To investigate the association between childhood social determinants of health (SDOH) and brain MRI outcomes in individuals with pediatric onset multiple sclerosis (POMS).

Accumulating evidence points to worse clinical outcomes among adults with MS belonging to minority or poverty-impacted groups. In contrast, little is known about the outcomes of these populations with POMS. Individuals with POMS represent 5% of the MS population and are more racially diverse, yet have been understudied with respect to socioeconomic environment or characteristics.

This is a retrospective study of POMS patients evaluated at the NYU Langone MS Comprehensive Care Center who underwent quantitative volumetric neuroimaging of the brain using icobrain software. Associations between volumetric MRI results (white matter lesion volume, black hole volume) and proxies of SDOH (including insurance type, childhood neighborhood social vulnerability index (SVI), and self-reported race and ethnicity) were assessed. Comprehensive linear regression models using LASSO (Least Absolute Shrinkage and Selection Operator) methods were utilized.

138 POMS patients (70% female) were included with a median disease duration of 4 years at time of scan. Public health insurance, Black race, Hispanic ethnicity, low parental education, and high SVI (greater neighborhood disadvantage) were each associated with white matter lesion and black hole volume. SVI was the strongest individual predictor of total white matter lesion (β=4.63, p=0.002) and black hole volume (β=2.91, p=0.003). In models incorporating all SDOH variables, public health insurance was the strongest predictor of total lesion (β=2.48, p=0.01) and black hole volume (β=1.50, p=0.02), attenuating the effect of SVI. There were no differences in disease modifying therapy (DMT) timing or efficacy between categories of social disadvantage.

Individual and neighborhood-level indicators of social disadvantage are associated with worse brain MRI outcomes in POMS. Further investigation of social risk factors for MS susceptibility and severity is needed to reduce MS health disparities.