Skrehot Henry C, Bhatnagar Anshul, Huang Austin, Lee Andrew G
School of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA.
Neuroophthalmology. 2023 Feb 16;47(3):136-144. doi: 10.1080/01658107.2023.2176891. eCollection 2023.
Multiple sclerosis (MS) is an autoimmune demyelinating disease that often initially presents with optic neuritis (ON). Little is known about the demographic factors and familial histories that may be associated with the development of MS after a diagnosis of ON. We utilised a nationwide database to characterise specific potential drivers of MS following ON as well as analyse barriers to healthcare access and utilisation. The database was queried for all patients who were diagnosed with ON and for all patients diagnosed with MS after an initial diagnosis of ON. Demographic factors, family histories, and survey data were analysed. Multivariable logistic regression was performed to analyse the potential association between these variables of interest with the development of MS following a diagnosis of ON. Out of 369,297 self-enrolled patients, 1,152 were identified to have a diagnosis of ON, while 152 of these patients were diagnosed with MS after ON. ON patients with a family history of obesity were more likely to develop MS (obesity odd ratio: 2.46; < .01). Over 60% of racial minority ON patients reported concern about affording healthcare compared with 45% of White ON patients ( < .01). We have identified a possible risk factor of developing MS after an initial diagnosis of ON as well as alarming discrepancies in healthcare access and utilisation for minority patients. These findings bring attention to clinical and socioeconomic risk factors for patients that could enable earlier diagnosis and treatment of MS to improve outcomes, particularly in racial minorities.
多发性硬化症(MS)是一种自身免疫性脱髓鞘疾病,通常最初表现为视神经炎(ON)。对于视神经炎诊断后可能与多发性硬化症发展相关的人口统计学因素和家族病史,人们了解甚少。我们利用一个全国性数据库来确定视神经炎后多发性硬化症的特定潜在驱动因素,并分析医疗保健获取和利用的障碍。在该数据库中查询所有被诊断为视神经炎的患者以及在视神经炎初步诊断后被诊断为多发性硬化症的所有患者。分析了人口统计学因素、家族病史和调查数据。进行多变量逻辑回归分析这些感兴趣的变量与视神经炎诊断后多发性硬化症发展之间的潜在关联。在369297名自行登记的患者中,有1152人被确诊为视神经炎,其中152名患者在视神经炎后被诊断为多发性硬化症。有肥胖家族史的视神经炎患者更有可能发展为多发性硬化症(肥胖比值比:2.46;P<0.01)。超过60%的少数族裔视神经炎患者表示担心支付医疗费用,而白人视神经炎患者这一比例为45%(P<0.01)。我们确定了视神经炎初步诊断后发展为多发性硬化症的一个可能风险因素,以及少数族裔患者在医疗保健获取和利用方面令人担忧的差异。这些发现引起了人们对患者临床和社会经济风险因素的关注,这些因素可以使多发性硬化症得到更早的诊断和治疗,以改善治疗效果,特别是在少数族裔中。