Socioeconomic, health-care access and clinical determinants of disease severity in Multiple Sclerosis in Chile

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dc.article.number104918
dc.catalogadoryvc
dc.contributor.authorCiampi Díaz, Ethel Leslie
dc.contributor.authorSoler León, Bernardita María
dc.contributor.authorUribe San Martín, Reinaldo
dc.contributor.authorJurgensen Heinrich, Lukas
dc.contributor.authorGuzmán, I.
dc.contributor.authorKeller Matamala, Karina Pascale
dc.contributor.authorReyes C., Ana Belén
dc.contributor.authorBravo Grau, Sebastián Eduardo
dc.contributor.authorCruz, Juan Pablo
dc.contributor.authorCárcamo Rodríguez, Claudia Andrea
dc.date.accessioned2024-01-19T14:06:44Z
dc.date.available2024-01-19T14:06:44Z
dc.date.issued2023
dc.description.abstractBackground: MS severity may be affected by genetic, patient-related, disease-related and environmental factors. Socioeconomic status, including income and healthcare access, amongst others, may also have a role in affecting diagnostic delay or therapy prescription. In Chile, two main healthcare systems exist, public-healthcare and private-healthcare, nonetheless universal care laws (e.g., access to High Efficacy Therapy-HET), including both systems, have been recently enacted for people with MS. Objective: To assess the role of Socioeconomic Conditions (SEC), clinical variables and public health policies on the impact of disease severity of MS patients in Chile. Methods: Multicentric, observational, cross-sectional study including patients from two reference centres (1 national reference centre from the private-health system and 1 regional reference centre from the public-health system). SEC and clinical variables included healthcare insurance (private or public), subclassification of health insurance according to monthly income, sex, age at onset, diagnostic delay, disease duration, diagnosis before HET law (as a proxy of HET delay), and current HET treatment. Progression Index (PI), EDSS ≥6.0 and Progressive MS diagnosis were used as outcome measures. Multivariable binary logistic regression was performed. Results: We included 604 patients (460 private-health, 144 public-health), 67% women, 100% white/mestizo, 88% RRMS, mean age 42±12 years, mean age at onset 32±11 years, mean disease duration 10±6 years, median diagnostic delay 0 (0–34) years, 86% currently receiving any DMT, 55% currently receiving HET, median EDSS at last visit of 2.0 (0–10), and median PI 0.17 (0–4.5). Lower monthly income was associated with higher EDSS and higher PI. In the multivariable analysis, public-healthcare (OR 10.2), being diagnosed before HET-law (OR 4.89), longer diagnostic delay (OR 1.26), and older age at onset (OR 1.05) were associated with a higher risk of PI>0.2, while current HET (OR 0.39) was a protective factor. Diagnosis before HET-law (OR 7.59), public-healthcare (OR 6.49), male sex (OR 2.56), longer disease duration (OR 1.2) and older age at onset (OR 1.1) were associated with a higher risk of Progressive MS. Public-healthcare (OR 5.54), longer disease duration (OR 1.14) and older age at onset (OR 1.08) were associated with a higher risk of EDSS ≥6.0 while current treatment with HET had a trend as being a protective factor (OR 0.44, p = 0.05). Conclusion: MS severity is impacted by non-modifiable factors such as sex and age at onset. Interventions focused on shortening diagnostic delay and encouraging early access to high-efficacy therapies, as well as initiatives that may reduce the disparities inherent to lower socioeconomic status, may improve outcomes in people with MS.
dc.fuente.origenORCID
dc.identifier.doi10.1016/j.msard.2023.104918
dc.identifier.eissn2211-0356
dc.identifier.issn2211-0348
dc.identifier.urihttp://doi.org/10.1016/j.msard.2023.104918
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/80622
dc.information.autorucEscuela de Medicina; Ciampi Díaz, Ethel Leslie; 0000-0002-7330-5433; 132794
dc.information.autorucEscuela de Medicina; Soler León, Bernardita María; 0000-0002-8143-4497; 189547
dc.information.autorucEscuela de Medicina; Uribe San Martín, Reinaldo; 0000-0002-3422-7962; 127201
dc.information.autorucEscuela de Medicina; Jurgensen Heinrich, Lukas; S/I; 1089180
dc.information.autorucEscuela de Medicina; Reyes C., Ana Belén; S/I; 1075784
dc.information.autorucEscuela de Medicina; Bravo Grau, Sebastián Eduardo; 0000-0001-7465-3555; 1015696
dc.information.autorucEscuela de Medicina; Cruz, Juan Pablo; S/I; 17836
dc.information.autorucEscuela de Medicina; Cárcamo Rodríguez, Claudia Andrea; 0000-0002-9430-216X; 562
dc.language.isoen
dc.nota.accesocontenido parcial
dc.pagina.final6
dc.pagina.inicio1
dc.rightsacceso restringido
dc.subjectMultiple sclerosis
dc.subjectSocioeconomic status
dc.subjectSocioeconomic condition
dc.subjectSocioeconomic indicator
dc.subjectDisability
dc.subjectDisease-modifying therapy
dc.subjectHealth policies
dc.subjectHealth care access
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.titleSocioeconomic, health-care access and clinical determinants of disease severity in Multiple Sclerosis in Chile
dc.typeartículo
dc.volumen78
sipa.codpersvinculados132794
sipa.codpersvinculados189547
sipa.codpersvinculados127201
sipa.codpersvinculados1089180
sipa.codpersvinculados1075784
sipa.codpersvinculados1015696
sipa.codpersvinculados17836
sipa.codpersvinculados562
sipa.trazabilidadORCID;2024-01-08
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