Racial Disparities in Multiple Sclerosis (MS) Diagnosis and Treatment
Approximately one million people are living with multiple sclerosis (MS) in the United States. For decades, experts believed the majority of those living with MS were white women, and many doctors still largely associate MS with that demographic. However, research over the past decade has shown that is not the case. In fact, Black women have a higher risk of MS than white women, while Latinx and Asians are less likely to develop the disease.
As scientists continue to learn more about the racial and ethnic factors contributing to this unpredictable disease, they push closer to a cure. To learn more about how MS affects patients of different races, we spoke with neurologist William A. Tosches, MD and Konstantin Balashov, MD, PhD, director of the Multiple Sclerosis Center at BMC. They shared their contribution to the evolving field and described how their deep understanding of MS equips them to care for patients of diverse backgrounds.
HealthCity: Does the clinical presentation of MS differ by race and ethnicity?
Konstantin Balashov, MD: Recent observational studies suggest that Black and Latinx patients with MS have a higher disability and increased symptoms burden compared with white patients. For example, motor symptoms are more common in Black patients, while optic neuritis (inflammation of the optic nerve) is more frequent among Latinx patients. There is also some initial research that different races may respond differently to medications. These findings are quite important for our patient population, which is 45% Black and 16% Latinx, but more research is needed to confirm these initial observations.
HC: How does systemic racism in healthcare affect MS patients? What can be done to ensure that Black and Latinx patients are appropriately diagnosed and get the right care for MS?
William Tosches, MD: Many people of color distrust the healthcare system, and I think we see that with our patients who are fearful of the newer MS medications. They come to us on old medications that are not working well, but even with progressive disease, they’re reluctant to start a more powerful disease-modifying therapy (DMT).
The best thing I can offer them is to be truthful about the medications, make sure they can connect with me when they have questions, and help them to not be frightened. It’s very gratifying to be able to gain someone’s confidence and help them get better.
KB: We spend time educating other healthcare providers as well, to make sure patients are getting referred for the care they need. We are working with the National Multiple Sclerosis Society to improve awareness of MS symptoms among primary care physicians (PCPs) and other healthcare specialists who might still think that MS only affects their white patients. We conducted a series of lectures at community healthcare centers affiliated with BMC to update their medical professionals on MS in general, typical MS-related symptoms, and the referral process for patients suspected to have MS.
When a patient is referred to our program, we try to see them as soon as possible, because we understand the urgency of being diagnosed and treated right away. Once they’re here, they see a group of highly trained medical professionals who provide exceptional MS care without exception. We rely on recently updated international diagnostic criteria for MS and use a combination of clinical evaluation, MRI, and laboratory tests to confirm the suspected diagnosis.
HC: What racial disparities exist in treating MS?
KB: One challenge we face is the insurance companies’ restriction of many high efficacy medications we want to prescribe to our patients. This may lead to a delay in MS treatment initiation. It’s important to start treatment as early as possible to reduce inflammation and nerve damage caused by MS, so we are trying to understand the other barriers to delayed treatment.
We recently received approval from the Institutional Review Board (IRB) for the study that will look at race and ethnicity as factors in how quickly patients start on high efficacy medications after an MS diagnosis. We are collaborating with Brigham and Women's Hospital (BWH) on this joint study. With our very diverse patient populations, we will be better able to look at race and ethnicity as factors.
HC: Do we have a cure for MS?
KB: I need to emphasize that we have witnessed remarkable clinical progress, with more than 20 MS medications approved by the FDA in the last 30 years. Still, there is no MS cure. This is our dream and goal — to understand what is causing MS and then eradicate it.
HC: How is the MS Center at BMC different than other centers?
WT: MS can take its toll on patients who are frightened and reluctant to get care. As MS providers, we need to do more. At BMC, we reach out to patients who may otherwise be overlooked, like those in homeless shelters and prisons. I have been treating MS for almost 45 years and I love working with patients with these types of social determinants of health, because I feel like I can make them comfortable and make inroads with them. Sometimes it’s just taking the time to listen to someone.
KB: We are proud to work at BMC, which was rated as the #2 most racially inclusive hospital out of 3,200 U.S. hospitals ranked by the Lown Institute in 2021. A significant number of our patients are recent immigrants and may not speak English. We try to provide the best care available to every patient regardless of their race or ethnicity.
We've heard from the providers. Now, let's meet Selina, a patient receiving MS care at BMC.