Pediatric-Onset MS Risk Impacted by Socioeconomic Status, Parental Education

Pediatric-onset multiple sclerosis (MS) risk is impacted by both low socioeconomic status (SES) at the neighborhood level and parental education, according to study findings published in Neurology.

Study authors conducted a case-control study using data from the Environmental and Genetic Risk Factors for Pediatric Multiple Sclerosis (E&G) Study to identify associations of socioeconomic disadvantage and psychosocial adversity with odds of pediatric-onset MS, age at pediatric-onset MS onset, and pediatric-onset MS disease activity. Youth aged 3 to 22 who were diagnosed with pediatric-onset MS prior to the age of 18 or a clinically isolated demyelinating syndrome indicative of high MS risk and at least 2 silent T2 hyperintense areas on a brain or spinal cord magnetic resonance imaging (MRI), of which at least 1 was in the brain, were eligible for inclusion. Retrospective questionnaires and zip code data were used to assess prenatal and postnatal adversity and postnatal socioeconomic factors. The primary outcome was MS diagnosis ascertained by at least 2 pediatric MS specialists. Multivariable logistic regression models were used in statistical analyses.

A total of 381 case (mean age, 15.4; women, 64%; White, 67%) and 611 control (mean age, 14.9; women, 60%; White, 72%) patients were included in the study. Among the case and control patients, 34% and 47% of mothers and 26% and 43% of fathers, respectively, had at least a bachelor’s degree level of education. Case and control patients both reported low rates of adverse psychosocial events. The mean postnatal neighborhood adversity score was -0.44 and 0.81 for control and case patients, respectively.

Compared with control patients, case patients were less likely to have a mother with at least a bachelor’s degree (odds ratio [OR], 0.42; 95% CI, 0.22-0.80; P =.009) and more likely to have a high postnatal neighborhood socioeconomic disadvantage score (OR, 1.04 per each additional point; 95% CI, 1.00-1.07; P =.025).

Children who identified as Asian, American Indian or Alaskan Native, and Native Hawaiian or Pacific Islander vs White had an earlier age of pediatric-onset MS onset (β, -610.83; 95% CI, -1015.80 to -115.86; P =.016).

Compared with no disease-modifying therapy, injectable disease-modifying therapies (β, 1.72; 95% CI, 1.14-2.58; P =.010) and oral or infusion disease-modifying therapies (β, 1.60; 95% CI, 1.07-2.38; P =.021) were associated with a higher relapse rate.

Compared with no disease-modifying therapy, injectable disease-modifying therapies (β, -0.21; 95% CI, -0.33 to -0.10; P <.001) and oral or infusion disease-modifying therapies (β, -0.12; 95% CI, -0.24 to -0.01; P =.037) were associated with lower Expanded Disability Status Scale scores, which were indicative of less severe disability.

In sensitivity analyses, higher maternal education remained protective against pediatric-onset MS (OR, 0.49; 95% CI, 0.24-1.00; P =.05); however, the effect of postnatal neighborhood disadvantage did not withstand (OR, 1.02; 95% CI, 0.99-1.06; P =0.236).

Study limitations include possible selection bias, inability to capture a wide range of postnatal psychosocial AEs, and potential false-positive findings.

“Future studies should incorporate assessments of a more detailed array of psychosocial adversities over time and potentially explanatory biological mechanisms linking SES and psychosocial adversity with risk of POMS [pediatric-onset MS],” the study authors concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.