Abstract Details

Title The Impact of Neighborhood-level Socioeconomic Status on Mental Health in a Multiple Sclerosis Cohort

Topic Health Care Disparities

Presentation(s) Health Care Disparities Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 010

Background

Depression and anxiety are common in MS. Low SES is associated with a greater burden of comorbidities with MS and symptom management disparities. The associations between nSES and MH in MS are unknown.

Objective

To explore the associations between neighborhood-level socioeconomic status (nSES) and the prevalence of psychiatric illness and mental health (MH) attitudes in patients with multiple sclerosis (MS).

Design/Methods

Participants with MS answered a national web-based survey including MH attitudes, the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder 7-item (GAD-7) scale, the Modified Fatigue Impact Scale 5-item version (MFIS-5), and selected Functional Assessment of Multiple Sclerosis (FAMS) subscales. nSES was calculated using the Agency for Healthcare Research and Quality (AHRQ) Index, a weighted composite score of 7 SES indicators obtained from publicly available 5-digit ZIP Code-linked US Census American Community Survey data (2014-2018). Participants were stratified by AHRQ quartile. Analyses were performed using descriptive statistics, chi-squared, and analysis of variance.

Results

2095 participants answered the survey (mean AHRQ index 54.6+5.4, age 51.3+12.2 years, 7% African American, 5.4% Hispanic, 81.8% female). Those in the lower quartile of nSES (most disadvantaged) had higher mean MFIS-5 (11.9+5.1; p=<0.001), PHQ-9 (9.2+6.3; p=<0.001), GAD-7 (7.1+5.9; p=0.006), and lower FAMS mobility (15+7.6; p=0.01) and FAMS symptoms (17.5+6.9; p=<0.001) scores as compared to those in higher quartiles (least disadvantaged). Fewer patients in the lowest AHRQ quartile felt comfortable discussing personal problems with a professional versus those in higher quartiles (85.5% vs. 88.7-92%; p=0.004). Of those who consume alcohol (n=1489), participants in the highest AHRQ quartile had higher mean AUDIT scores (2.9+4, p=0.01) as compared to those in lower quartiles.

Conclusions

MS participants with lower neighborhood-level SES report worse depression, fatigue, anxiety, mobility, MS symptoms, and less alcohol use when compared to those with higher SES. Neighborhood-level SES may affect MH care-related attitudes in MS.

Authors/Disclosures
Daniela A. Pimentel Maldonado, MD, MSCR (U.S. Food and Drug Administration) PRESENTER	Dr. Pimentel Maldonado has nothing to disclose.
	No disclosure on file
Christopher Hemond, MD (University of Massachusetts Memorial Medical Center)	Dr. Hemond has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for VIVIO Health. Dr. Hemond has stock in VIVIO Health. The institution of Dr. Hemond has received research support from Consorium of Multiple Sclerosis Centers. The institution of Dr. Hemond has received research support from National Multiple Sclerosis Society. The institution of Dr. Hemond has received research support from National Center for Advancing Translational Sciences, National Institutes of Health. The institution of Dr. Hemond has received research support from University of Massachusetts Memorial Medical Center. The institution of Dr. Hemond has received research support from National Institute Of Neurological Disorders And Stroke of the National Institutes of Health. Dr. Hemond has received personal compensation in the range of $0-$499 for serving as a Member of Data Safety and Monitoring Board with National Institute Of Neurological Disorders And Stroke of the National Institutes of Health.
Raffaella Umeton, MD	Dr. Umeton has nothing to disclose.
Idanis Berrios Morales, MD (University of Massachusetts Medical School)	Dr. Berrios Morales has nothing to disclose.
Carolina Ionete, MD (UMass Memorial)	Dr. Ionete has received personal compensation in the range of $50,000-$99,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Ionete has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BMS. The institution of Dr. Ionete has received research support from Genetech. The institution of Dr. Ionete has received research support from Biogen. The institution of Dr. Ionete has received research support from NIH.
Kathryn Fitzgerald, PhD (Johns Hopkins University)	The institution of Dr. Fitzgerald has received research support from NIH. The institution of Dr. Fitzgerald has received research support from National MS Society.