Examining Health Equity Among Different Racial and Ethnic Subpopulations With Multiple Sclerosis - Episode 3

The Importance of Early Diagnosis and Treatment in Patients with MS

Although MS prevalence is lower for Hispanic patients than Black and White patients, Hispanic patients tend to be younger at the time of diagnosis, particularly if they were born in the United States. (15) Results from a retrospective study showed the percentage of Hispanic patients with relapsing-remitting MS (vs other disease subtypes) was much higher than that of Black or White patients. Both Hispanic and Black patients had a shorter mean disease duration than White patients. The Patient-Derived Multiple Sclerosis Severity Score (P-MSSS), adjusted for age and gender, was significantly higher for Hispanic patients (3.9 ± 2.6) and Black patients (4.5 ± 3.0) than it was for White patients (3.4 ± 2.6; P < .0001 for each comparison). Race remained a significant predictor for P-MSSS when also adjusting for insurance coverage. (16)

Treatment Disparities

Disparities exist across the health care system regarding the treatment of MS among racial and ethnic minority populations. Notably, racial and ethnic minority subpopulations are consistently underrepresented in clinical trials, which makes it difficult to ascertain variations in the efficacy of treatment. According to results from a 2014 PubMed review of nearly 60,000 articles on MS, Black and Hispanic patients are represented in less than 1% of published literature. (10)

Black, Latino and White patients do not receive the same services for MS, according to results from a 2010 retrospective study funded by the National MS Society. The study reviewed data from the registry of the North American Research Committee on Multiple Sclerosis (NARCOMS) Project on Blacks patients with MS (n = 1313), Latino patients with MS (n = 715) and White patients with MS (n = 26,967). Latino patients were less likely to use rehabilitative, supportive, and alternative therapies compared with Black and White patients; 33.8% of Latino patients never received occupational therapy versus 21.1% of Black and 24.1% of White patients. In fact, more Latino patients had never had a home health aide (40%) compared with Black (28%) or White (30%) patients. Black patients were much less likely to receive an evaluation and treatment at an MS clinic than White and Latino patients (36.8% vs 49.2% and 47.0%, respectively). In addition, more Black patients (56.1%) had never received care from a neurologist specializing in MS than Latinos patients (47.2%). (17) Seeing a neurologist is associated with an increased likelihood of a patient using a DMT. (18)