A nationwide temporal analysis of socioeconomic outcomes in Denmark's multiple sclerosis population

Background: We investigated whether the improved prognosis in relapsing-remitting multiple sclerosis (RRMS) was also reflected in socioeconomic milestones. Methods: This 29-year nationwide cohort study linked the Danish MS Registry with national registries on social transfer payments and income. We created two cohorts of all persons aged 18–63 with RRMS: a clinical onset-based cohort (onset 1995–2018; N = 10,894); and a diagnosis-based cohort (diagnosed 1995–2018; N = 11,392). Cohort entry years were grouped: 1995–2000; 2001–2006; 2007–2012; 2013–2018. Socioeconomic milestones included disability pension receipt, employment in protected employment scheme (flexi-job, introduced in 2000), and loss of income from paid work. Age- and sex adjusted Fine-Gray hazard models were applied. Diagnosis-based cohort analyses were further adjusted for baseline Extended Disability Status Scale score. Results: Compared with the 1995–2000 onset group, persons with later onset had a lower risk of disability pension with HRs of 0.66 (95 %CI: 0.61–0.72), 0.46 (95 %CI: 0.42–0.51), and 0.33 (95 %CI: 0.30–0.38) in successive periods. HRs for income loss (0.78; 0.62; 0.49) and flexi-job (0.75; 0.64) also declined over time in a consistent exposure-response pattern. Diagnosis-based cohort results were similar. Conclusion: We found a lower risk of adverse socioeconomic milestones in recent compared to early cohorts of persons with RRMS, likely partly indicating improved workability throughout the disease course.