Poverty and socioeconomic deprivation and multiple sclerosis

Are any of you living in poverty or a deprived neighbourhood? If yes, have you been offered any help with these two domains of your life, which impacts MS outcomes?

Living in poverty and experiencing socioeconomic deprivation have a substantial negative impact on the health outcomes of people with multiple sclerosis (pwMS) and others living with chronic conditions. These disadvantages are linked to faster disease progression, increased disability, reduced access to essential healthcare and support, and a lower quality of life.

Studies highlight a clear association between lower socioeconomic status (SES) and a more aggressive MS disease course in pwMS. PwMS from more deprived backgrounds are more likely to reach higher levels of disability sooner and enter the clinically apparent progressive form of the disease more rapidly. This is thought to be a result of a complex interplay of factors related to limited resources and increased vulnerability.

Financial insecurity and deprivation create barriers to accessing optimal MS care. This can include difficulties affording medications, attending appointments, accessing rehabilitation services, or making home modifications necessary to manage increasing disability. The financial strain imposed by the disease itself, through lost income and increased expenses for care and equipment, can further exacerbate poverty, creating a vicious cycle that negatively impacts health. In medicine, this phenomenon is often referred to as downward drift, where individuals with chronic diseases tend to experience a downward socioeconomic mobility due to lower incomes.

Beyond direct healthcare access, poverty and deprivation are associated with higher levels of chronic stress, poorer nutrition, and limited opportunities for healthy lifestyle choices such as regular exercise – all of which can influence MS severity and progression. These factors probably contribute to increased systemic inflammation, which makes MS worse and can potentially impact the effectiveness of DMTs (disease-modifying therapies).

Furthermore, research indicates the role of broader health disparities associated with socioeconomic factors. Studies have shown that individuals from marginalised racial and ethnic groups, who may also experience higher rates of poverty and deprivation, often face worse MS outcomes, underscoring the intersecting nature of social determinants of health.

This Canadian study below shows that higher area-level deprivation and disability are associated with an increased incidence of peripartum mental illness in women with MS. These and other findings should assist clinicians in identifying women with MS who may benefit from peripartum mental health support.

In the UK, we use the so-called Index of Multiple Deprivation (IMD), which defines deprivation in terms of a range of living conditions or domains of deprivation, namely:

• Income

• Employment

• Health deprivation and disability

• Education, skills and training

• Crime

• Barriers to housing and services

• Living environment

PwMS may be considered to be living in poverty if they lack the financial resources to meet their needs, whereas people can be regarded as deprived if they lack any resources, not just income. There are several other methods for calculating levels of deprivation, including the Townsend deprivation scores, the Carstairs deprivation index and the Jarman score. The Jarman score is the most closely linked index to General Medical Practice workload and is used as part of the calculation to assess deprivation payments to GPs. The Jarman score combined responses from GPs about their workload using eight census variables:

1. % elderly living alone

2. % children under 5

3. % unskilled workers

4. % overcrowded households

5. % changed address in the last year

6. % residents living in a household where the head was born in the New Commonwealth or Pakistan

7. % unemployed

8. % households containing lone parents

The greater the positive score, the more deprived and in need of primary medical care the resident population of a particular area are. The Jarman score is now rarely calculated. If you live in the UK, you can work out how deprived you are using the English indices of deprivation rankings.

The point of highlighting the article below and discussing deprivation and poverty is to provide you with an understanding of the profound impact that poverty and deprivation have on the lives of pwMS. This understanding is crucial for developing effective strategies to mitigate disparities and improve outcomes for all pwMS. Addressing socioeconomic inequalities and ensuring equitable access to healthcare and support services are vital in working towards better and more just health outcomes in MS.

Am I being idealistic to expect MS HCPs (healthcare professionals) and MS services to consider poverty and deprivation in the mix when optimising MS outcomes? These issues are part of what I call social health, and unless we try to improve all aspects of health, we are not managing MS as effectively as we should.

I suspect subscribers to MS-Selfie are less likely than non-subscribers to be living in poverty or a deprived neighbourhood. If you do, have you been offered any help with these two domains of your life? Has anyone discussed social prescribing with you or referred you to one of the many organisations that can help?

Paper

Marrie et al. Risk factors for incident peripartum mental illness in multiple sclerosis. Mult Scler. 2025 Apr 18:13524585251330109.

Background: Mothers with MS face an increased incidence and prevalence of peripartum mental illness as compared to mothers without MS.

Objective: To determine the factors associated with the risk of peripartum mental illness among mothers with MS.

Methods: We identified mothers with MS with live births between 2002 and 2019 using linked population-based administrative data from Ontario, Canada. Using validated definitions, we estimated the incidence of mental illness (depression, anxiety, bipolar disorder) from conception through the first post-partum year (peripartum period). We used multivariable Poisson regression to assess the association between age, delivery year, area-level deprivation (Ontario Marginalization Index), disease duration, disability, and comorbidity and incidence of peripartum mental illness.

Results: Among 1745 mothers with MS, the mean (SD) age at conception was 31.2 (4.8) years. Mothers living in communities that lacked cohesion had increased rates of peripartum depression (incidence rate ratio [IRR] 1.25; 1.11-1.42) and anxiety (IRR 1.20; 1.07-1.33). Elevated MS disability level was associated with elevated peripartum depression rates (IRR 1.51; 1.12-2.04).

Conclusion: Higher area-level deprivation and disability levels are associated with an increased incidence of peripartum mental illness. These findings may assist clinicians in identifying women with MS who may benefit from peripartum mental health support.

Subscriptions and donations

MS-Selfie newsletters and access to the MS-Selfie microsite are available free of charge. In comparison, weekly off-topic Q&A sessions are restricted to paying subscribers. Subscriptions are being used to run and maintain the MS Selfie microsite, as I don’t have time to do it myself. You must be a paying subscriber if people want to ask questions unrelated to the Newsletters or Podcasts. If you cannot afford to become a paying subscriber, please email a request for a complimentary subscription to ms-selfie@giovannoni.net.

Important Links

📋 MS-Selfie microsite

💰 Donations to MS-Selfie

👈 Prof. G’s Backstory and CV

💾 Prof. G’s MS Blog Archive

❓ Conflicts of Interest

🦋 BlueSky Social

🔗 LinkedIn

🖋 Medium

General Disclaimer

Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of Queen Mary University of London or Barts Health NHS Trust. The advice is intended as general and should not be interpreted as personal clinical advice. If you have problems, please tell your healthcare professional, who will be able to help you.