◽  
Younger Age ◽  
Risk Of Progression ◽  
Pediatric Onset

ObjectiveTo evaluate long-term disability progression in pediatric-onset multiple sclerosis (POMS) and compare to adult-onset multiple sclerosis (AOMS).MethodsThis was a retrospective cohort study using prospectively collected clinical information from the Swedish MS Registry. Clinical features were compared and Kaplan-Meier and Cox proportional hazards regression were used to assess the risk of reaching sustained Expanded Disability Status Scale (EDSS) 3, 4, and 6 in POMS (multiple sclerosis [MS] onset <18 years) and AOMS (MS onset ≥18 years).ResultsA total of 12,482 persons were included; 549 (4.4%) were classified as POMS. The POMS cohort took longer to reach all 3 disability milestones from their MS onset, but did so at a younger age than the AOMS cohort. Primary progressive course (hazard ratio [HR] 4.63; 95% confidence interval [CI] 1.46–14.7), higher relapse rate in the first 5 years of disease (HR 5.35; 95% CI 3.37–8.49), and complete remission from the initial relapse (HR 0.41; 95% CI 0.18–0.94) were associated with an altered risk of progression to EDSS 4 among POMS cases. The same pattern emerged for the risk of reaching EDSS 3 and 6.ConclusionsPatients with pediatric-onset MS follow a distinctive clinical course, which should be considered in the treatment and management of the disease.

scholarly journals Effectiveness and safety of dimethyl fumarate in progressive multiple sclerosis

2021 ◽  
Vol 7 (2) ◽  
pp. 205521732110108
Author(s):  
Vanessa F Moreira Ferreira ◽  
Yanqing Liu ◽  
Brian C Healy ◽  
James M Stankiewicz
Keyword(s):  
Multiple Sclerosis ◽  
Proportional Hazards ◽  
Dimethyl Fumarate ◽  
Progressive Multiple Sclerosis ◽  
Cox Proportional Hazards ◽  
Small Sample ◽  
Cox Proportional Hazards Models ◽  
Disability Status ◽  
Clinically Significant ◽  
One Year

Background There is limited data analyzing the safety and effectiveness of dimethyl fumarate (DMF) in the progressive multiple sclerosis (PMS) population. Objective To analyze the safety and effectiveness of DMF in patients with PMS. Methods We used Cox proportional hazards models to compare the time to confirmed worsening and improvement on the Expanded Disability Status Scale (EDSS) and timed 25-foot walk (T25FW) between patients treated with DMF and glatiramer acetate (GA) for at least one year. Results We included 46 patients treated with DMF and 42 patients treated with GA. The safety and tolerability of GA and DMF were consistent with established profiles. There was no difference in confirmed EDSS progression. A trend towards reduced T25FW was seen in the DMF compared to GA after adjustment (HR = 0.86; 95% CI:0.37, 1.98; p = 0.72 and HR = 0.60; 95% CI:0.27, 1.34; p = 0.21, respectively). Conclusion Dimethyl fumarate showed a trend towards reduction in T25FW but no evidence of clinically significant impact on EDSS. The small sample precluded definitive determination.

scholarly journals Changes in Plant Based Diets and Subsequent Risk of Type 2 Diabetes: Results from 3 Large US Cohorts

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1387-1387
Author(s):  
Zhangling Cheng ◽  
Jean-Philippe Drouin-Chartier ◽  
Yanping Li ◽  
Megu Baden ◽  
JoAnn Manson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Proportional Hazards ◽  
Meta Analysis ◽  
Cox Proportional Hazards ◽  
Health Study ◽  
Weight Changes ◽  
Cox Proportional Hazards Models

