Marrie R A, Cutter G, Tyry T, Vollmer T, Campagnolo D
Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Neurology. 2006 Apr 25;66(8):1235-40. doi: 10.1212/01.wnl.0000208505.81912.82.
To investigate differences in disability between African American and Caucasian patients with multiple sclerosis (MS) by comparing the relationship between current age and disability between races and by assessing the effect of adjustment for socioeconomic status (SES) on the associations.
The authors selected US participants from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry with an age at symptom onset of 10 to 60 years, who reported their race as Caucasian or African American (n = 21,557). They classified participants as having mild, moderate, or severe disability in the domains of mobility, hand function, cognition, and vision using Patient Determined Disease Steps and Performance Scales and assessed the association of disability with race using polytomous logistic regression.
Disability increased more rapidly with increasing disease duration in older patients, but there was no interaction between race and age. African Americans had increased odds of severe vs mild disability in all four domains (odds ratio [OR] [95% CI]: hand 1.35 [1.10 to 1.64]; vision 1.75 [1.37 to 2.27]; cognition 1.32 [1.04 to 1.67]; mobility 1.32 [1.11 to 1.56]). Adjustment for all covariates, including SES, attenuated these associations (OR [95% CI]: hand 1.27 [1.00 to 1.61]; vision 1.59 [1.19 to 2.08]; cognition 0.98 [0.74 to 1.30]; mobility 1.37 [1.11 to 1.67]). Lack of adjustment for SES produced stronger associations. After enrollment in NARCOMS, disability progression did not differ between the groups.
African Americans experience greater multiple sclerosis-associated disability than Caucasians. Failure to account for socioeconomic status leads to overestimation of these differences. Disease progression is similar in African Americans and Caucasians after diagnosis.
通过比较不同种族当前年龄与残疾之间的关系，并评估社会经济地位（SES）调整对两者关联的影响，来研究非裔美国人和白人多发性硬化症（MS）患者在残疾方面的差异。
作者从北美多发性硬化症研究委员会（NARCOMS）注册中心选取了症状发作年龄在10至60岁之间、将自己的种族报告为白种人或非裔美国人的美国参与者（n = 21,557）。他们使用患者确定的疾病阶段和表现量表将参与者在运动、手部功能、认知和视觉领域的残疾程度分为轻度、中度或重度，并使用多分类逻辑回归评估残疾与种族之间的关联。
在老年患者中，残疾程度随疾病持续时间的增加而增长得更快，但种族与年龄之间没有相互作用。在所有四个领域中，非裔美国人出现重度残疾而非轻度残疾的几率更高（优势比[OR][95%置信区间]：手部1.35[1.10至1.64]；视觉1.75[1.37至2.27]；认知1.32[1.04至1.67]；运动1.32[1.11至1.56]）。对包括SES在内的所有协变量进行调整后，这些关联减弱（OR[95%置信区间]：手部1.27[1.00至1.61]；视觉1.59[1.19至2.08]；认知0.98[0.74至1.30]；运动1.37[1.11至1.67]）。未对SES进行调整会产生更强的关联。纳入NARCOMS后，两组之间的残疾进展没有差异。
与白人相比，非裔美国人经历的多发性硬化症相关残疾更严重。未考虑社会经济地位会导致对这些差异的高估。诊断后，非裔美国人和白人的疾病进展相似。
