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Déterminants socio-économiques et sclérose en plaques : Influence sur l'évolution et la prise en charge thérapeutique

Abstract : The general objective of the thesis was to study the influence of socio-economic determinants in Multiple Sclerosis (MS) evolution and therapeutic health care. In a 1st part, we performed a review of the literature, to identify the association between socio-economic déterminants and MS risk. The most recent studies performed with solid methodology on large cohort show that low socio-economic status seems to be associated with a higher risk of Multiple Sclerosis. In a 2nde part, we assessed the influence of socioeconomic deprivation on the risk to reach a moderate disability level (EDSS 4) and a severe disability level (EDSS 6) in RR-MS and SP-MM patients included in the databases of 3 MS expert centres (Caen, Rouen, Lille) of the French Observatory for MS (OFSEP) (N=3641). The EDI (European Deprivation Index), an ecological and aggregated indicator was used as an indicator of socio-economic level. The risk of reaching EDSS 4 and EDSS 6 for more socioeconomically deprived patients (EDI Q5) was independently higher than in the less socioeconomically deprived patients (EDI Q1), adjusted Hazard Ratio HRa=1.37 [1.15-1.64] to reach EDSS 4 and HRa=1.42 [1.13-1.75] to reach EDSS 6. Finally, in a 3rd part, we studied the influence of socio-economic determinants approached by the EDI on therapeutic health care, and specifically on the access to disease modifying treatments (DMT), taking into consideration the access to first DMT in RR-MS and SP-MS patients included in databases of the 3 same OFSEP centres (N=3293), then on the access to 2nde line DMT (Cyclophosphamide, Mitoxantrone, Natalizumab, and Fingolimod) in RR-MS patients, included in the regional database of Western-Normandy (N=733). According our results, socio-economic determinants do not seem to influence the access to a 1st DMT. However, we showed an influence of socio-economic determinants on the access to 2nde line DMT. Indeed, after 5 years from initiation of a first DMT the risk of accessing a 2nd line DMT is 3 times higher for patients with lower deprivation indices (1st quintile of EDI) HRa= 3.14 95%CI [1.72-5.72] compared to patients with higher values (EDI quintiles 2 to 5). We highlighted that socio-economic determinants influenced many key moments in evolution and therapeutic health care of MS patients. These observations encourage neurologist and paramedical team to take every provision to improve health care of socio-economically vulnerable MS patients and keep working to reduce social inequalities of health on evolution and access to care in MS.
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Floriane Calocer. Déterminants socio-économiques et sclérose en plaques : Influence sur l'évolution et la prise en charge thérapeutique. Médecine humaine et pathologie. Normandie Université, 2020. Français. ⟨NNT : 2020NORMC402⟩. ⟨tel-02534988⟩

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