Multiple Sclerosis in a Multi-Ethnic Population in Houston, Texas: A Retrospective Analysis

Abstract

Multiple Sclerosis (MS) is a progressive neurodegenerative disease that affects more than 2 million people worldwide. Increasing knowledge about MS in different populations has advanced our understanding of disease epidemiology and variation in the natural history of MS among White and minority populations. In addition to differences in incidence, African American (AA) and Hispanic patients have greater disease burden and disability in earlier stages of disease compared to White patients. To further characterize MS in AA and Hispanic populations, we conducted a retrospective chart analysis of 112 patients treated at an MS center in Houston, Texas. Here, we describe similarities and differences in clinical presentation, MRI findings, treatment regimens, disability progression, and relapse rate. While we found several similarities between the groups regarding mean age, disability severity, and degree of brain atrophy at diagnosis, we also describe a few divergences. Interestingly, we found that patients who were evaluated by a neurologist at symptom onset had significantly decreased odds of greater disability [defined as Expanded Disability Status Scale (EDSS) > 4.5] at last presentation compared to patients who were not evaluated by a neurologist (OR: 0.04, 95% CI: 0.16–0.9). We also found that active smokers had significantly increased odds of greater disability both at diagnosis and at last clinical encounter compared to nonsmokers (OR: 2.44, 95% CI: 1.10–7.10, OR= 2.44, 95% CI: 1.35–6.12, p = 0.01, respectively). Additionally, we observed significant differences in treatment adherence between groups. Assessment of the degree of brain atrophy and progression over time, along with an enumeration of T1, T2, and gadolinium-enhancing brain lesions, did not reveal differences across groups.

Do magnetic resonance imaging features differ between persons with multiple sclerosis of various races and ethnicities?

“…Importantly, there were no significant differences between the two groups with respect to demographics (smoking, body mass index, comorbidities, baseline vitamin D levels, educational attainment), age of onset, diagnostic lag, or treatment duration, suggesting that disease is inherently worse in Latin Americans ( 6 ). Conversely, a study from Texas, United States comparing non-Latin American White, Latin American, and non-Latin American Black pwMS did not find a significant difference in brain atrophy or spinal cord atrophy between groups ( 38 ). However, the number of non-Latin American White pwMS included in this study was low at 11, and thus could have been underpowered to detect differences between groups.…”

“…One study found significantly greater T2 lesion volumes in Latin American MS patients compared to non-Latin American White MS patients, and the T2 lesion volumes were correlated with expanded disability status scale (EDSS) scores in Latin American patients (6). Another study looking specifically at Latin American, non-Latin American White, and non-Latin American Black patients in Texas, United States did not find any significant differences between groups with respect to the number of T1, T2, and gadolinium-enhancing lesions at time of diagnosis, nor were there differences between groups in the number of T2 or gadoliniumenhancing lesions involving the spinal cord at diagnosis (38).…”

Health Disparities in Multiple Sclerosis among Hispanic and Black Populations in the United States

“…Since adequate MS treatment requires a comprehensive and multidisciplinary approach, the presence of these risk factors can suggest a potential increased risk of disability and disease progression in minority populations. In a previous single-center retrospective study, after adjustment for race and age, MS patients who were evaluated by a neurologist at diagnosis were found to have 60% lower odds of attaining an EDSS > 4.5 at subsequent follow-up visits compared to patients evaluated by a non-neurologist [ 47 ].…”

Clinical characteristics and dynamics of disability progression in a cohort of patients with multiple sclerosis in Latvians

“…There is wide variation in the time from the onset to the progression of SPMS [ 11 ] and some controversy regarding the clinical characteristics (initial symptoms, MRI features, disease prognosis, etc.) of both RRMS and SPMS clinical courses (phenotypes) of MS [ 11 , 12 ].…”