Marital Status and Disease Progression in Multiple Sclerosis: A Population-Based Study

Background: Married individuals tend to live longer and experience greater health-related quality of life. Previous research has indicated that being married is associated with less severe disease progression in several chronic diseases, such as dementia and rheumatoid arthritis. Whether marital status influences objective disease progression in MS is presently unknown.

Objectives: To evaluate the relationship between marital status and disease progression in MS.

Methods: We utilized the population-based Gulf War era MS cohort (n=2631), to investigate whether marital status predicted disease progression on the Kurtzke Disability Status Scale (DSS). Each case was adjudicated by the McDonald criteria as definite or possible MS. Marital status was categorized at the baseline and the most recent disability assessment according to the following categories: married-no change, single-no change, married-to-single, or single-to-married. In a series of ANOVAs, we analyzed these marital status changes and demographic variables in relation to time from disease onset to DSS=6 (cane) and DSS=7 (wheelchair).

Results: Over the mean follow-up period of 6.34 years, being married significantly predicted slower progression to a DSS 6 than remaining single, F (3,2623)=5.96, p<.001. On average, those remaining single progressed to cane 1.16 years more quickly than those being married at any point. Likewise, having a married status significantly predicted time from disease onset to a DSS 7, F(3,2623)=9.63, p<.001. On average, those remaining single progressed to a wheelchair 1.5 years more quickly than those married at any point. There was a significant interaction between sex and marital status predicting progression to DSS 6, F(3,2619)=6.83, p<.001, and to DSS 7, F(3,2619)=7.13, p<.001. For those who remained single, males progressed to both DSS endpoints significantly more quickly than females. Finally, there was a significant interaction between race and marital status predicting progression to DSS 7, F(3,2574)=3.29, p=.020. For those who remained married, blacks progressed more rapidly than whites.

Conclusions: Being married at any point during the course of MS appears to confer a benefit in MS disease progression. Further research is needed to understand the mechanism by which marital status influences MS disease progression.