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Journal Articles The Lancet Regional Health - Europe Year : 2023

Effects of socioeconomic status on excess mortality in patients with multiple sclerosis in France: A retrospective observational cohort study

1 UNICAEN - Université de Caen Normandie
2 ANTICIPE - Unité de recherche interdisciplinaire pour la prévention et le traitement des cancers
3 CHU Caen
4 Service de Neurologie [CHU Caen]
5 CRNL - Centre de recherche en neurosciences de Lyon - Lyon Neuroscience Research Center
6 Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL]
7 Fondation Eugène Devic EDMUS
8 OFSEP - Observatoire Français de la Sclérose En Plaques [Lyon]
9 LBBE - Laboratoire de Biométrie et Biologie Evolutive - UMR 5558
10 HCL - Hospices Civils de Lyon
11 Service de Biostatistiques [Lyon]
12 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
13 CIC - Centre d'Investigation Clinique [Rennes]
14 APEMAC - Adaptation, mesure et évaluation en santé. Approches interdisciplinaires
15 Service de neurologie [CHRU Nancy]
16 Infinity - Institut Toulousain des Maladies Infectieuses et Inflammatoires
17 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
18 UB - Université de Bordeaux
19 U1215 Inserm - UB - Neurocentre Magendie : Physiopathologie de la Plasticité Neuronale
20 CHU Bordeaux
21 CIC Bordeaux
22 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
23 Centre d’Investigation Clinique Plurithématique (CIC - P) - CIC Strasbourg
24 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
25 CRC-SEP Nord-Pas de Calais - Centre de Ressources et de Compétences sur la Sclérose en Plaques (CRC-SEP) [Lille]
26 LilNCog - Lille Neurosciences & Cognition - U 1172
27 CHU Dijon
28 CEP - Centre d'épidémiologie des populations
29 URRIS UR2CA - Unité de Recherche Clinique de la Côte d’Azur
30 CHU - Hôpital Pasteur [Nice]
31 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
32 U1064 Inserm - CR2TI - Centre de Recherche en Transplantation et Immunologie - Center for Research in Transplantation and Translational Immunology
33 CIC Nantes - Centre d’Investigation Clinique de Nantes
34 Université de Clermont-Ferrand
35 Neuro-Dol - Neuro-Dol
36 Service de Neurologie [CHU Clermont-Ferrand]
37 CHU Montpellier
38 UM - Université de Montpellier
39 Service de Neurologie [CHRU Besançon]
40 TIMONE - Hôpital de la Timone [CHU - APHM]
41 CHI Poissy-Saint-Germain
42 IGF - Institut de Génomique Fonctionnelle
43 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
44 Service de Neurologie [CHU de Saint-Étienne]
45 EHESP - École des Hautes Études en Santé Publique [EHESP]
46 RSMS - Recherche sur les services et le management en santé
47 ARENES - Arènes: politique, santé publique, environnement, médias
48 METIS - Département Méthodes quantitatives en santé publique

Abstract

Background: The effects of socio-economic status on mortality in patients with multiple sclerosis is not well known. The objective was to examine mortality due to multiple sclerosis according to socio-economic status.Methods: A retrospective observational cohort design was used with recruitment from 18 French multiple sclerosis expert centers participating in the Observatoire Français de la Sclérose en Plaques. All patients lived in metropolitan France and had a definite or probable diagnosis of multiple sclerosis according to either Poser or McDonald criteria with an onset of disease between 1960 and 2015. Initial phenotype was either relapsing-onset or primary progressive onset. Vital status was updated on January 1st 2016. Socio-economic status was measured by an ecological index, the European Deprivation Index and was attributed to each patient according to their home address. Excess death rates were studied according to socio-economic status using additive excess hazard models with multidimensional penalised splines. The initial hypothesis was a potential socio-economic gradient in excess mortality.Findings: A total of 34,169 multiple sclerosis patients were included (88% relapsing onset (n = 30,083), 12% progressive onset (n = 4086)), female/male sex ratio 2.7 for relapsing-onset and 1.3 for progressive-onset). Mean age at disease onset was 31.6 (SD = 9.8) for relapsing-onset and 42.7 (SD = 10.8) for progressive-onset. At the end of follow-up, 1849 patients had died (4.4% for relapsing-onset (n = 1311) and 13.2% for progressive-onset (n = 538)). A socio-economic gradient was found for relapsing-onset patients; more deprived patients had a greater excess death rate. At thirty years of disease duration and a year of onset of symptoms of 1980, survival probability difference (or deprivation gap) between less deprived relapsing-onset patients (EDI = -6) and more deprived relapsing-onset patients (EDI = 12) was 16.6% (95% confidence interval (CI) [10.3%-22.9%]) for men and 12.3% (95%CI [7.6%-17.0%]) for women. No clear socio-economic mortality gradient was found in progressive-onset patients.Interpretation: Socio-economic status was associated with mortality due to multiple sclerosis in relapsing-onset patients. Improvements in overall care of more socio-economically deprived patients with multiple sclerosis could help reduce these socio-economic inequalities in multiple sclerosis-related mortality.
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Dates and versions

hal-03875120 , version 1 (28-11-2022)

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Sarah Wilson, Floriane Calocer, Fabien Rollot, Mathieu Fauvernier, Laurent Remontet, et al.. Effects of socioeconomic status on excess mortality in patients with multiple sclerosis in France: A retrospective observational cohort study. The Lancet Regional Health - Europe, 2023, 24, pp.100542. ⟨10.1016/j.lanepe.2022.100542⟩. ⟨hal-03875120⟩
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