Poisson Kelsey E, Cofield Stacey S, Ness Jayne M
Department of Pediatrics, Division of Neurology, Nationwide Children's Hospital, Columbus, OH, USA.
Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
Mult Scler J Exp Transl Clin. 2024 Aug 26;10(3):20552173241274586. doi: 10.1177/20552173241274586. eCollection 2024 Jul-Sep.
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).
To evaluate racial, ethnic, and socioeconomic disparities in POMS outcomes.
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.
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.
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.
已在黑人/非裔美国人（AA）群体中发现成人型多发性硬化症的健康差异。有研究表明，患有儿童期发病的多发性硬化症（POMS）的黑人/非裔美国患者复发率更高，但很少有研究探讨医疗保健利用情况和健康的社会决定因素（SDOH）。
评估POMS结局中的种族、民族和社会经济差异。
通过回顾性病历审查，确定了2013年至2023年期间在阿拉巴马州儿童医院被诊断为POMS的31例合格患者。收集了诊断后2年的人口统计学、结局和医疗保健利用情况。将患者地址与美国人口普查的SDOH指标相关联。使用Fisher精确检验、Wilcoxin检验和双侧t检验进行双变量分析。
黑人/非裔美国儿童首次就诊时的扩展残疾状态量表（EDSS）得分更高（p = 0.0276），且与醋酸格拉替雷相比，更有可能开始使用芬戈莫德（p = 0.0464）。居住地离阿拉巴马州儿童医院较远与最近的EDSS得分较高（p = 0.0301）和神经科预约次数较少（p = 0.0167）相关。生活在社会经济条件较差的人口普查区的家庭住院次数明显更多。
黑人/非裔美国POMS患者的初始表现更为严重，并开始使用疗效更高的药物。我们根据与儿童家庭住址相关的SDOH数据确定了EDSS和医疗保健利用方面的差异。
