Abstract Details

Title Transverse Myelitis in Context: Investigating the Role of Social Determinants of Health (SDOH) in Clinical Outcomes at a Population Level

Topic Autoimmune Neurology

Presentation(s) P8 - Poster Session 8 (8:00 AM-9:00 AM)

Poster/Presentation
Number 8-008

Objective Understand the impact of social determinants of health (SDOH) in the clinical outcomes of transverse myelitis (TM).

Background TM is a rare neurologic condition with a diverse collection of etiologies targeting the spinal cord, manifesting in various neurologic symptoms. Established predictors of poor clinical outcomes include the presence of longitudinal-extensive-TM, severe deficit at onset of symptoms, acute TM, symptoms progression within 24 hours, relapse occurrence, and spinal shock. The impact of SDOH, including socioeconomic status, healthcare access, and quality of care, hasn’t been thoroughly investigated.

Design/Methods This secondary analysis utilized the National Veterans Health Administration (VHA) TM epidemiology cohort and the Agency for Healthcare Research Quality’s SDOH Database. Univariate and multivariate models were used to determine the association of the area deprivation index, Gini index of income inequality, median incomes of veterans, Rural-Urban Commuting Area Codes system, Medically Underserved Areas (MUA), and distance in miles to the nearest clinics and hospitals with clinical outcomes (autoimmune neurologist-adjudicated modified Rankin Scale [mRS]). Furthermore, Cox regression models were used to assess the impact of SDOH factors on survival times.

Results 1,001 patients met the TM criteria, with a median age of 64.2 years [IQR:53.5–69.9]; 90.7% were male, and 67.8% were white. The median mRS at the time of diagnosis was 3 [IQR:2-4], and remained 3 [IQR:2-4] at the last follow up. A random decision forest determined that LETM, median incomes, and MUA were associated with poor mRS at diagnosis. Multivariate logistic regression showed that increased mortality was associated with increase of age (OR:1.06, 95%CI:1.04–1.08), and higher mRS score at follow-up (OR:1.94, 95%CI:1.57–2.40), and tobacco use (OR 1.87, 95%CI:1.17–2.99). Further analysis will be conducted to understand the impact of specific SDOH-related factors in clinical outcomes.

Conclusions Poor outcomes in TM have been associated clinical factors. SDOH also appear to impact TM outcomes; further population-level analyses are needed.

Authors/Disclosures
Ka-Ho Wong (U of U Neurology Clinic) PRESENTER	The institution of Mr. Wong has received research support from The Sumaira Foundation . The institution of Mr. Wong has received research support from The Siegel Rare Neuroimmune Association.
Justin Abbatemarco, MD	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.
Alen Delic	Alen Delic has nothing to disclose.
John W. Rose, MD, FAAN (Imaging and Neurosciences Center)	The institution of Dr. Rose has received research support from National Multiple Sclerosis Society. The institution of Dr. Rose has received research support from Guthy Jackson Charitable Foundation. The institution of Dr. Rose has received research support from NIH . The institution of Dr. Rose has received research support from VA. The institution of Dr. Rose has received research support from Biogen. The institution of Dr. Rose has received research support from Friends of MS. Dr. Rose has received intellectual property interests from a discovery or technology relating to health care.
Tammy L. Smith, MD, PhD (Imaging and Neurosciences Center)	Dr. Smith 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. The institution of Dr. Smith has received research support from Alexion/AstraZeneca.
Stacey Clardy, MD, PhD, FAAN (University of Utah)	Dr. Clardy has received personal compensation for serving as an employee of Veterans Health Administration (VHA). Dr. Clardy has received personal compensation for serving as an employee of University of Utah Health. Dr. Clardy has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AstraZeneca/Alexion. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen/Horizon. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Arialys. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kyverna. Dr. Clardy has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology/AAN Publications. The institution of Dr. Clardy has received research support from NIH/NINDS. The institution of Dr. Clardy has received research support from SRNA. The institution of Dr. Clardy has received research support from Alexion/AstraZeneca. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a AAN Summer Meeting CoDirector Travel and Lodging with AAN. Dr. Clardy has received personal compensation in the range of $500-$4,999 for serving as a Grand Rounds Travel/Lodging/Honoraria with U of Iowa, Miami, Stanford, Barrow, Beaumont Health, CCF, Emory, Penn State, Mayo Clinic, Walter Reed.

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