MS Disability, Symptoms Are Worse in Non-White Patients, Study Finds

African and Hispanic Americans with multiple sclerosis (MS) are more likely to experience higher overall disability and more severe symptoms in 12 domains commonly affected by MS than their White counterparts, investigators concluded in a recent analysis.

The retrospective study, published in Neurology: Clinical Practice, is one of the first pieces of evidence to examine how symptoms severity and self-rated health (SRH) vary between age, sex, and racial/ethnic groups of patients with MS.

“Our work suggests that improvement in managing these symptoms will be most likely to improve patients’ quality of life and to reduce the disparities in SRH among race/ethnic groups,” wrote the investigators.

Non-White populations, including African and Hispanic Americans, are increasingly affected by MS. Also, African ancestry is known to be a risk factor for worse outcomes in MS and African Americans experience faster disease progression and more brain, spinal cord, and optic nerve atrophy. However, less than 1% of studies assessing MS have been devoted to investigating how MS impacts specific racial or ethnic groups.

“A better understanding of similarities and differences in symptomatology of the different race/ethnicity groups is necessary to fully address the disparities that may exist,” the authors said.

The investigators collected information on patients with MS who visited the New York University (NYU) MS Care Center (New York, New York) or the Barnabas MS Care Center (Livingston, New Jersey) between June 2010 and December 2018. The patients had to be 18 years or older and have an MS diagnosis.

Patient data on sex, race and ethnicity, disability, symptom severity, and quality of health was collected during clinic visits. Disability was rated using Patient-Determined Disability Steps (PDDS) and symptom severity was assessed using a 7-point Likert scale for 12 domains associated with MS:

• Mobility
• Dexterity
• Vision
• Fatigue
• Cognition
• Bladder function
• Sensory function
• Spasticity
• Pain
• Dizziness
• Depression
• Anxiety

The investigators used the data to develop a multivariable model and assessed its ability to predict good SRH, which is used as an indicator of health status that integrates multiple facets of life, including biological, mental, social, and functional aspects.

Of the 2851 patients who met the inclusion criteria, 2622 patients were included in the analysis, 1556 of whom derived from the NYU center and 1066 were from the Barnabas center. The mean (SD) age of the patients was 46.2 (13.0) and 73.6% were women. White patients comprised 66.4% of the cohort, and 21.7% of patients identified as African American (AA) and 11.9% identified as Hispanic American (HA).

The age-adjusted mean PDDS were worse for AA and HA individuals compared with White patients, regardless of sex (P < .001). The mean total symptoms severity scores were also higher among non-White patients than White patients after adjusting for age and sex (P < .05).

Additionally, AA and HA patients had worse scores than White patients on all 12 domains. HA patients has worse scores than AAs on 4 domains: pain (P < .0001), cognition (P < .0001), depression (P < .023), and anxiety (P < .026). SAH was worse in AA patients compared with White patients (P < .0001) and was similar compared with HA patients (P = .43).

Men had worse PDDS scores than women (P = .012) and total scores for symptom burden were similar between men and women (P = .39).

Unsurprisingly, disability and symptom burden increased with age in men (P < .0001), women (P < .0001), and all racial/ethnic groups, with the largest increase observed in patients between age 40 and 60 years. Patients aged 50 and older had less change in symptom burden probably because MS progresses slower in older populations or older patients may develop psychological accommodations to their physical limitations.

The logistic SRH prediction model achieved an area under the receiver operating characteristic curve of 0.78, showing that race (P < .0005) and PDDS scores (P < .0001) were the only statistically significant predictors in the multivariate model. The model achieved 69% sensitivity and 77% specificity.

“What determines how patients view their health is not their demographics but symptom severity in domains of invisible disability and, to a much lesser extent, their overall physical disability score,” the investigators noted.

The investigators listed several study limitations, including that genetic data was not examined, clinician-rated measures were not available, and information on socioeconomic status (SES) was not collected.

“We propose that the future observational studies comparing outcomes across ethno-ancestries use Area Deprivation Index, which can be derived from patient’s address as a more nuanced surrogate of SES, and address social determinants of health, which may disproportionately affect minoritized populations that extend beyond SES,” the authors suggested.

Reference

Kister I, Bacon T, Cutter GR. How multiple sclerosis symptoms vary by age, sex, and race/ethnicity. Neurol Clin Pract. August 2021;11(4):335-341. doi: 10.1212/CPJ.0000000000001105