Examining Health Equity Among Different Racial and Ethnic Subpopulations With Multiple Sclerosis - Episode 1

The Impact of Multiple Sclerosis on Quality of Life

Multiple sclerosis (MS) is a chronic disease that involves demyelination of plaque throughout the white and gray matter of the central nervous system. The early stages of MS are usually marked by a relapsing-remitting course of neurological deficits, which progress toward continuous, permanent dysfunction and disability. (1) Of those with a diagnosis of MS, 74% are women. (2)

Multiple sclerosis also takes a toll on quality of life, as patients often experience an inability to participate in activities of daily living, cognitive impairment, and depression. (3) Approximately 62% of those with MS also have comorbidities, the most common including anxiety, hypertension, migraine, smoking or history of smoking and obesity, according to results from a 2019 study. (4)

In addition to the clinical impact of disability and comorbidities, MS has also been shown to affect patients’ ability to maintain their professional lives, with approximately 50% of patients losing their jobs 5 years after receiving a diagnosis. (5) Unemployment related to MS is higher than that of any other reason for disability, and loss in productivity contributes to up to 44% of MS costs in the United States and Europe. (6) Additionally, employees with MS, when compared to healthy employees, work a higher number of unpaid hours and experience more interpersonal and performance challenges, such as verbal criticism, harassment, declining relationships and poor performance reviews.

The cost burden of MS is also significant. Following congestive heart failure, MS is the second most costly chronic condition, with total all-cause, per-patient direct and indirect health care costs reaching up to $54,244 per year.7 For those who have a severe disability associated with MS, costs can exceed $100,000 per year. (8) The high cost of MS care is also one factor that can lead patients to join Medicare before age 65 years or decrease their financial assets to become eligible for Medicaid for health care coverage. (9)

The clinical and economic burden of disease among patient with MS, while substantial across the broad spectrum of patients, may disproportionally affect patients of color. Black and Hispanic Americans particularly have been found to experience heightened challenges with an MS, with differences ranging from prevalence and disease course to treatment access and outcomes. (10) This article explores common disparities and how they influence the burden of MS in racial and ethnic minority populations.

Differences in Prevalence and Disease Course

The prevalence of MS in the United States varies by race and ethnicity. A retrospective, observational cohort study reviewed more than 1 million patients in a Northern California health care system to quantify MS prevalence. Of these patients, 3,286 had MS. Results demonstrated that among the cohort, the age-adjusted period prevalence of MS was highest among non-Hispanic Black patients, with 521.3 people with MS per 100,000 people. White patients had the second-highest age-adjusted period prevalence (384.6 per 100,000), Hispanic patients had the third highest (183.7 per 100,000) and Asian patients had the lowest (63.9 per 100,000). Regarding gender differences, Black women had the highest age-adjusted period prevalence of all groups (677.0 per 100,000). (11)