How Education, Income and Insurance Impact Pediatric MS Care
Research By: Elizabeth Wilson, MD
Post Date: July 30, 2025 | Publish Date: Nov. 12, 2024
Social determinants of health, such as education, income and insurance, can have varying influences on outcomes for children with multiple sclerosis (MS), but they do not appear to delay treatment from specialists, according to a recent study published in the journal Neurology.
Elizabeth Wilson, MD, a neurologist at Cincinnati Children’s, led an analysis conducted by the US Network of Pediatric MS Centers, that sought to shed light on social hardships and their effects on pediatric-onset MS.
A Surprise Finding
The study analyzed data from nearly 1,000 patients treated at network centers. Researchers expected to find that social hardships delayed initial treatment for pediatric MS patients—but the data told a different story.
“Some of the results were the opposite of what we were expecting,” Wilson says. “There was no delay in treatment, which might be because all of the children in the study were seen by or had access to neuroimmunology specialists.”
Wilson says this highlights a broader issue.
“We don’t have data on children who face the greatest hardships and are not receiving subspecialty care. These are the kids most at risk for delays in diagnosis and treatment.”
Understanding How Social Hardships Affect Disease Progression
Social hardships are all too common and can include lack of insurance, low maternal education, and low or no household income.
The study found that these factors may contribute to more severe disease progression and disability. Specifically:
- Public or no insurance may result in an increased rate of disability accrual and loss of follow-up care.
- Low or no household income may accelerate the time to a second MS event.
Understanding how these factors interact is complex. For instance, low or no household income can be associated with chronic stress, which can increase inflammation and disease activity.
To better understand these links, the care network plans deeper studies of the relationship among environmental stressors, hardships and inflammation, Wilson says. Researchers also are developing improved ways to measure chronic stress, including using geocoding data, with the goal of identifying imaging or blood markers of disease activity tied to social hardships.
Screening for Social Determinants of Health
Until then, Wilson emphasizes the importance of screening for social hardships in MS specialty clinics. Providers should be equipped to connect families with available resources, while community neurologists should know when—and how—to refer patients to the nearest MS Center.
“Ultimately, understanding how social hardships affect patient outcomes can lead to new treatment models that improve the course of disease,” Wilson says.
About the network
The Network of Pediatric Multiple Sclerosis Centers was created in 2006 with six participating centers. It has since grown to 12 clinical centers plus other affiliate centers that collaborate on individual studies. Cincinnati Children’s is an affiliate center.
The network members have published more than 60 studies, with work funded by organizations including the National Institute of Neurological Disorders and Stroke (NINDS), the National Multiple Sclerosis Society, the Guthy-Jackson Charitable Foundation, the Roche pharmaceutical company, and the Cleveland Clinic.
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| Original title: | Epidemiology and Impact of Social Hardships in Children With Multiple Sclerosis in the United States |
| Published in: | Neurology |
| Publish date: | Nov. 12, 2024 |
Research By
Through my research I aim to understand how a patient’s environment, including life stressors, interacts with their body and genetics in inflammatory neurologic conditions, such as multiple sclerosis.
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The Research Horizons blog features news and insights about the latest discoveries and innovations developed by the scientists of Cincinnati Children's. This blog does not provide medical advice, diagnosis, or treatment. Email researchnews@cchmc.org with questions or ideas.
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