Neighborhood disadvantage linked to shorter survival time in ALS
Survival reduced by over 35% in most disadvantaged regions in US study
Neighborhood disadvantage, or living in regions with poorer socioeconomic conditions, is significantly associated with shorter survival time among people with amyotrophic lateral sclerosis (ALS), according to a new Michigan-based study.
For those living in neighborhoods considered to be among the top 10% of the most disadvantaged, survival was reduced by 37% compared with those with the lowest scores, the data showed.
According to the researchers, such differences in survival between different regions were not due to imbalances in sex, ethnicity, or the severity of ALS, only to neighborhood disadvantage.
“Our results show a significant link between adverse social determinants of health and shorter survival in patients with ALS,” Stephen Goutman, MD, director of the Pranger ALS Clinic and associate director of the ALS Center of Excellence at the University of Michigan, said in a university news story, noting that “the lived environment … is important to consider” in ALS care.
“A deeper understanding of how socioeconomic factors contribute to ALS survival is important for making ALS a more livable disease and reducing the impact of health disparities,” added Goutman, who served as the study’s senior author.
The study, “Impact of the Adverse Social Exposome on Survival in Individuals With Amyotrophic Lateral Sclerosis,” was published in the journal Neurology.
Analyses ruled out sex, ethnicity, as influencing factors in ALS survival
While the exact cause of ALS is largely unknown, several factors — including genetics, environmental exposures, and lifestyle habits — have been linked to an increased risk of ALS and faster disease progression. Social determinants of health, such as socioeconomic status, access to healthcare, and a person’s level of education, can also play a role in ALS outcomes, research has shown.
Dae Gyu Jang, PhD, a postdoctoral fellow at the University of Michigan and the study’s first author, noted that “a person’s social determinants of health may uniquely impact ALS due to the incredible costs of care.”
Given that, Jang said, “it is important that we consider social factors and highlight the urgent need for interventions to reduce health disparities in ALS care.”
To learn more, the team of researchers at the University of Michigan looked to a mapping tool known as the Area Deprivation Index, or ADI, which describes neighborhood socioeconomic conditions. The ADI is a widely used measure of social health determinants.
Studies suggest that living in deprived neighborhoods with a high ADI is associated with multiple adverse health outcomes, including among people with neurological conditions like Alzheimer’s disease.
Now, the scientists set out to determine whether an association also exists between ADI and ALS survival. To that end, the team collected electronic medical records of 1,083 ALS patients at the Pranger ALS Clinic who had been diagnosed between 2012 and 2024.
The researchers converted the patients’ addresses into geographic coordinates and matched them to census blocks — the smallest geographical unit used to collect census data. ADI data were obtained from the Neighborhood Atlas website, and ADI percentile scores were matched to each patient by census block.
Based on these data, patients were divided into 10 deciles and ranked into three ADI groups: low, for the 1st decile; middle, for the 2nd to 9th deciles; and high, for the 10th decile. The high ADI decile group lived in the most disadvantaged neighborhoods.
Living in an adverse social [environment] is … tightly linked to measures of inflammation and biological aging, which may underpin disease trajectories. … [These findings] highlight the urgent need for interventions to reduce health disparities in ALS care.
According to the analysis, ADI was significantly associated with ALS survival. In particular, patients living in the highest ADI decile neighborhoods — meaning locations with the top 10% highest ADI scores — had a 37% shorter survival time than individuals in a low ADI location. The median survival was 2.68 years in the low ADI group, 1.71 years in the middle group, and 1.42 years in the high ADI group.
“Living in an adverse social [environment] is also tightly linked to measures of inflammation and biological aging, which may underpin disease trajectories,” the researchers wrote.
Among the nearly 1,000 patients with a classic ALS diagnosis, those in the high ADI group had a 33.6% shorter survival time than individuals in the low group. The findings were similar when patients were grouped by national ADI percentiles instead of deciles.
Sensitivity analyses ruled out sex, ethnicity, or distance to the clinic as influencing factors in the relationship between ADI and ALS survival. It also excluded ALS severity, as assessed by the Revised ALS Functional Rating Scale.
“Higher ADI scores are significantly linked to shorter survival in patients with ALS,” the scientists wrote. These findings “highlight the urgent need for interventions to reduce health disparities in ALS care.”
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