Sunday, 23 November 2014

Risk of MS maybe not based on social statratification

Goulden R, Ibrahim T, Wolfson C. Is high socioeconomic status a risk factor for multiple sclerosis? A systematic review. Eur J Neurol. 2014 Nov 5. doi: 10.1111/ene.12586. [Epub ahead of print]

High socioeconomic status (SES) is generally associated with better health outcomes, but some research has linked it with an increased risk of multiple sclerosis (MS). The evidence for this association is inconsistent and has not previously been systematically reviewed. A systematic review of cohort and case-control studies in any language was conducted looking at the association between MS and SES. MEDLINE and EMBASE were searched for articles in all languages published up until 23 August 2013. Twenty-one studies from 13 countries were included in the review. Heterogeneity of study settings precluded carrying out a meta-analysis, and a qualitative synthesis was performed instead. Five studies, all from more unequal countries, reported an association between high SES and MS. Thirteen studies reported no evidence of an association, and three studies reported an association with low SES. These 16 studies largely came from more egalitarian countries. The evidence for an association between high SES and increased MS risk is inconsistent but with some indication of a stronger effect in countries and time periods with higher inequality. Firm conclusions are hampered by the failure of most studies to control for other important risk factors for MS.

Some some argue that these is MS risk in the higher socio economic group...so is this why Pharma charge so much for their drugs:-). However, other studies argue that this is not the case, especially in more equal societies.  

15 comments:

  1. I've been "downwardly mobile" for years (sigh).

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    1. Yup - MS is doing that to me too, after years of hard work to try and have a secure and independent, though not necessarily wealthy, future, I'm having to turn the corner and go back in the other direction as well.

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  2. It is possible that MS & high SES go together in less egalitarian societies.
    But in these societies it is also possible that MS occurs among everyone but is diagnosed more often in people of high SES.
    Low SES goes with lower levels of education & general awareness. At least in India, I can imagine people with MS symptoms getting taken to faith healers and quacks of various types

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    1. Likewise, CCSVI will be more prevalent in lower SES class people as well as those seeking treatment for this condition.

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    2. Actually many people of all classes in India believe in all types of alternative 'medical' systems
      It's just that people with higher incomes are more likely to have access to proper doctors
      ~Anon 12:57 again

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    3. I can't believe all the stereotypes on this post - the 'working class ' get more sun and India is full of poor people who only have 'quack' medicine. And given the costs of CCSVI I'd hazard a guess this will be more individuals in the higher SES demographics. The work is full of shades of grey, it's not black and white, thank goodness.:-)

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    4. No, not all stereotypes. Look up the statistics on the number of doctors in India.
      India has one doctor for every 1700 people. The WHO standard is 1 doctor for every 1000 people.
      If you look at the number of neurologists the situation is even worse: the number is very small and they are very overworked.

      The problem is not so bad in big cities.But more than half the population lives in rural areas

      http://www.dnaindia.com/health/report-at-nerves-end-neurologists-in-short-supply-across-country-1755146
      "Not only are Indians miserably unaware of neurological ailments, but they are woefully short of neurologists, who come in a highly uneven ratio of 1:8,50,000 of the general population"

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  3. My guess would be that in highly unequal countries, many lower income patients simply go undiagnosed and untreated.

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  4. On the other hand, working class people might spend more time outdoors, and what you're really seeing is the Vit. D effect.

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    1. You are right, that could easily be the case

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    2. Eh, not sure how you arrive at this conclusion. Ye olde days of men toiling all day in the sun are long over in the UK! Just who are these "working class people" supposedly spending more time outside? I don't see it myself, plus we don't get much sun, especially 'oop North!

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    3. Hmmm, incidence of MS in house builders, farm workers etc. Should be a grant in that! ;-)

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  5. For those who have an interest in economic impacts of MS, have a look at the following report on what it all costs society and individuals. And this is just in Australia..........
    http://www.msra.org.au/files/msra/docs/Economic%20Impact%20of%20MS%20in%202010%20Full%20Report%20v2.pdf

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  6. Depends on how old you are when diagnosed.

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  7. What lower SES is an inflammatory exposure. Adverse SES is a 'chronic stressor', which leads to a chronically activated HPA axis. As a result, the wear and tear on the immune system (all systems) occurs. There has been recent work out of Northern CA that accounts for all known MS risk factors, including obesity, latitude, vitD use before onset, and individuals with a lower SES are at a great risk.
    http://www.ncbi.nlm.nih.gov/pubmed/24577137

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