Study: Socioeconomic opportunity may be at root of disparities in MS outcomes

January 25, 2024
While recent therapies have the potential to stall or delay the progression of multiple sclerosis, a new study suggests young Black and Hispanic women fare worse than young white women. Minority women were more likely to have more advanced disease and faced greater challenges in pregnancy. 

University of California - San Francisco researchers tracked medical records at nine MS centers throughout the country for 294 women whose pregnancies resulted in live births. Approximately half of the patients were white, more than one-quarter were Black and the remainder were Hispanic. The researchers found that close to 95 percent of the participants had relapsing-onset MS. 

Researchers found that Black and Hispanic women faced socioeconomic disadvantages that were likely to have an adverse effect on their health. At the time of conception, they were more likely to live in under-resourced neighborhoods, be unemployed, and less likely to have private health insurance.

Black and Hispanic women were ages 31 and 30, respectively, at the time of conception – younger than the white women, who were 34. The minority women had an Expanded Disability Status Scale ranking of 1.5, corresponding to symptoms in more than one functional system. White women had an average EDSS ranking of 1, the equivalent of symptoms in one functional system such as vision, bowel and bladder, or balance and coordination.

Minority women had higher levels of inflammation both before and after pregnancy, an indication they were more susceptible to myelin loss, and injury to the underlying axon, part of the nerve cell, representing disease progression. However, no significant racial differences were identified in MS care, including the type of treatment prescribed and how the disease was managed before and after pregnancy. 

The researchers found that minority women were slightly less likely to receive a 14-week ultrasound, Black women were more than twice as likely to undergo emergency C-section as Hispanic women, and minority women were more likely to give birth to lower-birthweight babies. All three groups had similar rates of breastfeeding, which is protective against MS relapse, but white mothers breastfed for six months, versus four-and-a-half months for the minority mothers. 

The researchers said their findings highlight the importance of considering race-ethnicity and disability in women with MS. They also suggest that socioeconomic opportunity, rather than MS-related care, may lay the foundation for disparities in MS outcomes.

The study was published in the journal Neurology.

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