Disparities in Multiple Sclerosis Disability Among Migrants to a Universal Healthcare System
Anna He1, Olga Ciccarelli2, Ali Manouchehrinia3, Anna Glaser3, Kyla McKay3, Jan Hillert4
1Department of Neuroinflammation, University College London, 2UCL Institute of Neurology, 3Karolinska Institutet, 4Karolinska Institute, Neurology R54
Objective:

To describe disparities in multiple sclerosis (MS) disability outcomes in migrants to a universal healthcare context.

Background:

Socioeconomic determinants of MS outcomes have gained recognition, with racial and ethnic minorities in user-pays systems experiencing worse disability. However, evidence for disparities in universal healthcare settings is mixed. Sweden has a short migration history and comprehensive universal healthcare. We hypothesise that non-Nordic migrants may experience worse MS outcomes due to socioeconomic factors but not healthcare access.

Design/Methods:

We conducted a population-level cohort study using the Swedish MS Registry, linked to national administrative registries. We included individuals with onset of relapsing MS at working age between 2001-2015, and residing in Sweden prior to onset. The primary exposure was birthplace, categorised as Nordic, Western (Europe, excluding Nordic countries/North America), and Non-Western (Asia, Africa, South America). Outcomes were clinical and work disability, measured as time to confirmed Expanded Disability Status Score (EDSS) 3 and disability pension use. Covariates included onset age, sex, premorbid socioeconomic status (education, individual and household income), and healthcare quality indicators (onset-to-diagnosis and diagnosis-to-treatment times).

Results:

Of 6005 participants, 5482 were Nordic-born, 250 migrated from Western regions, and 273 from Non-Western regions. Non-Western migrants had younger onset age (mean(SD) 34.1(7.5) vs 37.9(9.5)), higher male proportion (39.6% vs 29.7%), and lower median income (USD 8330 vs 20761). Diagnosis and treatment times did not differ significantly. Adjusting for age, sex and calendar year, non-Western migrants had higher hazard for work disability (aHR 1.41, 95%CI 1.03-1.93) compared to Nordic-born people. Both Western and Non-Western migrants had a higher hazard of reaching EDSS 3 (aHR 1.72, 95%CI 1.13-2.64; aHR 1.98, 95%CI 1.30-3.01). Estimates became nonsignificant when adjusted for socioeconomic indices and baseline EDSS.

Conclusions:

Adverse disability outcomes in non-Western migrants to Sweden may be driven by socioeconomic but not healthcare disparities.

10.1212/WNL.0000000000211000
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