Objective: To investigate how social determinants of health affect survival in people with Multiple System Atrophy

Background: The wider determinants of health (e.g. socioeconomic and environmental factors) are widely recognised to affect life expectancy(1). In PD, some ethnicities (South Asian, Black) and higher deprivation have been associated with more severe movement symptoms and survival (2-4). Here we report how these factors affect survival from onset of people with MSA (pwMSA) using a prospective observational cohort of 318 pwMSA from the PROSPECT-M-UK trial.

Method: Patients with clinically probable MSA (based on Gilman 2008) were recruited across 7 UK sites, with baseline reviews between 2 Jul 2015 and 2 Oct 2023, census date 31 Oct 2023. Disease onset was defined as first motor or autonomic symptom excluding constipation and RBD. Ethnicity was self-declared using UK Office of National Statistics (ONS) categories. Deprivation scores were based on home postcode at enrolment using the Index of Multiple Deprivation 2019 (IMD). Survival analysis was done using RStudio (R version 4.1.1).

Results: [Table 1] shows cohort demographics and study participant ethnicity. Cox analysis adjusted for age of onset showed that White ethnicity was associated with longer survival from onset (HR 0.13, 95% CI: 0.03-0.57, p=0.006).

264 pwMSA had IMD scores, with 75 sub-grouped to Higher Deprivation (Deciles 1-5) and 189 to Lower Deprivation (Deciles 6-10). After adjusting for age of onset and ethnicity, cox analysis showed no significant impact of Lower Deprivation (HR 0.81, 95%CI: 0.58-1.16, p=0.205), although Kaplan Meier plotting suggests a possible effect in rapidly progressive disease (survival < 9y) [figure1].

Subgroup analysis of pwMSA with onset before/after mean age of onset (59y) suggests that older pwMSA may be more affected by deprivation. [figure2]

There was no survival effect of educational attainment using International Standard Classification of Education (ISCED) (HR 0.95, 95% CI: 0.85-1.06, P = 0.33) or occupation class using ONS National Statistics Socio-economic Classification (HR 0.93, 95% CI: 0.82-1.06, P = 0.31) on survival

Conclusion: Here, ethnicity was associated with survival duration in pwMSA, although a larger sample size particularly of pwMSA from ethnic minorities is needed. Higher deprivation in older pwMSA could be associated with shorter survival and work to increase sample size and investigate potential mediating/reversible factors is ongoing

Table 1

Figure 1

Figure 2

References: 1. Marmot, M., Allen, J., Goldblatt, P., Boyce, T., McNeish, D., Grady, M., & Geddes, I. (2010). Fair society, healthy lives (The Marmot Review): Strategic Review of Health Inequalities in English post-2010. In The Marmot Review. https://doi.org/10.1016/j.puhe.2012.05.014
2. Zirra, A., Dey, K. C., Camboe, E., Waters, S., Haque, T., Huxford, B., Chohan, H., Donkor, N., Kahan, J., Ben-Joseph, A., Gallagher, D. A., Budu, C., Boyle, T., Simonet, C., Lees, A. J., Marshall, C. R., & Noyce, A. J. (2025). The East London Parkinson’s disease project – a case-control study of Parkinson’s Disease in a diverse population. Npj Parkinson’s Disease, 11(1). https://doi.org/10.1038/s41531-025-01031-x
3. Hill, E. J., Marcucci, S. B., Delano, K., Abanto, J., Sawyer, R. P., Marsili, L., Duque, K. R., Sun, Q., Woo, D., Langefeld, C. D., Hall, D. A., Skirpan, D., Paredes, N. C., Spikes, C., Bajaj, D. A., Gregor, N., Stivers, S., Mahajan, A., Woo, J. G., & Espay, A. J. (2025). Community Disadvantage Is Associated With More Severe Motor Symptoms in Parkinson Disease. Neurology: Clinical Practice, 15(4). https://doi.org/10.1212/CPJ.0000000000200506
4. Beydoun, M. A., Georgescu, M. F., Weiss, J., Noren Hooten, N., Beydoun, H. A., Tsai, J., Maino Vieytes, C. A., Evans, M. K., & Zonderman, A. B. (2025). Socioeconomic area deprivation and its relationship with dementia, Parkinson’s Disease and all-cause mortality among UK older adults: a multistate modeling approach. Social Science and Medicine, 379. https://doi.org/10.1016/j.socscimed.2025.118137

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MDS Abstracts - https://www.mdsabstracts.org/abstract/social-determinants-of-health-and-msa-survival/