The Interplay of Neighborhood Deprivation, Race, and Multiple Sclerosis.

Abstract

Objectives: Sociodemographic factors (SDFs) are associated with disparities in multiple sclerosis (MS) outcomes (eg, exacerbations, treatment status), yet the role of modifiable patient-reported health care experiences remains unclear. In this study, we explored neighborhood deprivation and race in relation to patient-reported SDFs and clinical characteristics as contributors to Black-White MS disparities.

Methods: A cross-sectional study conducted between 2021 and 2022 with 80 Black and 106 White patients with MS whose data were linked with the Area Deprivation Index (ADI).

Main outcome measures: SDFs (eg, race), clinical characteristics (eg, time between symptom onset and diagnosis, disease-modifying therapy [DMT] status), ADI.

Results: The proportion of Black participants increased (33%-53%) while that of White participants decreased (66%-47%) as neighborhood deprivation increased. Among Black participants, those in the most deprived neighborhoods were more likely to be on a DMT than those in the least deprived neighborhoods (OR = 10.51; 95% CI, 1.85-59.63) for tertile 2 and 6.24 (95% CI, 1.51-25.80) for tertile 3). DMT status did not significantly differ across ADI among White participants. Within racial groups, compared to those in the least deprived neighborhoods, Black participants in the most deprived neighborhoods had 3.33 years between MS symptom onset and diagnosis while White participants had 1.43 years.

Conclusions: Black participants from the most deprived neighborhoods experienced longer gaps between MS symptom onset and diagnosis, and were more likely to be on a DMT, which is indicative of greater disease severity. Consistent with the health disparities literature, our results suggest structural factors affect Black patients with MS more negatively than White patients.