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October 4, 2021

Health Disparities, Inequities, and Social Determinants of Health in Multiple Sclerosis and Related Disorders in the US: A Review

Author Affiliations
  • 1Keck School of Medicine, Department of Neurology, University of Southern California, Los Angeles
  • 2Department of Neurology, Baylor College of Medicine, Houston, Texas
  • 3National Institute of Neurology and Neurosurgery, Mexico City, Mexico
  • 4Keck School of Medicine, Department of Preventive Medicine, Institute for Health Promotion and Disease Prevention, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles
  • 5Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
JAMA Neurol. Published online October 4, 2021. doi:10.1001/jamaneurol.2021.3416

Importance  There is empirical evidence that social determinants of health (SDOH) impact health outcomes in Black and Hispanic and Latinx individuals in the US. Recently, SDOH have risen to the top as essential intervention targets that could help alleviate racial and ethnic disparities. Neuromyelitis optica spectrum disorder (NMOSD) disproportionately affects Black individuals, and multiple sclerosis (MS) has seen a recent shift in select racial groups. It is unclear to what degree SDOH have been investigated and contribute to racial and ethnic health disparities and inequities.

Observations  This narrative review provides a contemporary synthesis of SDOH associated with racial and ethnic health disparities and inequities in MS, NMOSD, and other autoimmune disorders, such as myelin oligodendrocyte glycoprotein antibody (MOG-Ab)–associated disease. These immune-mediated neurological diseases were chosen for their capacity to be a high burden to society and because of complementary SDOH-associated challenges among minority populations. A paucity of research addressing inequities and the role of SDOH in MS and NMOSD was noted despite findings that Black individuals have a higher risk of developing MS or NMOSD and associated mortality compared with White individuals. Greater health disparities were also found for those with lower income and education, lower health literacy, and negative illness perceptions in MS. No studies in MOG-Ab disorders were found.

Conclusions and Relevance  Increased efforts are needed to better understand the role of SDOH in racial and ethnic health disparities and inequities in MS, NMOSD, and emerging autoimmune disorders. This includes developing research frameworks aimed at understanding the magnitude and interrelationships of SDOH to better develop system-based multilevel interventions across the spectrum of care for these neurological conditions.

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