US Study: Black Patients Have More Severe Disease Than Whites

Blacks with multiple sclerosis (MS) have more severe disease and greater disability at their first visit than white patients, even when differences in socioeconomic status are taken into account, a large U.S. study found.

The data showed that Black patients with MS had lower scores on some measures of neurological health, such as walking and manual dexterity, or the ability to use one’s hands in a skillful, coordinated way. Moreover, Blacks showed more evidence of disease progression on brain magnetic resonance imaging (MRI) scans.

Such differences were evidenced at the first visit of more than 1,000 Black patients, the data showed.

These findings warrant further longer-term studies to understand the cause behind those variations and how to address them, according to a press release from the National MS Society.

“This study was a snapshot at a specific time point,” the National MS Society said. “Longer studies that would track these groups over time are needed to understand whether differences are due to disease-related factors, quality of care, or other factors and offer insights into how to address them.”

The study, “Association of Disease Severity and Socioeconomic Status in Black and White Americans With Multiple Sclerosis,” was published in the journal Neurology.

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Blacks tend to experience more disease exacerbations and greater disability — and to require help with mobility earlier in the disease course than white patients. On the other hand, certain B-cell depleting therapies are not as effective in these patients as they are in whites.

To understand these differences, researchers at the Johns Hopkins University set out to compare clinical and imaging features at the first visit between Black and white patients with MS — and understand whether socioeconomic status could play a role.

The study included a total of 8,744 people with MS from Multiple Sclerosis Partners Advancing Technology and Health Solutions (MS PATHS), a Biogen-funded collaborative network of healthcare organizations that collects patient information during routine visits. Among them, 1,214 identified as Black and 7,530 identified as white.

Overall, Blacks were younger, had lower education levels, and were more likely to have Medicaid or Medicare insurance. They also were more likely to be unemployed, to present with progressive forms of MS, and to report severe disability.

Next, the researchers looked at measures of neurological health that are commonly used to evaluate people diagnosed with MS. Blacks scored five points lower than white patients on a test of cognitive processing speed. On average, they also were 0.66 seconds slower on a walking test and 2.11 seconds slower on a manual dexterity test.

On brain MRI scans, Blacks had more lesions and increased tissue damage than did whites, as assessed by a smaller volume of certain brain regions.

In a smaller group of patients from one center, the researchers also looked at socioeconomic status based on the participants’ area of residence. Among whites, lower socioeconomic status was associated with slower cognitive processing, slower walking speeds, and slower manual dexterity. In Blacks, however, socioeconomic factors were only associated with slower manual dexterity, and not with other neurological measures.

Further studies that would track these groups over time are needed to understand the cause of a greater burden of disease in Black patients, the investigators said.

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“Such studies will be important for identifying prognostic factors and optimal treatment strategies,” they wrote.

The researchers also called for studies to investigate whether more aggressive treatment would have any impact on disability levels among Blacks.

“The results also reinforce the need for more racially representative phase 3 clinical trials,” they concluded.  One such study is underway.

To learn more about the challenges and experiences of Black patients with MS, anyone interested can join the Black MS Experience Program Series, which will be held Sep. 22–23. Registration for the virtual program will open in the next couple of months.