title: Are ethnicity, social grade, and social deprivation associated with severity of thyroid-associated ophthalmopathy?
abstract: OBJECTIVE
  Previous studies have extensively investigated the pathophysiology, genetics, and lifestyle risk factors of thyroid-associated ophthalmopathy (TAO). The aim of this study was to investigate the independent contribution of ethnic origin, social grade, and level of social deprivation to TAO severity in a large, multiethnic, and urban population.
  
  
  METHODS
  Retrospective case note review of all TAO patients seen at Birmingham and Midland Eye Centre, United Kingdom over a 14-year period. Ethnicity (White, Asian, or Black) was recorded, and residence postcode was used to determine social grade (National Readership Survey classification) and level of social deprivation (Index of Multiple Deprivation 2007). TAO severity was defined by European Group on Graves' Orbitopathy criteria. Moderate-to-severe: necessity for TAO treatment with oral or intravenous steroid, long-term immunosuppressants, or orbital radiotherapy. Sight-threatening: presence of dysthyroid optic neuropathy (DON) or need for urgent orbital decompression surgery. Multivariable logistic regression was performed to measure the independent influence of ethnicity, social grade, and social deprivation on indicators of severe TAO.
  
  
  RESULTS
  Lower social grade was significantly associated with increased odds ratio (OR) of TAO patients having severe TAO, including treatment with oral (OR: 2.3 (95% CI 1.1-5.1) p = 0.03) and intravenous steroid (OR: 2.6 (95% CI 1.0-7.0) p = 0.04) and DON (OR: 4.0 (95% CI 1.2-12.7) p = 0.02), compared with those of highest social grade. Similar results were observed for social deprivation. Ethnicity had no independent association with any measure of TAO severity.
  
  
  CONCLUSIONS
  In this cohort, lower social grade and higher social deprivation, but not ethnicity, had independent, statistically significant association with more severe TAO.
authors.affiliation: *Academic Unit of Ophthalmology, College of Medical and Dental Sciences, University of Birmingham, Birmingham and Midland Eye Centre; and †Birmingham & Midland Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Edmunds
authors.forename: Julie A
authors.initials: JA
authors.lastname: Huntbach
authors.forename: Omar M
authors.initials: OM
authors.lastname: Durrani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005006:Ethnicity; D005260:Female; D049970:Graves Ophthalmopathy / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011610:Psychosocial Deprivation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012923:Social Class; D055815:Young Adult