Abstract
Multiple sclerosis (MS) is a challenging and disabling condition, predominantly affecting individuals in early adulthood. MS affects the physical, cognitive, and mental health of persons suffering from the disease as well as having a great impact on their financial status and quality of life. However, there is a lack of systematic approach toward assessing the socioeconomic consequences of MS. Our objective was to systematically review analytical observational studies investigating the socioeconomic consequences in persons with MS with different levels of physical disability and cognitive function. We conducted a systematic review on socioeconomic consequences of MS with a focus on employment-, income-, work ability-, and relationship-related outcomes in persons with MS with special focus on disability and cognition. Additionally, the educational characteristics were examined. From 4,957 studies identified, 214 were assessed for eligibility and a total of 19 studies were included in this qualitative assessment; 21 different outcomes were identified. All identified studies reported higher unemployment, higher early retirement, and higher risk of unemployment in relation to higher physical disability. Also, cognitive function was found to be a predictor of employment (unemployment). The studies pointed out significant correlations between greater disability and lower earnings and higher income from benefits. A study found the same correlation in relation to cognitive function. The studies reported higher work disability in relation to higher physical disability and lower cognitive function. In conclusion, this systematic review summarizes the pronounced differences in various socioeconomic outcomes between patients with MS with regards to their physical disability and cognitive function. In addition, we identified a lack of studies with longitudinal design in this field that can provide more robust estimates with covariate adjustments, such as disease modifying treatments.
Highlights
2.8 million people worldwide are affected with multiple sclerosis (MS)—a chronic demyelinating and neurodegenerative disease of the central nervous system with increasing prevalence (1, 2)
As the disability of patients increases, they become dependent on their family for carrying out their daily routines and activities, which leads to a reduction of their quality of life (7)
A total of 19 studies were selected for inclusion into this systematic review of socioeconomic consequences of MS in relation to physical disability and cognitive function
Summary
2.8 million people worldwide are affected with multiple sclerosis (MS)—a chronic demyelinating and neurodegenerative disease of the central nervous system with increasing prevalence (1, 2). MS poses a major personal and socioeconomic burden: the average age of disease onset is 30 years—a time that is decisive for work and family planning; persons with MS die 7–10 years earlier and live on average almost 20 years with moderate and 30 years with severe disability (1, 3, 4). Within the MS population, the spectrum of disability ranges from essentially unaffected to highly disabled. As the disability of patients increases, they become dependent on their family for carrying out their daily routines and activities, which leads to a reduction of their quality of life (7). Even in a population with low physical disability, MS is responsible for a substantial economic burden due to indirect and informal care costs (8). We previously reported that the average level of earnings was ten times lower and the average level of health-related benefits was four times higher when comparing patients with MS with severe and mild disability (9)
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