Pediatric-Onset MS Associated With Worse Long-Term Socioeconomic Outcomes

Author(s):

Persons with pediatric-onset MS received higher rates of disability benefits, sickness absence days in their youngest age period, and disability pension days in their oldest age period than those without MS.

Kyla A. McKay, PhD

Recently published data from a prospective, register-based cohort study demonstrated an association between individuals with pediatric-onset multiple sclerosis (PoMS) and less education achievement, lower earnings, and greater use of disability benefits throughout the working-age life span.

Using a cohort of individuals with PoMS (n = 485) and a matched population reference cohort without MS (n = 4850), researchers found that those with PoMS were less likely to attend university (odds ratio [OR], 0.80; 95% CI, 0.66-0.97) and had significantly lower annual earnings than the reference cohort.

Led by Kyla A. McKay, PhD, postdoctoral researcher, Karolinska Univeristy, Sweden, the annual earnings difference for individuals with PoMS ranged from –$1618 (95% CI, –$2558 to –$678) in the youngest age period to –$10,683 (95% CI, –$18,187 to –$3178) in the eldest.

Earnings and days receiving disabilities were compared within 4 age periods (19-24, 25-34, 35-44, and 45-54 years). Among the 2 groups, patients with PoMS were more likely to have no earnings, 1 or more sickness absences, and 1 or more disability pension days, which was consistent across all 4 age periods (19-24 years: risk ratio [RR], 3.06 [95% CI, 2.08-4.52]; 25-34 years: RR, 3.16 [95% CI, 2.37-3.96]; and 35-44 years: RR, 1.77 [95% CI, 1.14-2.74]).

McKay and colleagues found that the adjusted rate ratio of disability pension days was not significantly higher for individuals with PoMS in the first 2 age periods compared with matched cohort. However, those in the PoMS cohort in the last 2 age periods demonstrated significantly higher rates (35-44: RR, 1.41 [95% CI, 1.17-1.71]; 45-54 years: RR, 1.43 [95% CI, 1.11-1.85]).

All analyses performed were stratified by childhood onset-MS (aged <13 years) and adolescent-onset MS (aged 13-17 years) and by era (MS onset during the period from 1980 to 1999 or during the period from 2000 to 2014). When observing just the childhood-onset MS population, the estimates were largely in the same direction, despite some of them not reaching significance due to small numbers (n = 55).

Similarly, researchers found the RRs between the 2 eras to be comparable, although effect sizes for earnings and sickness absence was larger in the earlier era for individuals with PoMS than matched cohort.

"Assessing whether specific clinical or demographic factors are associated with these socioeconomic outcomes will be the next step in understanding, and potentially preventing, these outcomes.” McKay et al concluded.

To the authors’ knowledge, this was the first study to explore the association between childhood MS and educational level at the national level. It did come with limitations, including the lack of details on educational achievements and the potentially limited generalizability outside of Sweden.

REFERENCE

McKay K, Friberg E, Razaz N, et al. Long-term socioeconomic outcomes associated with pediatric-onset multiple sclerosis. JAMA Neurol. Published online February 22, 2021. doi: 10.1001/jamaneurol.2020.5520