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. 2024 Aug 26;10(3):20552173241274586.
doi: 10.1177/20552173241274586. eCollection 2024 Jul-Sep.

Impact of race and socioeconomic deprivation on clinical outcomes and healthcare utilization in pediatric multiple sclerosis

Kelsey E Poisson  1 , Stacey S Cofield  2 , Jayne M Ness  3
Affiliations

Impact of race and socioeconomic deprivation on clinical outcomes and healthcare utilization in pediatric multiple sclerosis

Kelsey E Poisson et al. Mult Scler J Exp Transl Clin. .

Abstract

Background: Health disparities in adult-onset multiple sclerosis have been identified in the Black/African American (AA) population. A higher relapse rate has been suggested in Black/AA patients with pediatric-onset MS (POMS), but little work explores healthcare utilization and social determinants of health (SDOH).

Objective: To evaluate racial, ethnic, and socioeconomic disparities in POMS outcomes.

Methods: Retrospective chart review identified 31 eligible patients diagnosed with POMS at Children's of Alabama between 2013 and 2023. Demographics, outcomes, and healthcare utilization over 2 years from diagnosis were collected. Patient addresses were connected to SDOH measures from the US Census. Bivariate analysis was performed using Fisher's Exact Test, Wilcoxin Test, and 2-sided t-test.

Results: Black/AA children had a higher Expanded Disability Status Scale (EDSS) at first presentation (p = 0.0276) and were more likely to initiate fingolimod vs. glatiramer acetate (p = 0.0464). Living further from Children's of Alabama was associated with a higher most recent EDSS (p = 0.0301) and fewer neurology appointments (p = 0.0167). Families living in more socioeconomically deprived census tracts had significantly more hospital admissions.

Conclusion: Black/AA POMS patients had a more severe initial presentation and were started on higher efficacy medication. We identified disparities in EDSS and healthcare utilization based on SDOH data linked to a child's home address.

Keywords: Pediatric multiple sclerosis; health disparities; social determinants of health.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
EDSS over time by race. Solid line Black/AA, Dashed line White; unadjusted mean (95% CI) EDSS.
Figure 2.
Figure 2.
Change in EDSS by distance from children's hospital and starting EDSS Score. Change in EDSS from initial to most recent follow-up. Dashed line starting EDSS 0–2, Solid line starting EDSS 2.5–6. Least Squares Means from covariate adjusted model with 95% CI on predicted LS Means.
See this image and copyright information in PMC

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