Socioeconomic determinants of global distribution of multiple sclerosis: an ecological investigation based on Global Burden of Disease data

Vahid Kazemi Moghaddam,Seyedeh Nahid Seyedhasani,Jalil Momeni,Fereshteh Najafi,Mostafa Hadei,Ghasem Moradi,Aisha S Dickerson,Edris Bazrafshan,Mohammad Sarmadi

doi:10.1186/s12883-021-02170-3

Abstract

BackgroundSocioeconomic factors may be involved in risk of multiple sclerosis (MS), either indirectly or as confounding factors. In this study two comprehensive indicators reflecting socioeconomic differences, including the Human Development Index (HDI) and Prosperity Index (PI), were used to assess the impact of these factors on the worldwide distribution of MS.MethodsThe data for this global ecological study were obtained from three comprehensive databases including the Global Burden of Disease (as the source of MS indices), United Nations Development Programme (source for HDI) and the Legatum Institute Database for PI. MS indices (including prevalence, incidence, mortality, and disability-adjusted life years) were all analyzed in the form of age- and sex-standardized. Correlation and regression analyses were used to investigate the relationship between HDI and PI and their subsets with MS indices.ResultsAll MS indices were correlated with HDI and PI. It was also found that developed countries had significantly higher prevalence and incidence rates of MS than developing countries. Education and governance from the PI, and gross national income and expected years of schooling from the HDI were more associated with MS. Education was significantly related to MS indices (p < 0.01) in both developed and developing countries.ConclusionIn general, the difference in income and the socioeconomic development globally have created a landscape for MS that should be studied in more detail in future studies.

Highlights

Socioeconomic factors may be involved in risk of multiple sclerosis (MS), either indirectly or as confounding factors
Estimates on the frequencies of MS for both sexes were available in Global Burden of Disease (GBD) for 195 countries
The results demonstrated a positive association of overall Human Development Index (HDI) on Disabilityadjusted life year (DALY) (B (SE) = 25.90, p = 0.02)

Summary

Introduction

Socioeconomic factors may be involved in risk of multiple sclerosis (MS), either indirectly or as confounding factors. Researches have demonstrated that countries with better social and economic situations have higher MS prevalence [15,16,17]. Socioeconomic factors such as education level, life expectancy, and life course socioeconomic position, may be linked to MS incidence and its subsequent progression [18]. Adverse socioeconomic position in childhood has been linked with a proinflammatory phenotype [23], and may be an important factor to consider for complex neuroinflammation and neurological diseases such as MS [23,24,25]. It is of critical importance to comprehend and develop disease-modifying strategies

Objectives

Methods

Results

Discussion

Conclusion