Hispanic Americans and African Americans with multiple sclerosis have more severe disease course than Caucasian Americans

Ventura, Rachel E.; Antezana, Ariel; Bacon, Tamar; Kister, Ilya

doi:10.1177/1352458516679894

Cited by 88 publications

(66 citation statements)

References 12 publications

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“…Among racial/ethnic subgroups, African Americans had the highest baseline severity scores, followed by Hispanic Americans, followed by white Americans, in agreement with our prior analyses. 18 Interestingly, no change in severity scores was observed for any of the subgroups of interest, including patients with relapses 3 months or more from the last visit. Patients with progressive disease showed a trend for worsening PMSSS with time.…”

Section: Discussionmentioning

confidence: 86%

Short-term disability progression in two multiethnic multiple sclerosis centers in the treatment era

Kister

Bacon

Cutter

2018

Ther Adv Neurol Disord

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Background:Short-term disease progression is well documented in clinical trials, but there are limited published data on disease course in real-life practice.Methods:Patient-derived Multiple Sclerosis Severity Score (PMSSS), a disease severity rank score, was computed at each visit for consecutive MS patients attending two large, ethnically diverse MS centers in New York metropolitan area. Disability was assessed via Patient-Determined Disease Steps (PDDS). Clinicians recorded disease subtype and relapse status at each visit, but did not rate disability. PMSSS change from the first to the last visit was calculated for the cohort as a whole and for subgroups of interest. Multivariable regression models were constructed for predicting final PMSSS based on readily available predictor variables collected at the initial visit and relapse history during follow up.Results:A total of 1740 consecutive patients from New York University (n = 1079) and Barnabas (n = 661) MS Care Centers were included. During follow up (mean 2.4 ± 0.82 years, range 1–4 years), mean PDDS score increased from 1.9 ± 2.2 to 2.3 ± 2.2 (p < 0.0001), while PMSSS remained roughly unchanged (initial PMSSS = 3.71 ± 2.73, last PMSSS = 3.81 ± 2.76, paired t test, p = 0.28). The only major predictor of final PMSSS was the initial PMSSS. Demographic variables (age, sex, race) or relapse status did not predict final severity score.Conclusions:Baseline disability in two MS clinics was much lower than in the reference population from which PMSSS was derived. We observed no discernable slowing of disability accumulation during the short-term follow up in our cohort compared with the reference cohort. Overwhelmingly the most important predictor of final disease severity rank score was the initial disease severity rank score.

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Section: Discussionmentioning

confidence: 86%

Short-term disability progression in two multiethnic multiple sclerosis centers in the treatment era

Kister

Bacon

Cutter

2018

Ther Adv Neurol Disord

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“…This data suggests that blacks have a higher mortality risk at a younger age than whites. It is possible that the clinical differences in MS reported in blacks compared to whites, where blacks are more commonly reported to have a malignant disease course including a more rapid accumulation of disability and increase central nervous system damage, would be influencing [25-29]. Using the North American Research Committee for MS registry, blacks were reported to have a slightly higher mortality rate than whites or other races, particularly at younger ages [17].…”

Section: Discussionmentioning

confidence: 99%

Multiple Sclerosis Mortality by Race/Ethnicity, Age, Sex, and Time Period in the United States, 1999–2015

