Researchers discovered that poorer socioeconomic status is associated with faster retinal neurodegeneration in patients with multiple sclerosis (MS), according to a study published in Brain.

In epidemiological studies, scientists are increasingly interested in whether socioeconomic status plays a role in affecting the course of a disease.

“Socioeconomic status is a combination of financial, educational and occupational influences, and evidence implicates an interaction of socioeconomic status with individual mental and physical health,” Vasileiou and colleagues said.

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Studies have previously found an association between low socioeconomic status and a proinflammatory phenotype. Studies on MS have revealed that patients with lower socioeconomic status are at a higher risk of disability progression.

“In the following study, we assess the association between socioeconomic status and the rate of retinal neurodegeneration, as a robust indicator of disease progression, as well as evaluate how race, comorbidity risk, and contemporaneous multiple sclerosis disease modifying therapy timing could potentially have a role,” the researchers wrote. 

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They recruited patients from the John Hopkins Multiple Sclerosis Center with a confirmed diagnosis of MS. Patients who were seen there received approximately biannual optic coherence tomography scans. Socioeconomic status was determined through parameters such as median household income, the Agency for Healthcare Research and Quality Socioeconomic Status index, and state and national Area Deprivation Indices as estimated from 5-year American Community Surveys.

The results demonstrated that faster retinal atrophy could be linked with disadvantaged neighborhood-level and patient-level socioeconomic status indicators. Atrophy of the ganglion cell inner plexiform layer and loss of low contrast letter acuity were more pronounced in disadvantaged groups at the state and national levels, as well as patients that came from poorer households or had lower education levels. 

What could explain this association between socioeconomic status and retinal neurodegeneration?

“Underlying contributing mechanisms are undoubtedly complex. However, acknowledging the impact of such inequalities on the variability of disease outcomes may aid in the implementation of more efficient management strategies as well as therapeutic approaches that may benefit the less privileged,” the researchers concluded.


Vasileiou ES, Filippatou AG, Pimentel Maldonado D, et al. Socioeconomic disparity is associated with faster retinal neurodegeneration in multiple sclerosis. Brain. 2021;awab342. doi:10.1093/brain/awab342