Amezcua Lilyana, Cardenas-Iniguez Carlos, Orlando Christopher, Martinez Andrea, Nahar Iffat, Delgado Silvia R, Manrique Clara Patricia, Vicente Ivonne, Chinea Angel, McCauley Jacob L, Islam Khandaker Talat S
Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles.
Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles.
Neurology. 2025 Feb 11;104(3):e213332. doi: 10.1212/WNL.0000000000213332. Epub 2025 Jan 16.
Multiple sclerosis (MS)-related disability in Hispanic people with MS is associated with inequities in social determinants of health (SDOH) as measured by composite indices of areal-level census data. Studies of individual-level measures of SDOH are lacking. This study examined the separate and joint effects of person-centered SDOH indicators and an area-level composite on MS disability measures.
Hispanic people diagnosed with MS (≤5 years) who had SDOH and Social Deprivation Index (SDI) based on 2015-2019 American Community Survey estimates were included. At study entry, data on MS disability outcomes were collected: Expanded Disability Status Scale (EDSS) score, Symbol Digit Modality Test (SDMT) score, Hauser Ambulation Index (HA index), and 25-Foot Walk Time (25FWT). Principal component analysis was used to identify person-centered SDOH factors, mapped across a socioecological model. Multivariable regression modeling measured separate and joint effects of SDOH principal components (PCs) and SDI on outcome measures.
Of the 170 participants with MS, most were women (71.9%) and had a mean age at first symptom of 34.01 (SD ±11.24) years and at diagnosis of 36.27 (SD ±10.68) years. The top 2 PCs were identified to represent person-centered SDOH related to assimilation and socioeconomic disadvantage in multivariable models. In both separate and joint effect models, both PC1 and PC2 were significantly associated with longer 25FWT (β 0.43, 95% CI 0.04-0.82, and β 0.66, 95% CI 0.28-1.05), higher HA index (β 0.22, 95% CI 0.04-0.41, and β 0.31, 95% CI 0.12-0.51), and higher EDSS score (β 0.39, 95% CI 0.16-0.62, and β 0.36, 95% CI 0.13-0.60). PC1 was also significantly associated with a lower SDMT score (β -4.15, 95% CI -5.60 to -2.69). SDI was significantly associated with lower SDMT score and higher HA index in separate effect models but was not associated with any outcome measure in joint effect models with PCs.
Our findings suggest that census-based indicators may underestimate the effect of SDOH on MS outcomes and the person-centered level measures are better markers of disease severity in Hispanic people with MS. Future research and policy change can focus on the amelioration of assimilation barriers and socioeconomic disadvantage because these were strongly associated with MS-related ambulatory and cognitive disability.
通过区域层面人口普查数据的综合指数衡量，西班牙裔多发性硬化症（MS）患者的与MS相关的残疾与健康社会决定因素（SDOH）方面的不平等现象有关。缺乏对个体层面SDOH指标的研究。本研究探讨了以个人为中心的SDOH指标和区域层面综合指标对MS残疾指标的单独及联合影响。
纳入根据2015 - 2019年美国社区调查估计拥有SDOH和社会剥夺指数（SDI）的、诊断为MS（≤5年）的西班牙裔患者。在研究开始时，收集MS残疾结局数据：扩展残疾状态量表（EDSS）评分、符号数字模态测验（SDMT）评分、豪泽步行指数（HA指数）和25英尺步行时间（25FWT）。主成分分析用于识别以个人为中心的SDOH因素，并映射到社会生态模型中。多变量回归模型测量SDOH主成分（PCs）和SDI对结局指标的单独及联合影响。
在170名MS患者中，大多数为女性（71.9%），首次出现症状时的平均年龄为34.01（标准差±11.24）岁，诊断时的平均年龄为36.27（标准差±10.68）岁。在多变量模型中，确定前两个PCs代表与同化和社会经济劣势相关的以个人为中心的SDOH。在单独效应模型和联合效应模型中，PC1和PC2均与更长的25FWT显著相关（β 0.43，95%置信区间0.04 - 0.82，以及β 0.66，95%置信区间0.28 - 1.05）、更高的HA指数（β 0.22，95%置信区间0.04 - 0.41，以及β 0.31，95%置信区间0.12 - 0.51）和更高的EDSS评分（β 0.39，95%置信区间0.16 - 0.62，以及β 0.36，95%置信区间0.13 - 0.60）。PC1还与更低的SDMT评分显著相关（β -4.15，95%置信区间 -5.60至 -2.69）。在单独效应模型中，SDI与更低的SDMT评分和更高的HA指数显著相关，但在与PCs的联合效应模型中与任何结局指标均无关联。
我们的研究结果表明，基于人口普查的指标可能低估了SDOH对MS结局的影响，并且以个人为中心的层面指标是西班牙裔MS患者疾病严重程度的更好指标。未来的研究和政策变革可以专注于改善同化障碍和社会经济劣势，因为这些与MS相关的步行和认知残疾密切相关。
