title: Self-reported levels of education and disability progression in multiple sclerosis.
abstract: OBJECTIVE
  The purpose of our study is to investigate whether socioeconomic indicators such as education, financial concerns, employment, and living status are associated with disease progression in relapsing-onset and progressive-onset Multiple Sclerosis (MS).
  
  
  METHODS
  We performed a cross-sectional survey among individuals with MS, registered by the Flemish MS society and included socioeconomic indicators. A Cox proportional hazard regression was performed with the time from MS onset and from birth to reach an ambulatory disability milestone corresponding to Expanded Disability Status Scale (EDSS) 6 (requiring a cane) as outcome measure, adjusted for gender, age at MS onset, and immunomodulatory treatment.
  
  
  RESULTS
  Among the participants with relapsing-onset MS, subjects reporting education for more than 12 years had a reduced risk of reaching EDSS 6 compared to subjects reporting education for less than 12 years [HR from onset 0.68 (95% CI 0.49-0.95); HR from birth 0.71 (95% CI 0.51-0.99)]. In progressive-onset MS, longer education was associated with an increased hazard to reach EDSS 6 [HR from onset 1.25 (95% CI 0.91-1.70); HR from birth 1.39 (95% CI 1.02-1.90)].
  
  
  CONCLUSIONS
  Our study shows an association of self-reported levels of education with disability progression in MS, with the highest level being protective in relapsing-onset MS.
authors.affiliation: National Multiple Sclerosis Center, Melsbroek, Belgium. marie.dhooghe@mscenter.be.|Center For Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium. marie.dhooghe@mscenter.be.
authors.forename: M B
authors.initials: MB
authors.lastname: D'hooghe
authors.affiliation: Laboratory of Experimental Surgery and Center for Outcomes Research, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Haentjens
authors.affiliation: National Multiple Sclerosis Center, Melsbroek, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Van Remoortel
authors.affiliation: Center For Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.|Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: De Keyser
authors.affiliation: National Multiple Sclerosis Center, Melsbroek, Belgium.|Center For Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: Nagels
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D018450:Disease Progression; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology / Q000503:physiopathology* / Q000523:psychology; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D057566:Self Report; D012737:Sex Factors; D055815:Young Adult
keywords: education; health behavior; multiple sclerosis; progression; socioeconomic factors