Is high socioeconomic status a risk factor for multiple sclerosis?
Bibliographic record
Abstract
Multiple sclerosis (MS) is a chronic disease of the central nervous system characterised by inflammation and neurodegeneration. An increased risk of the disease among those of high socioeconomic status (SES) was first observed over 50 years ago. This is in contrast to a more common pattern whereby adverse health outcomes are generally associated with low SES. Most MS risk factors, such as smoking, obesity, and a late age of EBV infection, vary in their prevalence by SES, and thus all provide pathways through which SES could affect disease risk. Alternatively, stress-related immune changes linked to SES could influence disease susceptibility. To establish the strength and nature of the association between SES and MS, two studies were performed as part of this manuscript-based thesis.The first manuscript is a systematic review of published cohort and case-control studies that examined the association between SES and MS risk. 21 articles were included. 5 studies, all from countries with higher levels of income inequality, reported an association between high SES and increased MS risk. 13 studies reported insufficient evidence of an association, and 2 studies reported an association with low SES; these largely came from more egalitarian nations. Few studies adequately controlled for all important mediators and confounders, precluding clear conclusions about the nature of the SES-MS association.The second manuscript is an original analysis of the association between SES and MS, using data from the multinational Environmental Risk Factors in MS (EnvIMS) case-control study. The study population comprised 2,144 cases and 3,859 controls, from Norway, Canada, and Italy. Multiple logistic regression was used to evaluate the association between SES and MS, with SES measured by parental education level. Analyses were adjusted for age, sex, sunlight exposure, history of infectious mononucleosis, smoking, obesity, and family size. In Canada, the OR (95% CI) for MS among individuals with university-educated parents relative to those whose parents had primary school education or below was 1.47 (1.03-2.09), with a statistically significant dose-response relationship across education levels (p for trend = 0.029). In Norway, this association was only present for those who grew up during a period of rising inequality (p for trend = 0.031). No evidence for an association was found in Italy.These two studies provide only partial support for an association between high SES and increased MS risk. Differing ages of EBV infection by social class, or stress-related immune changes linked to SES, are both possible explanations for the findings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".