Background

Background: Multiple sclerosis (MS) incidence in Hispanic Americans (HA) is increasing, highlighting the need to understand disease features and clinical course trends among this subpopulation.

Objectives

Objective: To compare demographic features and clinical characteristics of a large population of HA and non-Hispanic Caucasian Americans (NHCA) with MS.

Methods

Methods: MS PATHS is a network of MS Centers in the United States (n=7) and Europe (n=3) contributing standardized data acquired during routine care. US-based MS PATHS participants who self-reported as HA (irrespective of race) or as NHCA, and compared the groups according to demographic (sex, years of education, smoking status, BMI, employment, and insurance status), MS clinical (self-reported disability via Patient Determined Disease Steps [PDDS]), and neuro-performance (via the MS Performance Test (MSPT): walking, manual dexterity, and processing speed) features. Odds ratios and mean differences for PDDS and neuro-performance outcomes were adjusted for age, sex, disease duration and subtype, smoking status, BMI, insurance status, employment status, and years of education. Z-score is compared to a representative healthy population.

Results

Results: Compared to NHCA (n=9003), HA (n=609) had earlier MS symptom onset (mean 28.6y [SD:10.7y] vs 33.6y [11.3y]; p<0.001) and younger age at diagnosis (31.6y [10.9y] vs 36.6y [10.9y]; p<0.001). HA were more likely to have mild disability by the PDDS, compared to NHCA (OR 0.62, 95% CI [-0.89, -0.06], p=0.02). However, HA had worse performance on both manual dexterity times (z score: 0.31 [0.14, 0.47], p<0.001), and cognitive processing speed score (# correct: 0.37 [0.27-0.47], p<0.0001). 25-foot walking speed was not different between the groups (z score:0.09 [-0.23,0.41], p=0.56).

Conclusions

Conclusion: Using standardized data collection in this large MS sample, HA compared to NHCA patients were found to have younger age of onset and diagnosis and higher levels of cognitive and manual dexterity slowing. However, HA were less likely to rate themselves with severe disability on the PDDS. As the groups did not differ in walking speed, this may reflect the scale relatively weighting ambulation over other functions or other language/cultural differences.

Background

The North American Registry for Care and Research in Multiple Sclerosis (NARCRMS) registry is a physician-based registry/longitudinal database for patients with multiple sclerosis (MS). NARCRMS may elucidate the patient characteristics of underserved populations such as Blacks/African Americans (AA) and Hispanics/Latinos.

Objectives

To describe the socio-demographic and clinical characteristics of patients presenting with relapsing-remitting MS (RRMS) within the NARCRMS registry by race and ethnicity.

Methods

The NARCRMS registry contains data of MS patients aged 18-50 years across 24 sites from the US and Canada. This exploratory analysis describes characteristics of patients who enrolled between December 2016 and May 2020 (N=722), including age, gender, education, income level and occupation, Expanded Disability Status Scale (EDSS) categories, and disease-modifying therapy (DMT) categories/DMT use. Patient characteristics were summarized by frequencies and proportions for categorical variables and by means, standard deviations (SDs) and medians for continuous variables.

Results

The mean age (SD) of patients in this study was 40.1 (10.4) years; 71% were female. Majority (85%, n=587/695) were White; Black/AA patients comprised 11% (n=74/695). Educational attainment was comparable between races ― 22-24% with a high school degree, and 47-49% with an undergraduate degree. However, more Black/AA than White patients were unemployed (8%, n=6/72 vs 3%, n=15/565) or had an annual income <$15K (16%, n=12/73 vs 6%, n=35/573). Overall, 72% of patients had mild MS (EDSS scores 0‒2.5). However, twice as many Blacks/AAs had substantial disability (EDSS score ≥4.0) vs Whites (20%, n=15/74 vs 9.7%, n=57/587, respectively). Over half of all patients (57%, n=370/646) were treated with DMTs, with 50% (n=198) using injectables and 37% (n=147) using oral DMTs. Hispanics comprised 24% (n=152/646) of the patients, including Black/AA-Hispanic (3%, n=19/646) and White-Hispanic (21%, n=133/646). Hispanic patients were less likely than non-Hispanics to use DMTs, 43% (n=65/152) vs 62% (n=305/494). Of the subgroups, Black/AA-Hispanics were least likely to use DMTs (26%, n=5/19).

Conclusions

Blacks/AAs present with more severe disability than White patients. More Hispanics than non-Hispanics are not treated with DMTs. Real-world data show disparities in socio-demographic and clinical characteristics of patients with MS.

Supported by: Biogen