Madera Ashley, Schrodt Clare, Mendizabal Adys
Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles (UCLA), Los Angeles, California, USA.
Curr Opin Neurol. 2025 Aug 1;38(4):337-342. doi: 10.1097/WCO.0000000000001376. Epub 2025 May 21.
Disparities in care and outcomes are well described in common neurologic disorders; however, less is known about disparities in rare diseases such as Huntington's disease (HD). This review summarizes HD epidemiology in the US and globally while highlighting disparities in HD diagnosis and outcomes across various HD groups. The review also discusses how the lack of diversity in HD research threatens the validity of clinical trials and raises concerns about global accessibility to emerging therapies.
Global HD prevalence and incidence vary worldwide, though the highest numbers are reported in Latin American cluster regions. Within North America, there are disparities in diagnosis and outcomes among Black and Latino patients. Socioeconomic status, educational attainment, and sex were also associated with differences in diagnosis, access, and outcomes. Many of the recent studies in this review used the ENROLL-HD longitudinal study. Yet, the dataset is 90% White Non-Hispanic, leading to an incomplete understanding of how HD manifests in diverse groups.
Racial, sex, and socioeconomic disparities exist in HD care and research. Addressing these disparities is imperative in improving access to HD care, clinical trial participation, and disease-specific outcomes for all patients with HD in the US and worldwide.
常见神经系统疾病在医疗护理和治疗结果方面的差异已有详尽描述;然而,对于亨廷顿舞蹈病(HD)等罕见疾病的差异了解较少。本综述总结了美国及全球范围内的HD流行病学情况,同时突出了不同HD群体在诊断和治疗结果方面的差异。该综述还讨论了HD研究缺乏多样性如何威胁临床试验的有效性,并引发了对新兴疗法全球可及性的担忧。
全球HD患病率和发病率在世界各地有所不同,不过拉丁美洲聚集地区报告的病例数最多。在北美,黑人和拉丁裔患者在诊断和治疗结果方面存在差异。社会经济地位、教育程度和性别也与诊断、就医机会和治疗结果的差异有关。本综述中的许多近期研究使用了“HD注册登记纵向研究”。然而,该数据集90%为非西班牙裔白人,导致对HD在不同群体中的表现了解不全面。
HD护理和研究中存在种族、性别和社会经济差异。解决这些差异对于改善美国和全球所有HD患者获得HD护理的机会、参与临床试验的机会以及特定疾病的治疗结果至关重要。