Author Of 2 Presentations
P0477 - Multiple Sclerosis and Disability Progression in South America, Africa, Asia and the Middle East: A Systematic Review (ID 956)
Abstract
Background
There is evidence of an increased prevalence and disease burden of Multiple Sclerosis (MS) in parts of the world where the risk was once considered low including Latin America (LA), Sub-Saharan Africa, Asia and the Middle East-North Africa (MENA). Despite the growing number of clinical reports over the past few decades, these regions remain understudied compared with Europe and North America. Much remains unknown about the presenting phenotype and disability progression.
Objectives
To investigate the features of MS and long-term disability progression in areas of the world where the disease has historically been less studied, and to compare these data with the disability progression experience of MS cohorts in the Western world.
Methods
We performed a systematic review of the peer-reviewed literature from January 1980 to April 2020 utilizing PubMed, SCOPUS, Global Health and Cochrane databases. A stratified list of keywords and phrases were used to identify articles which were managed by Covidence analytical software. Studies were assessed for inclusion and exclusion criteria and for quality.
Results
A total number of 1,604 studies were imported for screening, and 545 duplicates were identified and removed. Two authors independently screened 1059 abstracts and selected 480 for full-text screening. 166 articles were ultimately selected for inclusion, and 66 were used for quantitative analysis. A total of 21,987 cases of MS were included in the analysis with 18 studies from LA, 3 from sub-Saharan Africa, 18 from Asia and 27 from the MENA. The overall sex ratio was 2.5:1 (female: male). Subtypes of MS were assessed longitudinally including relapsing remitting, secondary progressive and primary progressive. Longitudinal disability progression was evaluated over time to standard disability endpoints and was compared by region. Patients with MS living in the MENA region appear to reach disability milestones faster than those in the Western world. The progression in East-Asia appears slightly slower than in the West. Populations in LA tend to have similar MS features to the Western world, except for African descendants that reach disability milestones earlier, as also shown by several North American studies.
Conclusions
The phenotype and disability progression of MS in LA, Africa, Asia and the Middle East have similarities to Western MS but in several regions take on a more aggressive course. More population-based MS longitudinal studies are needed in many regions, particularly Sub-Saharan Africa.
P0496 - Telemedicine utilization trends among patients with multiple sclerosis and controls in the United States Veterans Health Administration: 2008-2020 (ID 1772)
Abstract
Background
Patients with multiple sclerosis (PwMS) face barriers accessing specialty care for evaluation and treatment. Recently, clinical medicine in the U.S. has been transformed by the COVID-19 pandemic and social distancing measures have fueled a transition to non-face-to-face visits as a means of providing patient care. Telemedicine is an important tool to help fill this gap.
Objectives
The goal of this analysis is to use a large U.S. population-based administrative dataset to evaluate telemedicine utilization and determine intra- and inter-county variation of telemedicine utilization among PwMS and controls between 2008 and 2020. We will also examine health disparities in telemedicine utilization among PwMS to identify at-risk patient populations.
Methods
We conducted a population-based nested case-control study with a large cohort of PwMS in the VA healthcare system between 2008-2020. A validated algorithm was used to identify MS cases which were matched to controls (n=5) on age, sex and location at entry to VA. Utilization of telemedicine was assessed annually from 2008-2020 for cases and controls. Records were evaluated to show demographic variability in the study cohort and estimate odds ratios for any telemedicine utilization and subtype of telemedicine utilization using conditional logistic regression.
Results
The number of MS cases and controls was 16,788/74,044 (case/control) in 2008 and slowly increased to 26266/143087 in 2020. Overall, telemedicine utilization increased for both MS cases and controls over the study period (2008-2020), but PwMS had consistently higher annual telehealth encounter rates compared to controls. Conditional logistic regression analyses revealed increased adjusted odds ratio for telemedicine utilization for 2010 (aOR=1.26 95% CI: 1.18-1.33), 2016 (aOR=1.65 95% CI: 1.51-1.80), and 2020 (aOR=2.06 95% CI: 1.78-2.40) after adjusting for county and census tract-level social determinants of health. Specific geographic regions for higher telemedicine use included eastern and west coast metropolitan regions. Poverty, crowded housing, race/ethnicity, living in a rural environment, and being enrolled for medical care in 2020 during the CoVID-19 pandemic were independently associated with higher odds of telemedicine utilization.
Conclusions
PwMS have high utilization rates of telemedicine within the VA healthcare system with large increases in 2020. Our data demonstrate inter-county variation in telemedicine by key epidemiological risk factors, with a clustering of counties in certain states, allowing better characterization and support for PwMS with high telemedicine use. Further research is required to understand barriers and benefits in telemedicine and how telemedicine can optimize the healthcare for PwMS.