Thursday, 5 April 2018

How does your socioeconomic status affect your MS?

Does socioeconomic status predict outcomes in MS?


This rather startling paper shows that people with low socioeconomic status have reduced life expectancy that is predicted by slowed walking speed. As MS clips walking speed can these results be extrapolated to MS? I am sure they can, but we need MS-specific data. Let's hope the 'big-data' miners will help replicate these findings in a population of MSers. 

The EDSS, the gold-standard MS disability scale, goes from zero (normal physical neurological function) to 10 (death). Along this scale walking speed drops off from being normal to being unable to walk. The message here is that if you can maintain your walking speed you are less disabled and hence further away from EDSS 10. This study also indicates that we must think of MSers being outside of the 'normal population'. If we think like this then our treatment goals for MS change. This is why we are aiming beyond MS. The treatment target in MS is to 'Maximise Lifelong Brain Health'. If we adopt this target it should revolutionise the way we treat MS. 

Please note that it is not only low socioeconomic status that predicts poor life outcomes but comorbidities (hypertension, diabetes, obesity) and low physical activity. Therefore if we are serious about treating MS and life then we need to proactively be screening and treating these comorbidities and prescribing exercise as a DMT.

Stringhini et al.  Socioeconomic status, non-communicable disease risk factors, and walking speed in older adults: multi-cohort population-based study. BMJ 2018;360:k1046.

Objective: To assess the association of low socioeconomic status and risk factors for non-communicable diseases (diabetes, high alcohol intake, high blood pressure, obesity, physical inactivity, smoking) with loss of physical functioning at older ages.

Design: Multi-cohort population-based study.

Setting: 37 cohort studies from 24 countries in Europe, the United States, Latin America, Africa, and Asia, 1990-2017.


Participants: 109 107 men and women aged 45-90 years.
Main outcome measure: Physical functioning assessed using the walking speed test, a valid index of overall functional capacity. Years of functioning lost was computed as a metric to quantify the difference in walking speed between those exposed and unexposed to low socioeconomic status and risk factors.

Results: According to mixed model estimations, men aged 60 and of low socioeconomic status had the same walking speed as men aged 66.6 of high socioeconomic status (years of functioning lost 6.6 years, 95% confidence interval 5.0 to 9.4). The years of functioning lost for women were 4.6 (3.6 to 6.2). In men and women, respectively, 5.7 (4.4 to 8.1) and 5.4 (4.3 to 7.3) years of functioning were lost by age 60 due to insufficient physical activity, 5.1 (3.9 to 7.0) and 7.5 (6.1 to 9.5) due to obesity, 2.3 (1.6 to 3.4) and 3.0 (2.3 to 4.0) due to hypertension, 5.6 (4.2 to 8.0) and 6.3 (4.9 to 8.4) due to diabetes, and 3.0 (2.2 to 4.3) and 0.7 (0.1 to 1.5) due to tobacco use. In analyses restricted to high-income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was 8.0 (5.7 to 13.1) for men and 5.4 (4.0 to 8.0) for women, whereas in low and middle-income countries it was 2.6 (0.2 to 6.8) for men and 2.7 (1.0 to 5.5) for women. Within high-income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was greater in the United States than in Europe. Physical functioning continued to decline as a function of unfavourable risk factors between ages 60 and 85. Years of functioning lost were greater than years of life lost due to low socioeconomic status and non-communicable disease risk factors.

Conclusions: The independent association between socioeconomic status and physical functioning in old age is comparable in strength and consistency with those for established non-communicable disease risk factors. The results of this study suggest that tackling all these risk factors might substantially increase life years spent in good physical functioning.

ProfG    

3 comments:

  1. "Humans live on one-quarter of what they eat; on the other three-quarters lives their doctor"

    Obrigado

    ReplyDelete
  2. Well, it’s a 3rd world problems, but low socioeconomic status surely predict bad outcome where I do live not only in ms... just because decent medical services are available only if you pay.

    ReplyDelete
  3. I have some local data on this in Lanarkshire that we should chat about in Sornoway next weekend

    Niall MacDougall

    ReplyDelete

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