Monday, 10 March 2014

Socio-economic factors and the risk of MS

Adverse socio-economic factors in childhood increase your chances of getting MS. #MSBlog #MSResearch

"The study below links adverse socioeconomic position in childhood with a greater risk of MS in adulthood. This study was done using the Kaiser Permanente Medical Care Plan records. Some of you who have been criticising the Governments plans to allow academics to mine our health records should read this paper and think about the implications of blocking the Governments plans."

"What is Kaiser PermanenteKaiser Permanente is an integrated managed care consortium, based in Oakland, California. It was founded in 1945 by industrialist Henry J. Kaiser and physician Sidney Garfield. Kaiser Permanente operates in nine states and the District of Columbia, and is the largest managed care organization in the United States. Kaiser Permanente has 8.9 million health plan members, 167,300 employees, 14,600 physicians, 37 medical centers, and 611 medical offices. Kaiser Permanente has many similarities to the NHS. Importantly, the Kaiser Foundation Health Plan and Kaiser Foundation Hospitals are a non-profit. It is accepted by many in the field  that Kaiser Permanente is a very well run organization and has a lot to teach us. Interestingly, the use of the medical records in studies such as this is exactly what the NHS is trying to do with our medical records in the UK. As always it is worth considering the plus side of their plans and balance it against the very small risk to the individual of having the records identified or stolen."

"These results are a turnaround for the books; studies in the 1960's and 1970's suggested that MS was more common in higher socioeconomic groups, with more recent studies showing no link. I explained the earlier data by the differences in the incidence of infectious mononucleosis, or IM, between the social classes. At the time IM was commoner in higher socioeconomic groups. Children in lower socio-economic groups tended to have asymptomatic EBV infections at a younger age. However, as the general health of the population has changed the differences in relation to age of primary infection with EBV between the upper and lower socio-economic groups has disappeared. In this study, MSers were more likely to report having IM, a history of smoking, a family history of MS and increased body size at ages 10 and 28 compared with controls. It may be body size that now explains the difference in MS risk between socioeconomic groups; obesity is now commoner in the lower socioeconomic groups and as this is a risk factor for developing MS it may be the driver of these new results."

"The authors' make a case for increased inflammation in childhood in lower socioeconmic classes as the driver for the increased risk of MS in later life. I think this is speculative and will need more study."

"I wonder if we can delve into our NHS records via the HES (Hospital Episode Statistic) database to see if we can reproduce this studies findings? Some of you who don't want academics to access your medical records may not want this study's findings reproduced. Any thoughts?"



Epub: Briggs et al. Adverse socioeconomic position during the life course is associated with multiple sclerosis. J Epidemiol Community Health. 2014 Feb 27. doi: 10.1136/jech-2013-203184.

BACKGROUND: Adverse socioeconomic position (SEP) in childhood and adulthood is associated with a proinflammatory phenotype, and therefore an important exposure to consider for MS, a complex neuroinflammatory autoimmune disease. The objective was to determine whether SEP over the life course confers increased susceptibility to MS.

METHODS: 1643 white, non-Hispanic MS case and control members recruited from the Kaiser Permanente Medical Care Plan, Northern California Region, for which comprehensive genetic, clinical and environmental exposure data have been collected were studied. Logistic regression models investigated measures of childhood and adulthood SEP, and accounted for effects due to established MS risk factors, including HLA-DRB1*15:01 allele carrier status, smoking history, history of infectious mononucleosis, family history of MS and body size.

RESULTS: Multiple measures of childhood and adulthood SEP were significantly associated with risk of MS, including parents renting versus owning a home at age 10: OR=1.48, 95% CI 1.09 to 2.02, p=0.013; less than a college education versus at least a college education based on parental household: OR=1.28, 95% CI 1.01 to 1.63, p=0.041; low versus high life course SEP: OR=1.50, 95% CI 1.09 to 2.05, p=0.012; and low versus high social mobility: OR=1.74, 95% CI 1.27 to 2.39, p=5.7×10-4.

CONCLUSIONS: Results derived from a population-representative case-control study provide support for the role of adverse SEP in MS susceptibility and add to the growing evidence linking lower SEP to poorer health outcomes. Both genetic and environmental contributions to chronic conditions are important and must be characterised to fully understand MS aetiology.

9 comments:

  1. What does this mean for the average person with MS? It is very difficult to change your socio-economic status.

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  2. Especially the one you experienced while growing up!

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  3. HES does not have enough longitudinal data to do this

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    1. HES has your NHS number and linked to that is your postcode of birth, Your post-code at birth is the a key to your socioeconomic status.

      http://www.checkmyarea.com/

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    2. No NHS number is random. http://www.connectingforhealth.nhs.uk/systemsandservices/nhsnumber/patientfaqs.pdf

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    3. Check my area.com and get a link to a credit card that says every thing about bankers... exploiting people..at least it was not Wonga:-)

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    4. What's Wonga I hear our American readers ask?......Its like Robin Hood in reverse. You take from the poor and give to the Rich....a short payday loan with about 3000% interest. The Mafiia would be pleased with this one.

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    5. Wonga is in fact an Australian aboriginal word that has been hijacked by English speaking Australians to refer to money. The term is generally considered to be slang. It has now been taken over by a pay day lender in the UK. Please note wonga.com did not invent pay day lending they simply developed the technology to do it online, quickly and efficiently. We live in a world of debt, the so called engine of the modern economy. All they are doing is providing a service; they are not forcing people to take out a loan. Robin Hood was a robber who stole from the rich and gave to the poor.

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  4. I'm an American, a Californian and a member/ patient of Kaiser Permanente, Watching from afar, the part of the NHS plan that raised my hackles in sympathy was the threat of selling data to marketers and advertisers and the actual release of data to that consulting firm. To my knowledge Kaiser does not release such individualized data to outside organizations, although they may release aggregate data and statistics. Research, anonymized medical research is not the primary issue here. The issue is fund raising by selling what business wants most, granular, specific data about the needs of identified or identifiable individuals. If I understood correctly the NHS plan included release of such data. I'm not an NHS member, but if I were, I would be opting out, complaining, protesting etc. I would also be exploring what if any legal rights I had against such release of data.

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