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Brief Report
February 22, 2021

Long-term Socioeconomic Outcomes Associated With Pediatric-Onset Multiple Sclerosis

Author Affiliations
  • 1Neuro Division, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  • 2Centre for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
  • 3Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
  • 4Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
JAMA Neurol. 2021;78(4):478-482. doi:10.1001/jamaneurol.2020.5520
Key Points

Question  Is there an association between pediatric-onset multiple sclerosis (MS) and educational level, income, and use of disability benefits through adulthood?

Findings  This nationwide register-based cohort study included 485 patients with pediatric-onset MS and 4850 persons without MS, matched from the general population. Persons with pediatric-onset MS were less likely to attend university, had less earnings from work, and were more reliant on disability benefits than persons without MS.

Meaning  This study suggests that pediatric-onset MS may have lasting consequences that translate into lower educational achievements and earnings and a greater use of disability benefits in adulthood.

Abstract

Importance  Pediatric-onset multiple sclerosis (PoMS) is associated with significant cognitive and physical disability. Whether this disability translates into differences in educational achievements and earnings is unknown.

Objective  To evaluate the association between PoMS and educational level and income throughout adulthood.

Design, Setting, and Participants  A prospective register-based cohort study of individuals with PoMS and a population-based matched reference cohort was conducted using nationwide microdata from linked registers in Sweden from January 1, 1990, to December 31, 2016; analyses were completed from May 1, 2019, to September 1, 2020. Of 772 persons with PoMS identified in the Swedish MS registry, 485 had an onset during the period from 1980 to 2014 and had socioeconomic data available. The general population reference cohort without multiple sclerosis (MS) (n = 4850) was randomly selected from the full Swedish population, matched 10:1 on age, sex, and country of birth.

Exposure  Pediatric-onset MS, diagnosed by a neurologist, with onset before 18 years of age.

Main Outcomes and Measures  Highest educational level (elementary school, high school, or university) was assessed using logistic regression. Income, measured as the mean annual earnings from paid work in US dollars, was compared using Tobit models, and net annual sickness absence and disability pension days were compared using zero-inflated negative binomial regression. Earnings and days receiving disability benefits were compared within 4 age periods (19-24, 25-34, 35-44, and 45-54 years).

Results  The median age of the cohort with PoMS (n = 485) and the matched reference cohort (n = 4850) in 2016 was 32 years (interquartile range, 26-40 years), and most participants were women (348 [71.8%] in the PoMS cohort and 3480 [71.8%] in the matched reference cohort). Persons with PoMS were less likely than persons in the matched reference cohort to attend university (odds ratio, 0.80 [95% CI, 0.66-0.97]) and had significantly lower annual earnings than the reference cohort, ranging from −$1618 (95% CI, −$2558 to −$678) in the youngest age period to −$10 683 (95% CI, −$18 187 to −$3178) in the eldest. Persons with PoMS received higher rates of disability benefits, as sickness absence days in the youngest age period (rate ratio, 3.06 [95% CI, 2.08-4.52]) and disability pension days in the oldest age period (rate ratio, 1.43 [95% CI, 1.11-1.85]).

Conclusions and Relevance  This study suggests that having PoMS is associated with less educational achievement, lower earnings, and greater use of disability benefits throughout the working-age life span. As adults, persons with PoMS never earned as much as their counterparts without MS, and they exhibited a heavier reliance on disability benefits.

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