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Early Adversity and Socioeconomic Factors in Pediatric Multiple Sclerosis: A Case-Control Study
Sarah K G Jensen1, Susana Camposano1, Anne Berens1
1From the Pediatric Multiple Sclerosis and Related Disorders Program (S.K.G.J., S.C., L.A.B., M.P.G.), Department of Neurology, Boston Children's Hospital, Harvard Medical School; Boston College (S.K.G.J.), School of Social Work, MA; Stanford University School of Medicine (A.B.), Palo Alto, CA; Department of Pediatrics (M.W., T.C.C.), University of Utah, Salt Lake City; Pediatric Multiple Sclerosis Center (L.B.K., L.C., A.L.B.), NYU Grossman School of Medicine, New York; Pediatric Multiple Sclerosis Center at Loma Linda University Children's Hospital (G.S.A.), Loma Linda University, CA; Primary Children's Hospital (M.C.), University of Utah, Salt Lake City; Division of Child Neurology (T.C.), Department of Neurology, Massachusetts General Hospital, Boston; UCSD Pediatric MS Center (J.G.), San Diego, CA; Center for Pediatric-Onset Demyelinating Disease at the Children's of Alabama (Y.S.W.), University of Alabama, Birmingham; Children's National Medical Center (I.K.), Washington, DC; Baylor College of Medicine (T.E.L.), Houston, TX; Washington University Pediatric MS and other Demyelinating Disease Center (S.S.M.), Washington University in St. Louis, MO; Mellen Center for Multiple Sclerosis (M. Rensel), Cleveland Clinic, OH; Mayo Clinic (M. Rodriguez, J.-M.T.), Rochester, MN; Department of Neurology (J.W.R.), University of Utah, Salt Lake City; Ann and Robert H. Lurie Children's Hospital of Chicago (J.P.R.), IL; Division of Neurology (A.T.W.), Children's Hospital of Philadelphia, PA; The Pediatric MS Center at the Jacobs Neurological Institute (B.W.-G.), State University of New York at Buffalo; Division of Epidemiology and Genetic Epidemiology and Genomics Laboratory (L.F.B.), School of Public Health, University of California Berkeley; and UCSF Weill Institute for Neurosciences (E.W.), University of California San Francisco.
Neighborhood socioeconomic disadvantage increases pediatric-onset multiple sclerosis (MS) risk, while higher parental education may be protective. Further research is needed to explore other childhood adversities and their impact on pediatric MS.
Area of Science:
- Neuroimmunology
- Pediatric Neurology
- Environmental Epidemiology
Background:
- Childhood socioeconomic disadvantage is linked to psychosocial adversity and stress.
- These factors can lead to neurotoxicity and inflammation, potentially increasing risk for neurodegenerative disorders like multiple sclerosis (MS).
- Pediatric-onset MS (POMS) may be influenced by these early-life environmental factors.
Purpose of the Study:
- To investigate the association between socioeconomic disadvantage and psychosocial adversity with the risk of POMS.
- To examine the relationship between these factors and POMS disease activity, including age at onset and disability.
- To identify protective factors, such as higher parental education, against POMS.
Main Methods:
- A case-control study involving 381 POMS cases and 611 controls aged 3-21 years.
- Data collected from 17 US sites, assessing prenatal/postnatal adversity and socioeconomic factors via questionnaires and zip code data.
- Primary outcome: MS diagnosis; secondary outcomes: age at onset, relapse rate, and Expanded Disability Status Scale (EDSS).
Main Results:
- Lower maternal education (less than a bachelor's degree) was associated with increased POMS odds (OR 0.42).
- Higher childhood neighborhood disadvantage scores correlated with increased POMS risk (OR 1.04 per point).
- No significant associations were found between socioeconomic variables or prenatal/postnatal adversities and POMS age at onset, relapse rate, or EDSS.
Conclusions:
- Neighborhood-level socioeconomic status appears to be a significant risk factor for POMS.
- Higher parental education may offer a protective effect against developing POMS.
- Future studies should investigate a wider range of childhood stressors and their impact on POMS development.
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