The impact of multiple sclerosis on social determinants of health: Results from the SocialMS study

Introduction: Multiple Sclerosis (MS) affects several social determinants of health (SDH), but research remains limited and fragmented. We examined four SDH (education, work, financial resources and social life) to study the impact of MS and explore interrelationships, identify risk factors, and study the association with social support. Methods: SocialMS is a cross-sectional Italian questionnaire-based study including adults with MS. The number of SDH affected by MS was the primary endpoint and risk factors were identified using Poisson regression. Results: We included 1039 participants (mean age: 43.82 years (sd: 11.53); 68.82% females; 86.53% relapsing remitting; median Patient Determined Disease Steps (PDDS): 1 (iqr: 0-3)). Median number of SDH affected by MS was 1 (iqr: 0-3), with social life (51.20%) and work (48.22%) most impacted; high interrelationships among domains were observed. Relevant risk factors included socioeconomic factors (education incomplete at diagnosis: incidence-rate ratio (IRR)=1.19 [95% CI: 1.06; 1.35]; non-working or early retired: IRR=1.18 [1.05; 1.34]; economic strain: IRR=1.47, [1.31; 1.64]), comorbidities (IRR=1.23 [1.11; 1.37]) and PDDS (IRR=1.17 [1.13; 1.20]). Almost 90% received tangible (64.29%) or intangible (85.18%) social support, and number of SDH impacted by MS was positively associated with both (p < 0.05). Conclusion: MS substantially affects multiple SDH, with greater burden among individuals with socioeconomic and health-related vulnerabilities.