Keck School of Medicine, Department of Neurology, University of Southern California, Los Angeles.
Department of Neurology, Baylor College of Medicine, Houston, Texas.
JAMA Neurol. 2021 Dec 1;78(12):1515-1524. doi: 10.1001/jamaneurol.2021.3416.
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.
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.
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.
有经验证据表明，健康的社会决定因素（SDOH）会影响美国黑人和西班牙裔及拉丁裔个体的健康结果。最近，SDOH 已成为重要的干预目标，这些目标可能有助于缓解种族和族裔差异。视神经脊髓炎谱系障碍（NMOSD）不成比例地影响黑人，多发性硬化症（MS）在某些种族群体中也出现了近期的转变。目前尚不清楚 SDOH 在多大程度上得到了调查，并对种族和族裔健康差异和不平等产生了影响。
本叙述性综述提供了与 MS、NMOSD 及其他自身免疫性疾病（如髓鞘少突胶质细胞糖蛋白抗体（MOG-Ab）相关疾病）的种族和族裔健康差异和不平等相关的 SDOH 的当代综合分析。选择这些免疫介导的神经疾病是因为它们对社会有很高的负担，并且少数族裔群体中存在互补的 SDOH 相关挑战。尽管发现与白人相比，黑人患 MS 或 NMOSD 及其相关死亡率的风险更高，但仍注意到针对 MS 和 NMOSD 中不平等问题以及 SDOH 作用的研究很少。在 MS 中，还发现收入和教育水平较低、健康素养较低以及对疾病的负面看法的人存在更大的健康差异。在 MOG-Ab 疾病中没有发现研究。
需要加大努力，更好地了解 SDOH 在 MS、NMOSD 和新兴自身免疫性疾病中的种族和族裔健康差异和不平等中的作用。这包括制定研究框架，旨在了解 SDOH 的规模和相互关系，以便更好地为这些神经状况的护理谱制定基于系统的多层次干预措施。
