在普遍医疗保健背景下,患病前的社会人口统计状况和多发性硬化症结果
Anna He1,2,3,4, Ali Manouchehrinia1,2, Anna Glaser1
1Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
JAMA network open
|September 26, 2023
概括
包括收入和教育在内的更高的社会经济地位与较低的多发性硬化症 (MS) 障碍和症状严重程度有关. 婚姻状况也会影响MS的结果,这表明社会决定因素会影响疾病的进展.
科学领域:
- 神经学 神经学
- 流行病学 流行病学
- 公共卫生 公共卫生
背景情况:
- 多发性硬化症 (MS) 的严重程度可能受到疾病发病前存在的因素的影响.
- 了解患病前的社会人口统计影响对于管理MS至关重要.
- 社会经济地位可能在MS残疾和症状负担中发挥作用.
研究的目的:
- 调查疾病前的教育,收入和婚姻状况与未来的MS残疾和症状严重程度之间的关联.
- 为了确定这些关联是否在普遍医疗保健系统内独立于治疗而持续存在.
- 分析这些因素与不同的多发性硬化症病程相关.
主要方法:
- 一项全国性的观察队列研究,使用瑞典MS注册和国家人口登记 (2000-2020).
- 包括在2005-2015年间患有多发性硬化症的劳动年龄人群,数据采集于病发前1至5年.
- 扩展残疾状况量表 (EDSS) 和MS影响量表 (MSIS-29) 评分的分析,根据临床和人口因素进行调整,按疾病过程分层.
主要成果:
- 在复发性多发性硬化症中,更高的先发病收入和教育与明显较低的残疾和症状严重程度 (身体和心理) 相相关.
- 婚姻分离与复发性多发性多发性硬化症的更糟糕结果有关.
- 在逐渐发作的MS中,更高的收入和教育与较低的残疾和症状负担有关.
- 无论是在发病前1年还是5年进行评估,以及经过对伴随性疾病进行调整后,研究结果都是一致的.
结论:
- 病前收入,教育和婚姻状况与复发性MS和进展性MS的残疾和症状严重程度有关.
- 这些社会经济因素会影响MS的结局,而不影响治疗.
- 研究结果强调了社会经济地位作为多发性硬化症健康决定因素的作用.
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