Recognizing Health Disparities in Multiple Sclerosis: Experiences and Perspectives of Patients of Diverse Racial and/or Ethnic Background
Mitzi Williams1, Stephen Krieger2, Annette Okai3, Chloe Gianatasio4, Natalie Goldberg4, Hollie Schmidt5, Sara Loud5, Kasey Minnis6, Natalie Blake6, Brian Moss4
1Joi Life Wellness Group, 2Mount Sinai Dept of Neurology, 3North Texas Institute of Neurology and Headache, 4EfficientCME, 5Accelerated Cure Project, 6Multiple Sclerosis Foundation
Objective:

Identify areas of disparate care between patients with multiple sclerosis (MS) of diverse racial/ethnic backgrounds for focus in continuing medical education.

Background:
Despite the considerable impact of MS on racial/ethnic minority populations, sources suggest insufficient clinician recognition of differences in disease presentation and experience across minority groups that could compromise their care. 
Design/Methods:
A survey was developed to assess patient perspectives on their diagnosis, management, and interest/participation in medical research. Respondents, recruited through the iConquerMS network, completed the survey in April 2022.
Results:

Findings from 94 BIPOC and Hispanic (BIPOC-H) and 48 non-Hispanic White (nHW) individuals were analyzed (45% Black/African American (AA), 34% White, 14% Mixed/Other, 11% Hispanic; 87% female). BIPOC-H patients reported earlier age of symptom onset (54% <30 years vs 33% of nHW; p=0.02). Initial symptoms of blurred/loss of vision (31% vs 23%) or fatigue (14% vs 8%) trended more common among BIPOC-H patients. The BIPOC-H group was more likely to seek immediate care (80% vs 60%, p=0.04) and trended toward more frequent misdiagnosis (28% vs 19%) and longer diagnostic delay (49% vs 42% >1 year).

 

There were no significant differences in initial or current disease modifying therapy between groups, though BIPOC-H patients trended more likely to receive high efficacy agents. Patients of Black/AA or Mixed background (23% or 26% vs 4%; p=0.037) more often changed providers in response to feeling treated unfairly/inadequately. The majority of respondents (64% BIPOC-H, 65% nHW) were interested in clinical trial participation. For BIPOC-H patients, interest was largely related to new treatment access (56%) and helping others of similar backgrounds (60%).

Conclusions:
Patient racial/ethnic background may influence MS presentation and contribute to discrepancies in care, particularly early in disease course. Data suggest a need for education on inclusive approaches to MS management to resolve shortfalls in the care of BIPOC-H patients.
10.1212/WNL.0000000000203047