Abstract
Multiple Sclerosis (MS) is a progressive neurodegenerative disease that affects more than 2 million people worldwide. Increasing knowledge about MS in different populations has advanced our understanding of disease epidemiology and variation in the natural history of MS among White and minority populations. In addition to differences in incidence, African American (AA) and Hispanic patients have greater disease burden and disability in earlier stages of disease compared to White patients. To further characterize MS in AA and Hispanic populations, we conducted a retrospective chart analysis of 112 patients treated at an MS center in Houston, Texas. Here, we describe similarities and differences in clinical presentation, MRI findings, treatment regimens, disability progression, and relapse rate. While we found several similarities between the groups regarding mean age, disability severity, and degree of brain atrophy at diagnosis, we also describe a few divergences. Interestingly, we found that patients who were evaluated by a neurologist at symptom onset had significantly decreased odds of greater disability [defined as Expanded Disability Status Scale (EDSS) > 4.5] at last presentation compared to patients who were not evaluated by a neurologist (OR: 0.04, 95% CI: 0.16–0.9). We also found that active smokers had significantly increased odds of greater disability both at diagnosis and at last clinical encounter compared to nonsmokers (OR: 2.44, 95% CI: 1.10–7.10, OR= 2.44, 95% CI: 1.35–6.12, p = 0.01, respectively). Additionally, we observed significant differences in treatment adherence between groups. Assessment of the degree of brain atrophy and progression over time, along with an enumeration of T1, T2, and gadolinium-enhancing brain lesions, did not reveal differences across groups.
Highlights
Multiple Sclerosis (MS) is an autoimmune inflammatory demyelinating condition that affects more than 2 million people worldwide [1,2]
About 73% of NH-White, 92% of NH-Black, and 95% of Hispanic patients had Relapsing Remitting MS (RRMS), whereas only 18% of NH-White, 5% of NH-Black, and 2.5% of Hispanic patients were diagnosed with Primary Progressive MS (PPMS) (Table 1)
NH-White, NH-Black and Hispanic patients exhibited no differences in symptoms at diagnosis or mean Expanded Disability Status Scale (EDSS) score at diagnosis and last encounter (Table 2)
Summary
Multiple Sclerosis (MS) is an autoimmune inflammatory demyelinating condition that affects more than 2 million people worldwide [1,2]. A recent study estimates that in 2017, nearly 1 million adults had MS in the United States [1]. MS leads to an accumulation of disability over time, disease-modifying therapies (DMT) may lessen long-term disability severity in most. MS is considered a heterogeneous disease thought to result from a complex interaction among genetic predisposition, sex, and environment [4]. Increasing evidence suggests that racial disparities are important factors that may explain differences in the disease course, prevalence, incidence, and outcomes [5,6,7,8].
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