Racial disparities present in MS treatment, disability severity
Black and African American patients with multiple sclerosis present with more severe disability vs. white patients, while Hispanic patients are less likely than non-Hispanic patients to receive disease-modifying therapy, data show.
Victor Rivera, MD, FAAN, a professor of neurology at Baylor College of Medicine, and colleagues also found socioeconomic disparities among patients with MS.
“Racial and ethnic, social and health inequities in the United States are well documented,” Rivera said during a presentation at the American Academy of Neurology annual meeting, which is being held virtually. “Racial and ethnic minority populations tend to be overrepresented in socially, economically disadvantaged groups that also disproportionately experience barriers to health care.”
Rivera and colleagues analyzed data from 722 adults aged 50 years and younger (mean age, 40.1 years; 71% women; 84% white) with relapsing-remitting MS who were enrolled in the North American Registry for Care and Research in Multiple Sclerosis (NARCRMS) registry between December 2016 and May 2020. They compared demographic and clinical characteristics among patients to identify trends in Expanded Disability Status Scale (EDSS) scores and disease-modifying therapy (DMT) use.
The researchers wrote that educational attainment was comparable among all patients, but compared with white patients, more Black and African American patients were unemployed (3% vs. 8%) or had an annual income less than $15,000 (6% vs. 16%).
Additionally, more Black and African American patients had EDSS scores of 4 or higher, indicating “substantial disability,” compared with white patients (21% vs. 10%).
Furthermore, although 57% of all patients were treated with DMTs, fewer Hispanic patients than non-Hispanic patients received the treatment (43% vs. 62%). Black, African American and Hispanic patients were least likely to receive treatment with DMTs (26%), according to the researchers.
“Real-world data from the NARCRMS registry show disparities in sociodemographic and clinical characteristics of patients with MS,” Rivera said.
Perspective
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This kind of work examining sociodemographic and clinical characteristics is certainly important for the clinician caring for patients with MS. It is well established at this point that MS does not only affect people of European ancestry. The data presented from the NARCRMS Registry is consistent with previously published work, indicating that Black and African American patients are at risk for accruing disability earlier compared with white Americans with MS. The presented data also indicates that certain groups of patients are less likely to be treated with disease-modifying therapies. As clinicians we need to be aware of these observations and ask the question: why? This is undoubtedly an area of further research.
I continue to be vigilant for ways that socioeconomic status and aspects of culture may impact access to care and quality of care. I want to make sure that all my patients have access to high-quality, individualized care for MS.
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Rivera V, et al. Sociodemographic and Clinical Characteristics of Patients With Multiple Sclerosis by Race and Ethnicity (NARCRMS Registry). Presented at: American Academy of Neurology Annual Meeting; April 17-22, 2021 (virtual meeting).
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