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Matthew Edmunds, Julie Huntbach, Omar Durrani; Lower Social Grade and Higher Social Deprivation are Independently Associated with Severe Thyroid Eye Disease. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5906.
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Previous studies have investigated the pathophysiology, genetics and lifestyle risk factors of Thyroid Eye Disease (TED). However, there has been little consideration of ethnic origin, socioeconomic position or level of social deprivation as influences on TED severity. The aim of this study was to investigate the independent contribution of these three factors to TED in a socially diverse, multi-ethnic population.
Retrospective case note review of all patients seen for TED at Birmingham and Midland Eye Centre, U.K. over a 14-year period. Note was taken of ethnicity (White, Asian or Black). Residence postcode was used to determine social grade using the National Readership Survey (NRS) classification and level of social deprivation using the Index of Multiple Deprivation 2010 (IMD 2010). Multivariate logistic regression was performed to simultaneously measure the influence, in the form of odds ratios (OR), of a number of independent variables, including social grade, level of social deprivation and ethnicity, on the presence of indicators of severe TED.
Three hundred and forty-three TED patients were seen during the study period. Lower social grade (NRS D and E) was significantly associated with increased OR (95% confidence intervals) of the presence of indicators of severe TED, including the need for treatment with oral steroid (2.3 (1.1 - 5.1) P=0.03) and intravenous steroid (2.6 (1.0 - 7.0) P=0.04), as well as the presence of dysthyroid optic neuropathy (DON) (4.0 (1.2 - 12.7) P=0.02), compared to those of the highest social grade (NRS A and B). Similarly, IMD 2010 quintiles of higher levels of social deprivation were significantly associated with increased OR for treatment with oral steroid (3.5 (1.4 - 8.7) P=0.008), intravenous steroid (3.3 (1.1 - 10.4) P=0.04) and presence of DON (3.1 (1.0 - 10) P=0.05) compared with quintiles of lower deprivation. However, ethnicity had no independent association with any measure of TED severity.
This is the first study to examine the influence of social grade, social deprivation and ethnicity in TED. In this large cohort, lower social grade, higher social deprivation and greater age, but not ethnicity, had independent, statistically significant associations with severe TED. These findings have relevance for targeting interventions and education in these apparently at-risk groups.
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