Black MS patients experience a higher disease burden

Disclosures: Gray-Roncal does not report any relevant financial information. Zhovtis Ryerson states that he received personal compensation for his participation in advisory boards and research support from Biogen. Please see the full study for relevant financial information from all other authors.


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Black MS patients experienced a higher disease burden than white MS patients, even after adjusting for socioeconomic status, according to results published in Neurology.

“Although lower socioeconomic status appears to be linked to poorer neurological performance test scores in white people with MS, we don’t see this for black people with MS, at least at the unique time we have. examined ”, author of the study. Lana Jovtis Ryerson, MD, an MS specialist at NYU Langone Health in New York and a fellow of the American Academy of Neurology, said in a press release.

Reference: Gray-Roncal K, et al. Neurology. 2021; doi: 10.1212 / WNL.00000000000012362.

Researchers compared features of MS, including self-reported disability, objective assessments of neurological function, and quantitative measures of brain MRI after adjusting for covariates, including education level, occupational status. or insurance as socio-economic indicators, among black and white participants in the MS Partners Advancing Technology program. Health Solutions, or MS PATHS, cohort. The MS PATHS network is a collaborative effort between 10 MS centers, including seven in the United States, according to the study results. They also examined indicators of socioeconomic status at the neighborhood level and within race using nine-digit zip codes in a subgroup of patients.

The analysis included 7,530 people who identified as white (86%) and 1,214 people who identified as black (14%). Men made up about a quarter of the participants in each cohort (black participants, 28.2%; white participants, 26.6%). The researchers found that participants in the white patient cohort were slightly older than participants in the black cohort (mean age, 50.9 years versus 47.1 years). White participants were also slightly older than black participants at the time of symptom onset, according to the study results (33.7 years versus 32.6 years). The researchers found that black patients had lower education levels and were more likely to have Medicaid for insurance or to be disabled or unemployed.

Regarding MS outcome, black patients had a lower self-reported disability (1.47 times more likely to have severe disability than mild; 95% CI: 1.18-1.86) . They also scored worse on cognitive processing speed tests (-5.06 lower correctly; 95% CI, -5.72 to -4.41), walking (0.66 seconds slower; 95% CI, 0.36-0.96) and manual dexterity (2.11 seconds slower; 95% CI, 1.69, 2.54).

Gray-Roncal and colleagues also found that black patients had more brain damage on MRI, as well as lower overall brain and gray matter volumes, including a decrease in thalamic (-0.77 ml; 95% CI, -0.91 to -0.64), cortical gray matter volumes (-30.63 ml; 95% CI, -35.93 to -25.33) and deep (-1 , 58 ml; 95% CI, -1.92 to -1.23).

A multivariate analysis among a subset of patients looked “in more depth” to the relationship between race and socioeconomic status compared to clinical and MRI measures related to MS. This analysis demonstrated that lower median household income was correlated with decreased cognitive processing and walking speeds in white patients, while a poorer score on the Zone Deprivation Index was related to cognitive processing. slower and at manual dexterity speeds. Conversely, in black patients, lower median income correlated only with slower manual dexterity performance, while worse scores on the Zone Deprivation Index were not “significantly associated.” differences in cognitive processing speed, walking or manual dexterity. The researchers observed “relatively consistent results” across the MS PATHS cohort when they used less detailed general indicators of socioeconomic status, such as level of education.

The researchers noted that the cross-sectional design of the study may have impacted the study results, adding that longitudinal studies should be done. However, Gray-Roncal and his colleagues also said it was “less likely” than race and the many health and social conditions that differ by race in the United States, which begin early in life and can develop. spread from generation to generation, whether a “consequence” of MS or disability related to MS.

“Future studies should consider the role of unmeasured factors like systemic racism to see if they may play a role in greater disability among blacks with MS,” Zhovtis Ryerson said in the press release. “These findings also reinforce the need for more diverse clinical trials and research focused on treatment strategies specifically for blacks to identify whether certain therapies or more aggressive early treatment could help slow disability over time. . “

Reference:

American Academy of Neurology. Does socioeconomic status explain why black people with MS have more disabilities? Available at: https://www.aan.com/PressRoom/Home/PressRelease/4906. Accessed July 1, 2021.

About Bradley J. Bridges

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