Abstract Details

Title Race and Social Determinants of Health in Performance Outcomes among Relapsing Remitting Multiple Sclerosis Patients

Topic Multiple Sclerosis

Presentation(s) P13 - Poster Session 13 (8:00 AM-9:00 AM)

Poster/Presentation
Number 3-017

Objective

To investigate the relationship of race and social determinants of health (SDoH) with clinical outcomes in relapsing remitting multiple sclerosis (RRMS).

Background Increased efforts are needed to better understand the role of SDoH in racial health disparities and inequities in MS.

Design/Methods This retrospective study was conducted at Cleveland Clinic. Utilizing census tract data, we analyzed the relationship of SDoH with MS Performance Test (MSPT) measures. SDoH included the following: Area Deprivation Index-3 (ADI) consisting of neighborhood financial strength, economic hardship, and educational attainment, along with public transportation access, housing stock built before 1979, and urban-rural living status. We then assessed differences in MSPT measures across racial groups while adjusting for SDoH, disease severity, living status and comorbidities.

Results

3534 RRMS patients (mean age 46.9 ± 12.1 years, 74.7% female, 80.4% self-identified White and 13.2% Black) were included. Lower educational attainment on ADI-3 metrics was associated with slower manual dexterity (0.15 seconds, p = 0.022) but none of the other SDoH were associated with MSPT measures (p > 0.05). After adjusting for SDoH metrics including ADI, Black patients had worse measures of cognitive processing speed (4.25 fewer correct, p < 0.001), walking speed (0.97 seconds slower, p < 0.001) and manual dexterity (2.32 seconds slower, p < 0.001) when compared to White patients despite a shorter disease duration (Black patients 12.2 ± 10.0 years vs White patients 13.8 ± 11.2, p <0.001). There was no significant difference in initial disease modifying therapy category (moderate vs high efficacy) (p = 0.34) nor in follow-up visits (p = 0.23) across race.

Conclusions Increased disability seen in Black patients was not explained by measured SDoH, suggesting other societal and biological causes may be responsible for this discrepancy. Further efforts are needed to understand the role of racial health disparities and inequities in MS.

Authors/Disclosures
Justin Abbatemarco, MD PRESENTER	Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon. Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech . Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics, Inc.. Dr. Abbatemarco has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen. The institution of Dr. Abbatemarco has received research support from Amgen.
Daniel Ontaneda, MD, PhD, FAAN (Cleveland Clinic)	Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech/Roche. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen Idec. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Dr. Ontaneda has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. The institution of Dr. Ontaneda has received research support from NIH. The institution of Dr. Ontaneda has received research support from PCORI. The institution of Dr. Ontaneda has received research support from NMSS. The institution of Dr. Ontaneda has received research support from Genetech.
Mary R. Rensel, MD, FAAN	Dr. Rensel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Rensel has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for genentech. Dr. Rensel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis . Dr. Rensel has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for EMD Serono. Dr. Rensel has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for TG. Dr. Rensel has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for biogen. Dr. Rensel has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Rensel has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sanofi. Dr. Rensel has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for EMD Serono. Dr. Rensel has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for TG. Dr. Rensel has stock in Brain Fresh LLC . The institution of Dr. Rensel has received research support from NMSS. The institution of Dr. Rensel has received research support from Roche- Genentech . The institution of Dr. Rensel has received research support from Biogen.
Devon Conway, MD	Dr. Conway has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Conway has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Conway has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. Dr. Conway has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Amgen. Dr. Conway has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Conway has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. The institution of Dr. Conway has received research support from Novartis. The institution of Dr. Conway has received research support from BMS. The institution of Dr. Conway has received research support from Biogen.
Marisa P. McGinley, DO (Cleveland Clinic)	Dr. McGinley has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. McGinley has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. The institution of Dr. McGinley has received research support from Biogen. The institution of Dr. McGinley has received research support from Genentech. The institution of Dr. McGinley has received research support from NIH. The institution of Dr. McGinley has received research support from AHRQ. The institution of Dr. McGinley has received research support from EMD Serono.
Robert A. Bermel, MD, FAAN (Cleveland Clinic)	Dr. Bermel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sanofi/Genzyme. Dr. Bermel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech/Roche. Dr. Bermel has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novartis. Dr. Bermel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for TG Therapeutics. The institution of Dr. Bermel has received research support from Biogen. The institution of Dr. Bermel has received research support from Roche. The institution of Dr. Bermel has received research support from Novartis. Dr. Bermel has received intellectual property interests from a discovery or technology relating to health care.
Scott Husak	Scott Husak has nothing to disclose.
	No disclosure on file
	No disclosure on file
Deja Rose, MD	Dr. Rose has nothing to disclose.
Deborah M. Miller, PhD (Cleveland Clinic Foundation)	Dr. Miller has received intellectual property interests from a discovery or technology relating to health care.

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