Objective:

Understand the impact of social determinants of health (SDOH) in the clinical outcomes of transverse myelitis (TM). 

Background:

TM is a rare neurologic condition with a diverse collection of etiologies targeting the spinal cord, manifesting in various neurologic symptoms. Established predictors of poor clinical outcomes include the presence of longitudinal-extensive-TM, severe deficit at onset of symptoms, acute TM, symptoms progression within 24 hours, relapse occurrence, and spinal shock. The impact of SDOH, including socioeconomic status, healthcare access, and quality of care, hasn’t been thoroughly investigated.

Design/Methods:

This secondary analysis utilized the National Veterans Health Administration (VHA) TM epidemiology cohort and the Agency for Healthcare Research Quality’s SDOH Database. Univariate and multivariate models were used to determine the association of the area deprivation index, Gini index of income inequality, median incomes of veterans, Rural-Urban Commuting Area Codes system, Medically Underserved Areas (MUA), and distance in miles to the nearest clinics and hospitals with clinical outcomes (autoimmune neurologist-adjudicated modified Rankin Scale [mRS]). Furthermore, Cox regression models were used to assess the impact of SDOH factors on survival times.

Results:

1,001 patients met the TM criteria, with a median age of 64.2 years [IQR:53.5–69.9]; 90.7% were male, and 67.8% were white. The median mRS at the time of diagnosis was 3 [IQR:2-4], and remained 3 [IQR:2-4] at the last follow up. A random decision forest determined that LETM, median incomes, and MUA were associated with poor mRS at diagnosis. Multivariate logistic regression showed that increased mortality was associated with increase of age (OR:1.06, 95%CI:1.04–1.08), and higher mRS score at follow-up (OR:1.94, 95%CI:1.57–2.40), and tobacco use (OR 1.87, 95%CI:1.17–2.99). Further analysis will be conducted to understand the impact of specific SDOH-related factors in clinical outcomes. 

Conclusions:

Poor outcomes in TM have been associated clinical factors. SDOH also appear to impact TM outcomes; further population-level analyses are needed.