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Impact of remoteness on patient outcomes for people with multiple sclerosis in Australia

Published:August 09, 2021DOI:https://doi.org/10.1016/j.msard.2021.103208

      Highlights

      • Remoteness was not associated with substantial worse health outcomes in Australia.
      • Those living in inner regional areas having slightly worse health outcomes.
      • Those living in inner regional areas were less likely to use high efficacy DMTs.
      • Migration for improved treatment access may have reduced the effect sizes.

      Abstract

      Background

      Little is known about whether living in remote areas is associated with worse health outcomes in Australians with MS.

      Objectives

      To evaluate whether living in remote areas was associated with worse health outcomes, employment outcomes and different disease modifying therapy (DMTs) utilisation among Australians with MS.

      Methods

      We included 1,611 participants from the Australian MS Longitudinal Study. Level of remoteness (major cities, inner regional, outer regional, remote, and very remote Australia) was determined using postcode. Data were analysed using linear, log-binomial, log-multinomial and negative binomial regression.

      Results

      Living in more remote areas was not associated with substantial worse health/employment outcomes. There was a consistent pattern of those living in inner regional areas having worse outcomes, but the effect sizes were relatively small with no clear dose-response relationships with increasing remoteness. Those living in more remote areas were less likely to use high efficacy DMTs. Adjusting for age, disease duration, and education level only marginally reduced the associations.

      Conclusions

      There is no large inequity in health outcomes in the Australian MS population due to remoteness. However, modest and consistent differences in health outcomes and DMTs treatment are likely to have a substantial cumulative impact at an individual level.

      Keywords

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