To evaluate the impact of neighborhood-level disadvantage on time to treatment and relapses rates in a geographically diverse cohort of pediatric patients with MOGAD.

Prior studies examining social determinants of health (SDOH) in demyelinating diseases have primarily focused on adult populations with multiple sclerosis or neuromyelitis optica spectrum disorder. Consequently, SDOH impact on pediatric patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) remains insufficiently characterized. 

We conducted a retrospective chart review of pediatric patients (<18 years) diagnosed with MOGAD (per 2023 criteria) treated between 2016-2025 at a single academic center serving a five-state region. Neighborhood-level disadvantage was assessed using the Childhood Opportunity Index (COI), Rural-Urban Commuting Area (RUCA) classifications, and the Area Deprivation Index (ADI). Associations with time to treatment initiation and relapse rates were analyzed using Fisher’s exact tests, and linear regression adjusted for demographic covariates.

Fifty-four patients (mean age 9.46 years, 50% female) met inclusion criteria. Low COI (p=0.176) and high ADI (p=0.136) were not significantly correlated with longer time to treatment initiation (specified as > 7 days from symptom onset). Among 50 patients with ≥6 months of follow-up, neither low COI (p=0.18) nor high ADI (p=0.196) was predictive of relapse risk. Rural versus urban residence (RUCA) was also not significantly related to time to treatment or relapse rates. 

Neighborhood-level disadvantage was not associated with longer time to treatment initiation or increased relapse rates in this cohort of pediatric patients with MOGAD. Similarly, outcomes did not differ between rural versus urban residence. These findings suggest that neighborhood-level disadvantage may not be associated with access to care and clinical outcomes, however, should be interpreted in the context of the sample size and single-center design. Multicenter, prospective studies are needed to better delineate if SDOH has an impact on access to care and the overall disease course in pediatric MOGAD.