From the Departments of Neurology (R.R., K.A.O.N., R.K., A.S., L.B.K.), Population Health (R.K.), and Radiology (J.T.L.), New York University Grossman School of Medicine, New York; Department of Neurology (R.R.), Weill Cornell Medical Center, New York; Department of Biostatistics (R.A.B.), New York University School of Global Public Health, New York; icometrix (T.B.), Leuven, Belgium; Department of Pediatrics (M.M.-S.), Baylor College of Medicine, Houston, TX; Jan and Dan Duncan Neurological Research Institute at Texas Children's Hospital (M.M.-S.), Houston; and Department of Pediatrics (H.D.M., M.W.), University of Utah, Salt Lake City.
Neurology. 2024 Dec 24;103(12):e210140. doi: 10.1212/WNL.0000000000210140. Epub 2024 Nov 27.
Accumulating evidence points to worse clinical outcomes among adults with multiple sclerosis (MS) belonging to minority or poverty-affected groups. By contrast, little is known about the outcomes of these populations with pediatric-onset MS (POMS). Individuals with POMS represent 5% of the MS population and are more racially diverse yet have been understudied regarding socioeconomic environment or characteristics. In this study, we investigated the association between childhood social determinants of health (SDOH) and brain MRI outcomes in patients with POMS.
This is a retrospective single-site cohort study of patients with POMS with brain MRI quantitatively analyzed using icobrain software to yield total white matter lesion, black hole, whole brain, white matter, and gray matter volumes. All patients with POMS evaluated at New York University Langone MS Center and who underwent high-quality volumetric MRI scans were included in this study. SDOH indicators of race, ethnicity, health insurance type, parental education, and childhood neighborhood social vulnerability index (SVI) were examined for association with MRI outcomes using linear least absolute shrinkage selection operator penalized regression modeling. Disease-modifying therapy (DMT) timing and DMT efficacy were compared for each SDOH category.
A total of 138 patients with POMS (70% female) were included with a mean age of 19.86 years and median disease duration of 4 years at time of scan. Public health insurance, Black race, Hispanic ethnicity, low parental education, and high SVI (greater neighborhood disadvantage) were each associated with white matter lesion and black hole volume. SVI was the strongest individual predictor of total white matter lesion (β = 4.63, = 0.002) and black hole volume (β = 2.91, = 0.003). In models incorporating all SDOH variables, public health insurance was the strongest predictor of total lesion (β = 2.48, = 0.01) and black hole volume (β = 1.50, = 0.02), attenuating the effect of SVI (β = 1.66, = 0.33 and β = 1.00, = 0.39). There were no differences in DMT timing or efficacy between categories of social disadvantage.
Individual-level and neighborhood-level indicators of social disadvantage are associated with worse brain MRI outcomes in POMS. Further investigation of race, ethnicity, and childhood disadvantage as risk factors of MS susceptibility and severity is needed to reduce MS health disparities.
越来越多的证据表明，多发性硬化症（MS）患者属于少数民族或贫困群体，其临床结局更差。相比之下，对于儿科发病的 MS（POMS）患者，人们对这些人群的结局知之甚少。POMS 患者占 MS 患者的 5%，他们的种族更加多样化，但在社会经济环境或特征方面的研究较少。在这项研究中，我们调查了儿童健康社会决定因素（SDOH）与 POMS 患者脑 MRI 结果之间的关联。
这是一项回顾性单站点队列研究，纳入了在纽约大学朗格尼医学中心接受脑 MRI 定量分析的 POMS 患者，采用 icobrain 软件得出总白质病变、黑洞、全脑、白质和灰质体积。本研究纳入了所有在纽约大学朗格尼医学中心接受评估且接受高质量容积 MRI 扫描的 POMS 患者。使用线性最小绝对收缩选择算子惩罚回归模型，研究种族、族裔、医疗保险类型、父母教育程度和儿童邻里社会脆弱性指数（SVI）等 SDOH 指标与 MRI 结果的相关性。比较了每个 SDOH 类别的疾病修正治疗（DMT）时机和 DMT 疗效。
共纳入 138 名 POMS 患者（70%为女性），平均年龄为 19.86 岁，扫描时的中位病程为 4 年。公共医疗保险、黑人、西班牙裔、父母教育程度低和 SVI 高（邻里劣势更大）与白质病变和黑洞体积相关。SVI 是总白质病变（β=4.63， =0.002）和黑洞体积（β=2.91， =0.003）的最强个体预测指标。在纳入所有 SDOH 变量的模型中，公共医疗保险是总病变（β=2.48， =0.01）和黑洞体积（β=1.50， =0.02）的最强预测指标，削弱了 SVI 的作用（β=1.66， =0.33 和β=1.00， =0.39）。社会劣势类别的 DMT 时机或疗效无差异。
个体和邻里层面的社会劣势指标与 POMS 的脑 MRI 结果较差相关。需要进一步研究种族、族裔和儿童劣势作为 MS 易感性和严重程度的危险因素，以减少 MS 健康差距。