Abstract Objectives Plant-based diets may lower type 2 diabetes (T2D) risk. Whether changes in adherence to plant-based diets are associated with subsequent T2D risk remains unknown. We aimed to evaluate the associations between 4 year changes in plant based diets and subsequent 4 year risk of T2D. Methods We prospectively followed 76,530 women in the Nurses’ Health Study (NHS, 1986–2012), 81,586 women in NHS II (1991–2017), and 34,468 men in the Health Professionals’ Follow-up Study (1986–2016). Diet was assessed every 4 years using validated food-frequency questionnaires. Adherence to plant-based diets was assessed using previously developed indices – the overall plant-based diet index (PDI), the healthful PDI (hPDI), and the unhealthful PDI (uPDI). Self reported T2D cases were validated by supplementary questionnaires. We used multivariable time dependent Cox proportional hazards models to estimate hazard ratios (HR) and 95% CIs for T2D associated with 4 year changes in adherence to plant based diets. Results of the three cohorts were pooled using an inverse variance-weighted meta-analysis. Results We documented 12,016 cases of T2D during 2818,485 person-years of follow-up. After adjustment for initial BMI, initial and 4-year changes in lifestyle and other factors, compared with participants whose indices remained relatively stable (±3%), participants with the largest 4-year decrease (&gt;10%) in PDI and hPDI had a 12%-23% higher T2D risk in the subsequent 4 years (HR for PDI, 1.12 (95% CI 1.05, 1.20), HR for hPDI, 1.23 (1.16, 1.31)). Conversely, each 10% incremental increase in PDI and hPDI over 4 years was associated with a 7%–9% lower T2D risk in subsequent 4 years (HR for PDI, 0.93 (0.90, 0.95), HR for hPDI, 0.91 (0.87, 0.95)). Changes in uPDI were not associated with T2D risk. Further adjustment for concurrent changes in body weight, a potential mediator, modestly attenuated the associations but results remained significant. We estimated that body weight changes explained 6.0%–36% of the associations between 4 year changes in PDI and hPDI and subsequent T2D risk. Conclusions Improving adherence to overall and healthful plant based diets over a 4 year period was associated with a lower T2D risk, whereas decreased adherence to overall and healthful plant based diets was associated with a higher T2D risk. Funding Sources Nutricia Research Foundation/NIH.

scholarly journals No association between dietary sodium intake and the risk of multiple sclerosis

Neurology ◽  
2017 ◽  
Vol 89 (13) ◽  
pp. 1322-1329 ◽  
Author(s):  
Marianna Cortese ◽  
Changzheng Yuan ◽  
Tanuja Chitnis ◽  
Alberto Ascherio ◽  
Kassandra L. Munger
Keyword(s):  
Multiple Sclerosis ◽  
Fixed Effects ◽  
Proportional Hazards ◽  
Sodium Intake ◽  
Cox Proportional Hazards ◽  
Dietary Sodium ◽  
Health Study ◽  
Cox Proportional Hazards Models ◽  
Using Data

Objective:To prospectively investigate the association between dietary sodium intake and multiple sclerosis (MS) risk.Methods:In this cohort study, we assessed dietary sodium intake by a validated food frequency questionnaire administered every 4 years to 80,920 nurses in the Nurses' Health Study (NHS) (1984–2002) and to 94,511 in the Nurses' Health Study II (NHSII) (1991–2007), and calibrated it using data from a validation study. There were 479 new MS cases during follow-up. We used Cox proportional hazards models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the effect of energy-adjusted dietary sodium on MS risk, adjusting also for age, latitude of residence at age 15, ancestry, body mass index at age 18, supplemental vitamin D intake, cigarette smoking, and total energy intake in each cohort. The results in both cohorts were pooled using fixed effects models.Results:Total dietary intake of sodium at baseline was not associated with MS risk (highest [medians: 3.2 g/d NHS; 3.5 g/d NHSII] vs lowest [medians: 2.5 g/d NHS; 2.8 g/d NHSII] quintile: HRpooled 0.98, 95% CI 0.74–1.30, p for trend = 0.75). Cumulative average sodium intake during follow-up was also not associated with MS risk (highest [medians: 3.3 g/d NHS; 3.4 g/d NHSII] vs lowest [medians: 2.7 g/d NHS; 2.8 g/d NHSII] quintile: HRpooled 1.02, 95% CI 0.76–1.37, p for trend = 0.76). Comparing more extreme sodium intake in deciles yielded similar results (p for trend = 0.95).Conclusions:Our findings suggest that higher dietary sodium intake does not increase the risk of developing MS.

Socioeconomic status, race, and mortality disparities in insured patients in southern California.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19060-e19060
Author(s):  
Robert Michael Cooper ◽  
Reina Haque ◽  
Joanne E. Schottinger
Keyword(s):  
Socioeconomic Status ◽  
Mortality Risk ◽  
Southern California ◽  
Proportional Hazards ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models ◽  
Race Ethnicity ◽  
Overall Mortality

