Race and Social Determinants of Health in Performance Outcomes among Relapsing Remitting Multiple Sclerosis Patients
Justin Abbatemarco1, Daniel Ontaneda1, Mary Rensel1, devon conway1, Marisa McGinley1, Robert Bermel1, Scott Husak1, David Bruckman1, Jesse Schold2, Deja Rose3, Deborah Miller4
1Cleveland Clinic, 2university of colorado, 3Emory University, 4Cleveland Clinic Foundation
Objective:
To investigate the relationship of race and social determinants of health (SDoH) with clinical outcomes in relapsing remitting multiple sclerosis (RRMS).
Background:
Increased efforts are needed to better understand the role of SDoH in racial health disparities and inequities in MS.
Design/Methods:
This retrospective study was conducted at Cleveland Clinic. Utilizing census tract data, we analyzed the relationship of SDoH with MS Performance Test (MSPT) measures. SDoH included the following: Area Deprivation Index-3 (ADI) consisting of neighborhood financial strength, economic hardship, and educational attainment, along with public transportation access, housing stock built before 1979, and urban-rural living status. We then assessed differences in MSPT measures across racial groups while adjusting for SDoH, disease severity, living status and comorbidities.
Results:
3534 RRMS patients (mean age 46.9 ± 12.1 years, 74.7% female, 80.4% self-identified White and 13.2% Black) were included. Lower educational attainment on ADI-3 metrics was associated with slower manual dexterity (0.15 seconds, p = 0.022) but none of the other SDoH were associated with MSPT measures (p > 0.05). After adjusting for SDoH metrics including ADI, Black patients had worse measures of cognitive processing speed (4.25 fewer correct, p < 0.001), walking speed (0.97 seconds slower, p < 0.001) and manual dexterity (2.32 seconds slower, p < 0.001) when compared to White patients despite a shorter disease duration (Black patients 12.2 ± 10.0 years vs White patients 13.8 ± 11.2, p <0.001). There was no significant difference in initial disease modifying therapy category (moderate vs high efficacy) (p = 0.34) nor in follow-up visits (p = 0.23) across race.
Conclusions:
Increased disability seen in Black patients was not explained by measured SDoH, suggesting other societal and biological causes may be responsible for this discrepancy. Further efforts are needed to understand the role of racial health disparities and inequities in MS.