Racially/ethnically diverse people with multiple sclerosis (pwMS) have worse outcomes than their White counterparts. Social determinants of health (SDOH), like healthcare factors, may contribute to these disparities, though much remains unknown. The current studies investigate the impact of healthcare factors on crucial outcomes in diverse pwMS and explore how partnerships can reduce health disparities. In Study 1, three groups- Latinx (N=22), non-Latinx Black (NLB; N=30), and non-Latinx White (NLW; N=31) were included. FreeSurfer-derived global structural measures (total subcortical, gray, and white matter) and Alzheimer’s Disease/dementia (AD) and aging signature region composites were calculated. Study 2 included eighteen Latinx and NLB pwMS. Barriers to Care Questionnaire total and subscale scores were used. Neuropsychological testing measured processing speed and visual and verbal memory. Accelerated brain aging (ABA) was calculated using brainageR. Lastly, in Study 3, narrative review and qualitative methods (i.e., open ended questions) assessed lived experiences of pwMS interacting with the healthcare system. Study 1 showed a significant effect of race/ethnicity indicating significant differences in AD signature regions. Post-hoc testing showed NLB to have less volume in AD signature regions compared to NLW. There was also a significant effect of race/ethnicity on global brain measures. Study 2 demonstrated marginalization-related barriers to healthcare to be associated with poorer processing speed performance. Greater knowledge-based barriers to healthcare were associated with ABA, and ABA was significantly related to cognition. Lastly, Study 3 revealed themes related to the patient experience, including providers understanding, healthcare knowledge, delayed diagnosis, and financial hardships. Regarding overcoming barriers, participants reported inner strength, strong support systems/family, perseverance, and self-advocacy. These studies are a crucial first step towards understanding the link between social/systemic factors and health outcomes in MS. This and future work will have direct implications for early interventions focusing on improving healthcare access and quality.
Cristina A F Román (Wed,) studied this question.