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Abstract Details

The Relationship Between Socioeconomic Status and Disability in MS Is Linked to Diet
Multiple Sclerosis
P4 - Poster Session 4 (11:45 AM-12:45 PM)
6-010
A recent publication concluded lifestyle factors (e.g., smoking, alcohol, BMI) help explain the link between SES and incident MS. Lower SES is also associated with worse MS disability. Investigators hypothesize a role for modifiable lifestyle factors in explaining this association; here we evaluated the contribution of diet.  
Evaluate whether the association between socioeconomic status (SES) and disability in multiple sclerosis (MS) is mediated by diet.
Persons with MS (n=563; 71% women; aged 44.2±11.3 years) completed the MS Functional Composite (MSFC) to assess MS-related disability. An SES index was derived from educational attainment (self/parental), literacy, and neighborhood deprivation (AHRQ formula utilizing zip code socioeconomic indicators). Participants completed the Mediterranean Diet Adherence Screener (MEDAS) to assess diet. After confirming intercorrelations among SES, MEDAS, and MEDAS, the PROCESS macro for SPSS (version 4.2, model 4) tested whether MEDAS mediates the relationship between SES and MSFC, first with variables adjusted for demographics (age, sex, race/ethnicity), then additionally adjusted for health factors (BMI, exercise, sleep disturbance, histories of smoking, diabetes, hypertension, hyperlipidemia). 
Adjusting for demographics, MSFC correlated with SES (r=0.28) and MEDAS (r=0.26), and SES correlated with MEDAS (r=0.23, Ps<0.001). Mediation analysis: MEDAS partially mediated the link between SES and MSFC; MEDAS explained 18.8% of that relationship (meditation: 0.003 [0.001, 0.004]; total: 0.016 [0.011, 0.020]; direct: 0.013 [0.009, 0.017]). Additionally adjusting for relevant health factors, MSFC still correlated with SES (r=0.27) and MEDAS (r=0.24), and SES correlated with MEDAS (r=0.19, Ps<0.001). MEDAS continued to partially mediate the link between SES and MSFC, explaining 13.3% of that relationship (mediation: 0.002 [0.001, 0.003]; total: 0.015 [0.011, 0.020]); direct: 0.013 [0.009, 0.018].
The relationship between SES and MS-related disability is partially explained by dietary habits, highlighting the particular need for healthcare initiatives focused on modifiable lifestyle factors that are available and accessible to those from socially disadvantaged backgrounds.
Authors/Disclosures
Ilana B. Katz Sand, MD (Corinne Goldsmith Dickinson Center for MS)
PRESENTER
The institution of Dr. Katz Sand has received research support from National Multiple Sclerosis Society. The institution of Dr. Katz Sand has received research support from Hirschl Foundation. The institution of Dr. Katz Sand has received research support from National Institutes of Health. Dr. Katz Sand has received personal compensation in the range of $500-$4,999 for serving as a Conference presenter with American Academy of Neurology.
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.
Sammita Satyanarayan, MD (Mount Sinai Medical Center) Dr. Satyanarayan has nothing to disclose.
Michelle Fabian, MD, FAAN (Mount Sinai Hospital) Dr. Fabian has nothing to disclose.
James F. Sumowski (Icahn School of Medicine At Mount Sinai) Mr. Sumowski has nothing to disclose.