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Abstract：
OBJECTIVE: Psychosocial adversity and stress, known to predispose adults to neurodegenerative and inflammatory immune disorders, are widespread among children who experience socioeconomic disadvantage, and the associated neurotoxicity and proinflammatory profile may predispose these children to multiple sclerosis (MS). We sought to determine associations of socioeconomic disadvantage and psychosocial adversity with odds of pediatric-onset MS (POMS), age at POMS onset, and POMS disease activity.
METHODS: This case-control study used data collected across 17 sites in the United States by the Environmental and Genetic Risk Factors for Pediatric Multiple Sclerosis Study. Cases (n = 381) were youth aged 3-21 years diagnosed with POMS or a clinically isolated demyelinating syndrome indicating high risk of MS. Frequency-matched controls (n = 611) aged 3-21 years were recruited from the same institutions. Prenatal and postnatal adversity and postnatal socioeconomic factors were assessed using retrospective questionnaires and zip code data. The primary outcome was MS diagnosis. Secondary outcomes were age at onset, relapse rate, and Expanded Disability Status Scale (EDSS). Predictors were maternal education, maternal prenatal stress events, child separation from caregivers during infancy and childhood, parental death during childhood, and childhood neighborhood disadvantage.
RESULTS: MS cases (64% female, mean age 15.4 years, SD 2.8) were demographically similar to controls (60% female, mean age 14.9 years, SD 3.9). Cases were less likely to have a mother with a bachelor\'s degree or higher (OR 0.42, 95% CI 0.22-0.80, p = 0.009) and were more likely to experience childhood neighborhood disadvantage (OR 1.04 for each additional point on the neighborhood socioeconomic disadvantage score, 95% CI 1.00-1.07; p = 0.025). There were no associations of the socioeconomic variables with age at onset, relapse rate, or EDSS, or of prenatal or postnatal adverse events with risk of POMS, age at onset, relapse rate, or EDSS.
CONCLUSIONS: Low socioeconomic status at the neighborhood level may increase the risk of POMS while high parental education may be protective against POMS. Although we did not find associations of other evaluated prenatal or postnatal adversities with POMS, future research should explore such associations further by assessing a broader range of stressful childhood experiences.
METHODS: This case-control study used data collected across 17 sites in the United States by the Environmental and Genetic Risk Factors for Pediatric Multiple Sclerosis Study. Cases (n = 381) were youth aged 3-21 years diagnosed with POMS or a clinically isolated demyelinating syndrome indicating high risk of MS. Frequency-matched controls (n = 611) aged 3-21 years were recruited from the same institutions. Prenatal and postnatal adversity and postnatal socioeconomic factors were assessed using retrospective questionnaires and zip code data. The primary outcome was MS diagnosis. Secondary outcomes were age at onset, relapse rate, and Expanded Disability Status Scale (EDSS). Predictors were maternal education, maternal prenatal stress events, child separation from caregivers during infancy and childhood, parental death during childhood, and childhood neighborhood disadvantage.
RESULTS: MS cases (64% female, mean age 15.4 years, SD 2.8) were demographically similar to controls (60% female, mean age 14.9 years, SD 3.9). Cases were less likely to have a mother with a bachelor\'s degree or higher (OR 0.42, 95% CI 0.22-0.80, p = 0.009) and were more likely to experience childhood neighborhood disadvantage (OR 1.04 for each additional point on the neighborhood socioeconomic disadvantage score, 95% CI 1.00-1.07; p = 0.025). There were no associations of the socioeconomic variables with age at onset, relapse rate, or EDSS, or of prenatal or postnatal adverse events with risk of POMS, age at onset, relapse rate, or EDSS.
CONCLUSIONS: Low socioeconomic status at the neighborhood level may increase the risk of POMS while high parental education may be protective against POMS. Although we did not find associations of other evaluated prenatal or postnatal adversities with POMS, future research should explore such associations further by assessing a broader range of stressful childhood experiences.
摘要：
目标：心理社会逆境和压力，已知成人易患神经退行性和炎性免疫疾病，在经历社会经济劣势的儿童中普遍存在，和相关的神经毒性和促炎谱可能使这些儿童易患多发性硬化症（MS）。我们试图确定社会经济劣势和心理社会逆境与儿童发病MS（POMS）的几率的关联。POMS发病年龄，和POMS疾病活动。
方法：本病例对照研究使用了在美国17个地点收集的儿童多发性硬化研究环境和遗传风险因素数据。病例（n=381）是3-21岁的青年，诊断为POMS或临床孤立的脱髓鞘综合征，表明MS的高风险。从同一机构招募3-21岁的频率匹配对照（n=611）。使用回顾性问卷和邮政编码数据评估了产前和产后逆境和产后社会经济因素。主要结果是MS诊断。次要结果是发病年龄，复发率,和扩展的残疾状态量表（EDSS）。预测因素是母亲教育，产妇产前应激事件，儿童在婴儿期和儿童期与看护者分离，父母在童年时期死亡，和童年邻居的劣势。
结果：MS病例（64％为女性，平均年龄15.4岁,SD2.8)在人口统计学上与对照组相似(60%为女性，平均年龄14.9岁，标准差3.9)。案例中母亲拥有学士学位或更高学位的可能性较小（OR0.42，95％CI0.22-0.80，p=0.009），并且更有可能经历童年社区劣势（社区社会经济劣势得分上每增加一点，OR1.04，95%CI1.00-1.07；p=0.025）。社会经济变量与发病年龄没有关联，复发率,或EDSS，或有POMS风险的产前或产后不良事件，发病年龄,复发率,或EDSS。
结论：社区水平的低社会经济地位可能会增加POMS的风险，而父母的高教育水平可能对POMS具有保护作用。虽然我们没有发现其他评估的产前或产后逆境与POMS的关联，未来的研究应该通过评估更广泛的儿童压力经历来进一步探索这种关联.
方法：本病例对照研究使用了在美国17个地点收集的儿童多发性硬化研究环境和遗传风险因素数据。病例（n=381）是3-21岁的青年，诊断为POMS或临床孤立的脱髓鞘综合征，表明MS的高风险。从同一机构招募3-21岁的频率匹配对照（n=611）。使用回顾性问卷和邮政编码数据评估了产前和产后逆境和产后社会经济因素。主要结果是MS诊断。次要结果是发病年龄，复发率,和扩展的残疾状态量表（EDSS）。预测因素是母亲教育，产妇产前应激事件，儿童在婴儿期和儿童期与看护者分离，父母在童年时期死亡，和童年邻居的劣势。
结果：MS病例（64％为女性，平均年龄15.4岁,SD2.8)在人口统计学上与对照组相似(60%为女性，平均年龄14.9岁，标准差3.9)。案例中母亲拥有学士学位或更高学位的可能性较小（OR0.42，95％CI0.22-0.80，p=0.009），并且更有可能经历童年社区劣势（社区社会经济劣势得分上每增加一点，OR1.04，95%CI1.00-1.07；p=0.025）。社会经济变量与发病年龄没有关联，复发率,或EDSS，或有POMS风险的产前或产后不良事件，发病年龄,复发率,或EDSS。
结论：社区水平的低社会经济地位可能会增加POMS的风险，而父母的高教育水平可能对POMS具有保护作用。虽然我们没有发现其他评估的产前或产后逆境与POMS的关联，未来的研究应该通过评估更广泛的儿童压力经历来进一步探索这种关联.
