Establish the MS-diverseCITY cohort to investigate sociodemographic and modifiable lifestyle factors impacting disease severity in Black and White persons with MS (BpwMS/WpwMS) living in NYC.

A more severe disease course has been described in BpwMS without definitive biological underpinnings; sociodemographic and modifiable lifestyle factors warrant investigation. We analyzed the relationship between race and MS outcomes in BpwMS and WpwMS and how socioeconomic and modifiable factors may affect it.

Chart review identified BpwMS aged 18-65 and 1:1 age-and-sex matched WpwMS; all underwent neuropsychological evaluation (MS Functional Composite [MSFC], cognitive [SDMT, verbal/nonverbal memory] and physical measures [T25FW, NHPT, dynamic balance]) as part of routine care. Patient-reported outcomes assessed gait-disturbance, mood, sleep, and adherence to Mediterranean-style diet. Socioeconomic status (SES) index included: neighborhood deprivation index, educational attainment, and literacy. Single/parallel mediation analyses explored the extent to which these factors accounted for the relationship between race and MS outcomes.

The MS-diverseCITY cohort includes 150 BpwMS (36 Black/Hispanic) and 150 WpwMS (9 White/Hispanic), mean age=42.7±10; 78% women. There were no group differences in disease duration, MS phenotype, or use of high-efficacy therapies. The percent holding bachelor’s degrees—although higher than the NYC population—was lower in BpwMS (59%) versus WpwMS (77%) (p<0.001). BpwMS had lower SES index (p<0.001, Cohen’s d=0.84) and diet adherence (p<0.001, d=0.69) and worse performance on cognitive & physical measures (Ps: 0.004 to <0.001; Ds: 0.41 to 0.63) and MSFC (p<0.001, d=0.74). SES and diet partially mediated the relationship between race and MSFC (48.7%), SDMT (43.1%), NHPT (47.9%), and T25FW (57.1%).

Despite higher-than-average educational attainment and equivalent use of high-efficacy treatments in this NY-based cohort, BpwMS experienced disparate disease outcomes. Our work explicated substantial group differences using detailed cognitive measures and established significant mediation using a composite SES proxy. These results provide an initial roadmap towards targeting these disparities in clinical practice.