et al. 2018

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Background: Multiple sclerosis (MS) carries high morbidity and shortens life span. While there is recent recognition of other US minority populations such as blacks and Hispanics being affected with MS, examination of MS-specific mortality trends by race/ethnicity has been lacking. Objective: To investigate MS mortality rates and trends in the United States by sex, age, and race/ethnicity. Methods: We used the Compressed Mortality data file for 1999–2015 in the Wide-ranging online Data for Epidemiological Research system developed by the Center for Disease Control and Prevention to calculate the age-adjusted (US 2000 standard population) and age-specific MS mortality rate (per 100,000) by race/ethnicity and sex over time. Five mutually exclusive racial/ethnic groups were included in the analysis: non-Hispanic (NH) white, NH black, NH Asian or Pacific Islander (API), NH American Indian or Alaska Native, and Hispanic. Results: The average annual age-adjusted MS mortality rate was highest among NH whites (0.90 for males and 1.50 for females) immediately followed by NH blacks (0.75 for males and 1.42 for females), and lowest among APIs (0.05 for males and 0.12 for females). Statistically significant, increasing trend in age-adjusted MS mortality was observed during 1999–2015 among NH whites and NH blacks regardless of sex, more substantially in the latter. Age-specific MS mortality patterns showed NH blacks had the highest rate under age 55 and NH whites had the highest rate after that age point. For these 2 groups, MS mortality increased with age in both sexes and peaked at ages 55–64 for NH blacks and 65–74 for NH whites before declining substantially, while for Hispanic and API groups the risk plateaued after age 55. Conclusion: MS-specific mortality trends demonstrate distinctive differences by race/ethnicity and age. The observations that whites and females are more likely to die from MS is in line with the overall understanding that these groups are affected more by MS. However, the findings of blacks dying at an earlier age and having more substantially increasing mortality trends than whites suggest that MS burden weighs unequally by race. Further investigation into these trends may provide additional evidence into risk or protective factors within each group.

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“…Our finding that higher proportions of NA and African ancestry increase the chance of presenting with MS at a younger age is of great interest as well. A recent study that compared Hispanics and African Americans to Whites ascertained in the Northeastern United States, with similar socioeconomic background, indicated that Hispanics have a younger age of onset compared to Whites and a similar age of onset to African Americans . Previous studies have also observed an even more pronounced age of onset difference between U.S. and non‐U.S.…”

Section: Discussionmentioning

confidence: 97%

“…An early study from Mexico reported ON as presenting symptom in 33%, a much higher proportion when compared to White historical cohorts . The observations that any deviation in the presentation and clinical progression of MS in Hispanics from Whites could be influenced by genetic admixture, until now, were simply speculative …”

Section: Discussionmentioning

confidence: 99%

Native ancestry is associated with optic neuritis and age of onset in hispanics with multiple sclerosis

Amezcua

Beecham

Delgado

et al. 2018

Ann Clin Transl Neurol

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Background and ObjectiveHispanics with multiple sclerosis (MS) present younger and more often with optic neuritis (ON) as compared to Whites in the western United States. Regional differences related to Hispanic genetic admixture could be responsible. We investigated the association between global genetic ancestry and ON and age at onset of MS in Hispanics.MethodsData were obtained for 1033 self‐identified Hispanics with MS from four MS‐based registries from four academic institutions across the United States January 2016–April 2017. Multivariate regression models, utilizing genetic ancestry estimates for Native American (NA), African, and European ancestry, were used to assess the relationship between genetic ancestry and ON presentation and age of MS onset, defined as age at first symptom.ResultsGenetic ancestry and ON proportions varied by region where NA ancestry and ON proportions were highest among Hispanics in the southwestern United States (40% vs. 19% overall for NA and 38% vs. 25% overall for ON). A strong inverse correlation was observed between NA and European ancestry (r = −0.83). ON presentation was associated with younger age of onset (OR: 0.98; 95% CI: 0.96–0.99; P = 7.80 × 10−03) and increased NA ancestry (OR: 2.35 for the highest versus the lowest quartile of NA ancestry; 95% CI: 1.35–4.10; P = 2.60 × 10−03). Younger age of onset was found to be associated with a higher proportion NA (Beta: −5.58; P = 3.49 × 10−02) and African ancestry (Beta: −10.07; P = 1.39 × 10−03).InterpretationEthnic differences associated with genetic admixture could influence clinical presentation in Hispanics with MS; underscoring the importance of considering genetic substructure in future clinical, genetic, and epigenetic studies in Hispanics.

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Hispanic Americans and African Americans with multiple sclerosis have more severe disease course than Caucasian Americans

Cited by 88 publications

References 12 publications

Short-term disability progression in two multiethnic multiple sclerosis centers in the treatment era

Short-term disability progression in two multiethnic multiple sclerosis centers in the treatment era

Multiple Sclerosis Mortality by Race/Ethnicity, Age, Sex, and Time Period in the United States, 1999–2015

Native ancestry is associated with optic neuritis and age of onset in hispanics with multiple sclerosis

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