Association of Socioeconomic Disadvantage and Neighborhood Disparities with Clinical Outcomes in Progressive Multiple Sclerosis
Justin Abbatemarco1, Alise Carlson1, Daniel Ontaneda1, Marisa McGinley1, Robert Bermel1, Scott Husak2, David Bruckman2,3, Jesse Schold2,3, Deborah Miller1
1Mellen Center, 2Quantitative Health Sciences, Cleveland Clinic, 3Center for Populations Health Research, Lerner Research Institute
Objective:
Examine the relationship between Area Deprivation Index (ADI), a validated measure of neighborhood-level disadvantage, and clinical measures in progressive multiple sclerosis (MS).
Background:
Socioeconomic disadvantage may be an important contributor to MS disability but is not well understood.
Design/Methods:
Data were collected between 2015 – 2020 at the Cleveland Clinic (OH, USA). Relationships between MS Performance Test (MSPT) and Quality of Life in Neurological Disorders (Neuro-QoL) scores were assessed across ADI quartiles (Q1: lowest deprivation – Q4 highest deprivation).  
Results:

A total of 1000 patients (51.5 ± 12.0 years old, 83.4% Caucasian) with 4801 encounters (median: 3; range 2-13) were included. Baseline Manual Dexterity Test (MDT) illustrated particular disparity as patients living in areas of greatest deprivation had MDT scores 2.5 seconds longer than someone living in areas of least deprivation (Q1 30.9 ± 9.0 seconds vs Q4 33.4 ± 8.3, p = 0.018). Baseline Processing Speed Test showed a similar relationship (Q1: 41.6 ± 12.8 correct answers vs Q4: 38.2 ± 12.4, p = 0.008). Walking Speed Test did not differ across quartiles (Q1: 9.7 ± 6.8 seconds vs Q4: 10.4 ± 5.7, p = 0.23). Longitudinal analysis did not reveal incremental worsening on the MSPT measures associated to ADI. At baseline, Neuro-QoL measures showed better functioning and fewer symptoms in patients living in areas of lowest deprivation (Q1) when compared to those living in the most disadvantaged areas (Q4). Longitudinally, Neuro-QoL measures for patients living in highest deprivation areas (Q4) demonstrated less favorable outcomes for all Neuro-QoL measures. Trends were consistent over time for all ADI quartiles (p>0.05 in interaction testing).

Conclusions:
This study provides evidence for socioeconomic disadvantage as a risk factor for disability accrual in progressive MS and may be targeted to improve care while informing resource allocation.