Impact of race and socioeconomic deprivation on clinical outcomes and healthcare utilization in pediatric multiple sclerosis.

IF 2.5 Q2 CLINICAL NEUROLOGY Multiple Sclerosis Journal - Experimental, Translational and Clinical Pub Date : 2024-08-26 eCollection Date: 2024-07-01 DOI:10.1177/20552173241274586
Kelsey E Poisson, Stacey S Cofield, Jayne M Ness
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Abstract

Background: Health disparities in adult-onset multiple sclerosis have been identified in the Black/African American (AA) population. A higher relapse rate has been suggested in Black/AA patients with pediatric-onset MS (POMS), but little work explores healthcare utilization and social determinants of health (SDOH).

Objective: To evaluate racial, ethnic, and socioeconomic disparities in POMS outcomes.

Methods: Retrospective chart review identified 31 eligible patients diagnosed with POMS at Children's of Alabama between 2013 and 2023. Demographics, outcomes, and healthcare utilization over 2 years from diagnosis were collected. Patient addresses were connected to SDOH measures from the US Census. Bivariate analysis was performed using Fisher's Exact Test, Wilcoxin Test, and 2-sided t-test.

Results: Black/AA children had a higher Expanded Disability Status Scale (EDSS) at first presentation (p = 0.0276) and were more likely to initiate fingolimod vs. glatiramer acetate (p = 0.0464). Living further from Children's of Alabama was associated with a higher most recent EDSS (p = 0.0301) and fewer neurology appointments (p = 0.0167). Families living in more socioeconomically deprived census tracts had significantly more hospital admissions.

Conclusion: Black/AA POMS patients had a more severe initial presentation and were started on higher efficacy medication. We identified disparities in EDSS and healthcare utilization based on SDOH data linked to a child's home address.

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种族和社会经济贫困对小儿多发性硬化症临床结果和医疗保健利用率的影响。
背景:在黑人/非裔美国人(AA)人群中,已发现成人发病型多发性硬化症存在健康差异。有研究表明,黑人/非裔美国人小儿多发性硬化症(POMS)患者的复发率较高,但很少有研究探讨医疗保健利用率和健康的社会决定因素(SDOH):评估 POMS 结果中的种族、民族和社会经济差异:回顾性病历审查确定了 2013 年至 2023 年期间在阿拉巴马州儿童医院确诊的 31 名符合条件的 POMS 患者。收集了患者的人口统计学特征、治疗效果以及诊断后两年内的医疗保健使用情况。患者地址与美国人口普查中的 SDOH 指标相关联。使用费雪精确检验、Wilcoxin 检验和双侧 t 检验进行双变量分析:结果:黑人/亚裔儿童首次就诊时的残疾状况扩展量表(EDSS)较高(p = 0.0276),且更有可能开始使用芬戈莫德(fingolimod)而非醋酸格拉替雷(glatiramer acetate)(p = 0.0464)。居住地距离阿拉巴马州儿童医院较远的家庭最近的 EDSS 值较高(p = 0.0301),神经内科就诊次数较少(p = 0.0167)。居住在社会经济条件较差的人口普查区的家庭入院次数明显较多:结论:黑人/非裔美国人POMS患者的初始症状更为严重,开始接受的药物疗效更高。根据与儿童家庭住址相关联的 SDOH 数据,我们确定了 EDSS 和医疗保健利用率方面的差异。
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来源期刊
CiteScore
4.70
自引率
0.00%
发文量
54
审稿时长
15 weeks
期刊最新文献
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