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.
P0723 - Internuclear Ophthalmoplegia Characterizes Multiple Sclerosis Rather Than Neuromyelitis Optica Spectrum Disease (ID 1542)
Abstract
Background
Neuromyelitis optica spectrum disease (NMOSD) and multiple sclerosis (MS) share clinical presentations including brainstem syndromes. Internuclear ophthalmoplegia (INO) is characterized by paresis of ipsilateral eye adduction in horizontal gaze. It usually corresponds to a lesion in the medial longitudinal fasciculus (MLF) and is commonly seen in MS. However, it is unclear if INO is as common in NMOSD.
Objectives
To determine the comparative prevalence of INO in patients with NMOSD and MS and compare clinical features of both disease processes.
Methods
This was a retrospective study of patients who have an established diagnosis of NMOSD and MS and visited both neuro-ophthalmology and MS clinics between 2015 and 2020. We used ICD10 billing codes for MS (G35) and NMOSD (G36) and patients were identified as having an INO if documented at any time during follow up. Logistic regression was used to evaluate the likelihood of developing an INO for NMO vs. MS patients. Multivariable analysis was adjusted for age, race, gender, and length of follow up.
Results
259 patients (70 NMOSD, 180 MS) were analyzed. Age range was 21 to 79 years with a mean age of 36.2 (SD+ 13.6 years) and mean disease duration of 1.8 years (SD + 4.6 years). Mean follow-up was 9.69 + 8.3 years. Most of the NMOSD patients were seropositive for AQP4 antibody (67.1%, n=47) followed by MOG antibody (17.1%, n=12). The overall frequency of INO in NMOSD was 1.4% (n=1) compared to 16% (n=30) in MS. Adjusted analysis showed that NMOSD patients were 9 times (OR: 0.112, 95% CI: 0.014-0.902, p=0.04) less likely to develop an INO compared to those with MS.
Conclusions
Our results show that NMOSD patients are less likely to develop an INO than MS patients at any point during their disease course. This suggests that INO and consequently MLF lesions are less common in NMOSD. Clinical implications lie in differentiation of NMOSD from MS and earlier pursuit of appropriate therapy.