Author Of 2 Presentations
P0428 - Acculturation and lower socioeconomic status are associated with early disability in Hispanic/Latinx with Multiple Sclerosis. (ID 1494)
Abstract
Background
Acculturation and socioeconomic (SES) factors are known to play a large role in racial and ethnic health disparities in the United States (US). Lower SES has been reported to increase the risk of disability progression in multiple sclerosis (MS) in whites. How these measures relate to early MS in vulnerable US populations is not known. This is being evaluated as part of GAHMS, a prospective longitudinal study of Genetic ancestry and Acculturation in Hispanic background with early MS.
Objectives
To examine the association of sociodemographic and acculturation measures in early MS disability in Hispanic/Latinx (Latinx).
Methods
Cross-sectional assessment of 219 self-identified US Latinx, including Puerto Rico. Early MS was defined as a diagnosis of <5 years. Sociodemographic status (SES) markers (education, household income, public assistance) and acculturation measures including language preference, place of birth, years in the US and Short Acculturation Scale for Hispanics (SASH; a composite measure of acculturation to US) were collected as part of the baseline examination. Bivariate correlations assessed SASH correlation with acculturation proxies. Unadjusted and adjusted multivariable logistic and linear regression were used to examine the relationship between ambulatory disability (using the Expanded Disability Status Scale; EDSS) and acculturation and SES.
Results
Most participants were female (75.8%), had a mean age of onset of 30.65 years (SD±13.93), had relapsing remitting MS (85.3%), and self-identified as Latinx with Caribbean (46.3%) or Mexican origin (37.8%). Most were overweight (BMI Mean: 28.9±8.04) and unemployment was reported by 35%. A strong correlation was seen between SASH and language preference (0.75, <0.0001) and place of birth (0.70, <0.0001). Increased odds of severe ambulatory disability was associated: with being male, longer disease duration, education of high school or less (3.90, 95%CI 0.33-45.65), household income <$60,000 (3.22, 95%CI 0.26-39.75), and acculturation to US culture (4.041, 95%CI 0.79-20.62) after adjustment. EDSS also increased with acculturation to US (Beta 0.53, p=0.05) and low income (Beta 0.80, p=0.02) using adjusted linear regression.
Conclusions
Our study reveals insights into early disability patterns among diverse Latinx heritage, in the context of SES and cultural integration differences defined by strong acculturation measures. Preservation of Latinx cultural heritage in the US could have the capacity to alter disease severity and be protective in Latinx with MS. Further sociocultural investigations are warranted.
P0886 - Multiple Sclerosis diagnosis at USNS Comfort during the aftermath of Hurricane Maria: A Case Report (ID 1870)
Abstract
Background
The early diagnosis of Multiple Sclerosis (MS) is important for prognosis. On September 20, 2017 Hurricane Maria (HM) passed through Puerto Rico (PR) leaving severe devastation on its path. The electric infrastructure on the island collapsed, gasoline was rationed, medications were scarce and daily living was a challenge for patients with chronic conditions. The island has a high prevalence of MS (70.6/100,000), approximately 156 neurologists and 69 hospitals, most of which were not connected to the electric grid or habitable after the hurricane. Due to the lack of fully operational hospitals and medical offices, patients in need of medical attention did not have many options.
Objectives
We aim to highlight the effects of Hurricane Maria natural disaster in the diagnosis and treatment of an MS patient in Puerto Rico.
Methods
A case review was performed to describe the diagnosis process of a patient during the aftermath of Hurricane Maria on the island.
Results
A 41 y/o Puerto Rican woman had an episode of hemi paresthesia when she was 20y/o it was associated with stress and disregarded. Two weeks prior to HM she was presenting diplopia, internuclear ophthalmoplegia, ataxia and fatigue which worsened immediately after the event. Patient went to a local hospital but she was only referred to a neurologist and discharged. She decided to go on board the USNS Comfort (USNSC) due to the unavailability of medical appointment with neurologists on the island. Due to clinical signs presented and history of symptoms, MS was suspected, but no functional MRI facilities were available to confirm diagnosis. Methylprednisolone was administered and improvement of symptoms was observed. Diagnosis was made without MRI to confirm lesions. Fingolimod was recommended as treatment, but it was not available due to the scarcity of resources and MS treatments. Eventually, fingolimod was provided to the patient. Follow-up with a neurologist for evaluation and MRI of brain performance were advised. Five months after the hurricane, the MRI showed periventricular white matter lesions, some juxtacortical lesions and a single callosal lesion that were not active. Also, black hole was present in the right peri-atrial white matter supporting diagnosis.
Conclusions
This case demonstrates the importance of disaster guidelines for the management of possible diagnosis of MS, availability of functioning MRI facilities and consequent availability of treatment in the hope of preventing progression on these patients. Future work could include creation of collaborations between pharmaceutical companies and MS foundations to receive and distribute DMT samples in case of natural disasters.
Presenter Of 1 Presentation
P0428 - Acculturation and lower socioeconomic status are associated with early disability in Hispanic/Latinx with Multiple Sclerosis. (ID 1494)
Abstract
Background
Acculturation and socioeconomic (SES) factors are known to play a large role in racial and ethnic health disparities in the United States (US). Lower SES has been reported to increase the risk of disability progression in multiple sclerosis (MS) in whites. How these measures relate to early MS in vulnerable US populations is not known. This is being evaluated as part of GAHMS, a prospective longitudinal study of Genetic ancestry and Acculturation in Hispanic background with early MS.
Objectives
To examine the association of sociodemographic and acculturation measures in early MS disability in Hispanic/Latinx (Latinx).
Methods
Cross-sectional assessment of 219 self-identified US Latinx, including Puerto Rico. Early MS was defined as a diagnosis of <5 years. Sociodemographic status (SES) markers (education, household income, public assistance) and acculturation measures including language preference, place of birth, years in the US and Short Acculturation Scale for Hispanics (SASH; a composite measure of acculturation to US) were collected as part of the baseline examination. Bivariate correlations assessed SASH correlation with acculturation proxies. Unadjusted and adjusted multivariable logistic and linear regression were used to examine the relationship between ambulatory disability (using the Expanded Disability Status Scale; EDSS) and acculturation and SES.
Results
Most participants were female (75.8%), had a mean age of onset of 30.65 years (SD±13.93), had relapsing remitting MS (85.3%), and self-identified as Latinx with Caribbean (46.3%) or Mexican origin (37.8%). Most were overweight (BMI Mean: 28.9±8.04) and unemployment was reported by 35%. A strong correlation was seen between SASH and language preference (0.75, <0.0001) and place of birth (0.70, <0.0001). Increased odds of severe ambulatory disability was associated: with being male, longer disease duration, education of high school or less (3.90, 95%CI 0.33-45.65), household income <$60,000 (3.22, 95%CI 0.26-39.75), and acculturation to US culture (4.041, 95%CI 0.79-20.62) after adjustment. EDSS also increased with acculturation to US (Beta 0.53, p=0.05) and low income (Beta 0.80, p=0.02) using adjusted linear regression.
Conclusions
Our study reveals insights into early disability patterns among diverse Latinx heritage, in the context of SES and cultural integration differences defined by strong acculturation measures. Preservation of Latinx cultural heritage in the US could have the capacity to alter disease severity and be protective in Latinx with MS. Further sociocultural investigations are warranted.