e19060 Background: One known factor related to increased mortality is lack of health insurance coverage. To eliminate this variable we evaluated overall mortality by socioeconomic status (SES) in an insured southern California population diagnosed with cancer accounting for confounding factors including race/ethnicity. Methods: We identified adults diagnosed with eight common cancers from 2009-2014 from the California Cancer Registry and followed them through 2017. We calculated person-year mortality rates by SES and race/ethnicity. Adjusted hazard ratios for the association between all-cause mortality and SES were estimated using Cox proportional hazards models accounting for covariates (race/ethnicity, demographics, stage, treatments). Results: A total of 164,197 adults were diagnosed with cancers of the breast, prostate, lung, colon, melanoma, uterus, kidney and bladder; total of numbers of deaths was N=41,727. Compared to subjects in the highest SES quintile, we found an increased overall mortality risk in each of the lower SES quintiles. In multivariable models, mortality risk was 16% to 37% greater in the lower SES groups versus the highest SES group. Conclusions: After multivariable adjustment that accounted for race/ethnicity, cancer treatments and tumor factors, insured individuals in lower SES groups had a significantly higher overall mortality risk compared those in the highest SES group. [Table: see text]

scholarly journals Duration of natalizumab therapy and reasons for discontinuation in a multiple sclerosis population

2020 ◽  
Vol 6 (1) ◽  
pp. 205521732090248
Author(s):  
Devon S Conway ◽  
Carrie M Hersh ◽  
Haleigh C Harris ◽  
Le H Hua
Keyword(s):  
Multiple Sclerosis ◽  
Disease Duration ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Patient Characteristics ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Cox Proportional Hazards Models ◽  
Natalizumab Treatment ◽  
Relapsing Multiple Sclerosis

Objective To determine multiple sclerosis patient characteristics that predict a shorter duration of natalizumab treatment. Methods The Tysabri Outreach: Unified Commitment to Health database was reviewed to identify patients treated with natalizumab at our centers. Cox proportional hazards models were used to evaluate patient characteristics associated with shorter treatment durations on natalizumab. Associations were also assessed with respect to specific reasons for stopping natalizumab. Results We identified 554 patients who began and stopped natalizumab treatment during the observation period. The average disease duration at natalizumab initiation was 7.6 years, and the average number of infusions was 30. The multivariable Cox proportional hazards model identified greater age ( P = 0.035), longer disease duration ( P < 0.001), progressive relapsing multiple sclerosis phenotype ( P = 0.003), current smoking ( P = 0.031), and greater depression ( P = 0.026) as significant predictors for natalizumab discontinuation. Greater disability levels ( P = 0.022) and gadolinium-enhancing lesions on baseline magnetic resonance imaging ( P < 0.001) were significantly associated with longer natalizumab treatment. Individuals with progressive relapsing multiple sclerosis had a 14-fold increased hazard of discontinuing natalizumab due to inflammatory events ( P < 0.001) than those with relapsing–remitting multiple sclerosis. Smokers had an 80% increased hazard of discontinuation due to intolerance ( P = 0.008). Conclusions Our results suggest that smoking, depression, and a progressive relapsing multiple sclerosis phenotype are associated with shorter natalizumab treatment durations.

scholarly journals Confirmed disability progression provides limited predictive information regarding future disease progression in multiple sclerosis

2021 ◽  
Vol 7 (2) ◽  
pp. 205521732199907
Author(s):  
Brian C Healy ◽  
Bonnie I Glanz ◽  
Elyse Swallow ◽  
James Signorovitch ◽  
Kaitlin Hagan ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Univariate Analysis ◽  
Information Criterion ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Lesion Volume ◽  
Disability Progression ◽  
Fit Statistics

Background Although confirmed disability progression (CDP) is a common outcome in multiple sclerosis (MS) clinical trials, its predictive value for long-term outcomes is uncertain. Objective To investigate whether CDP at month 24 predicts subsequent disability accumulation in MS. Methods The Comprehensive Longitudinal Investigation of Multiple Sclerosis at Brigham and Women’s Hospital includes participants with relapsing-remitting MS or clinically isolated syndrome with Expanded Disability Status Scale (EDSS) scores ≤5 (N = 1214). CDP was assessed as a predictor of time to EDSS score 6 (EDSS 6) and to secondary progressive MS (SPMS) using a Cox proportional hazards model; adjusted models included additional clinical/participant characteristics. Models were compared using Akaike’s An Information Criterion. Results CDP was directionally associated with faster time to EDSS 6 in univariate analysis (HR = 1.61 [95% CI: 0.83, 3.13]). After adjusting for month 24 EDSS, CDP was directionally associated with slower time to EDSS 6 (adjusted HR = 0.65 [0.32, 1.28]). Models including CDP had worse fit statistics than those using EDSS scores without CDP. When models included clinical and magnetic resonance imaging measures, T2 lesion volume improved fit statistics. Results were similar for time to SPMS. Conclusions CDP was less predictive of time to subsequent events than other MS clinical features.

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