Social and socioeconomic factors and cognitive outcomes in multiple sclerosis.

BACKGROUND: Race and social and socioeconomic conditions are associated with disability outcomes in people with multiple sclerosis (MS). Given that cognitive impairment is common in MS, social and structural factors may also relate to cognitive outcomes. OBJECTIVE: To investigate associations between social and socioeconomic factors and cognitive function in adults with MS and to determine whether these associations differ by race. METHODS: We conducted a secondary analysis of data from 274 adults with MS (average age 50.9 ± 11.9 years; 77.4% female; 72.3% White). Key social and socioeconomic factors included educational attainment, employment, marital/cohabitation status, and neighborhood disadvantage (measured via Area Deprivation Index). Cognitive outcomes included the PROMIS Cognitive Abilities, NIH Toolbox Cognition Battery, Symbol Digit Modalities Test, Paced Auditory Serial Addition Test, and Rey Auditory Verbal Learning Test. Hierarchical linear regression models were used to examine associations between these factors and cognitive performance, with interaction terms included to assess moderation by race. Conditional (simple slope) effects were examined for significant interactions. RESULTS: Non-White race and adverse social and socioeconomic factors-lower education, unemployment, unmarried status, and greater neighborhood disadvantage-were each associated with poorer cognitive performance (p < 0.05). The negative associations of unmarried status and neighborhood disadvantage with cognitive outcomes were more pronounced among non-White individuals. CONCLUSIONS: Adverse social and socioeconomic factors are associated with poorer cognitive outcomes in MS, with disproportionate impact among non‑White individuals. These findings underscore the importance of incorporating social context into cognitive risk assessment and addressing structural inequities in MS care and research.