Racial Disparities in Multiple Sclerosis: Differences in Neurodegeneration, Metabolism, Cognition, and Motor Functions in Black and White Patients
Fen Bao1, Anas Nourelden1, Abigail Biddix1, Mawadda Abdelhai1, Nidhi Patel1, Zaima Liaquat1, Kalyan Yarraguntla1, Jacob Rube1, Carla Santiago-Martinez1, Anza Memon2
1Neurology, Wayne State University, School of Medicine, 2Neurology, John D. Dingell, VAMC; Wayne State University, School of Medicine
Objective:
This cross-sectional study investigates racial disparities in neurodegeneration, functional outcomes, and disease burden between black and white individuals with multiple sclerosis (MS).
Background:
MS is characterized by chronic inflammation and neurodegeneration, leading to brain atrophy and functional impairment. Racial differences in MS progression are recognized, but their impact on structural, metabolic, and functional outcomes remains underexplored.
Design/Methods:
All patients underwent volumetric, microstructural, functional, metabolic, and QoL assessments. MRI analyses were conducted using FreeSurfer v7.2, Jim v6, SPM12, LCModel v6.3, DTIStudio v3.0, and LST v3.0. Group differences were tested using the t-test or Mann-Whitney U in SPSS.
Results:
A total of 120 patients (59 Black, 61 White) on DMTs (OCR-19, FTY-48, GA-27, NTZ-26) were included. No significant differences were found in age (39.5 vs. 43 years, p=0.07) or gender (p=0.079). Black patients showed lower GM volume (589.58 ± 67.45 vs. 642.34 ± 70.55 ml, p<0.001), thinner cortex (2.36 ± 0.12 vs. 2.41 ± 0.08 mm, p=0.024), and higher T2 lesion volume (20.05 ± 21.92 vs. 11.80 ± 10.85 ml, p=0.011). They also had poorer cognitive and motor scores (9HPT-D 28.74 ± 9.92 s vs. 22.11 ± 4.58 s, p=0.005; 9HPT-ND 36.17 ± 26.89 s vs. 24.44 ± 5.22 s, p=0.035; SDMT 37.80 ± 13.28 vs. 53.67 ± 10.97, p<0.001; PASAT 24.82 ± 8.61 vs. 35.24 ± 16.01, p=0.012). Metabolic and microstructural indices were worse in Black (tNAA/tCr 1.93 ± 0.21 vs. 2.08 ± 0.24, p<0.001; FA in NAWM 0.418 ± 0.027 vs. 0.434 ± 0.025, p<0.001). Despite shorter disease duration (5.82 ± 4.65 vs. 10.25 ± 9.30 years, p=0.013), Black patients reported lower physical QoL (41.14 ± 18.62 vs. 55.16 ± 24.02, p=0.030).
Conclusions:
Significant racial disparities exist in neurodegeneration, metabolic, cognitive, and motor functions. Black patients experience greater disease burden and poorer QoL despite shorter disease duration, emphasizing the need for tailored race-specific interventions.
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