Langer-Gould Annette M, Cepon-Robins Tara J, Benn Torres Jada, Yeh E Ann, Gildner Theresa E
Department of Neurology, Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles, CA, USA.
Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
Nat Rev Neurol. 2025 May 27. doi: 10.1038/s41582-025-01096-5.
Disparities in the incidence, prevalence and outcomes of multiple sclerosis (MS) exist in the USA, often to the detriment of Black and Hispanic people. Despite the common misconception that MS is a disease of white people, the incidence is highest in Black people. Disability accumulates faster and at younger ages in Black and Hispanic people with MS than in their white counterparts, and MS-related mortality in early and mid-adulthood is highest in Black people. These differences are often erroneously interpreted as evidence of innate racial or ethnic variations. In this Perspective, we demonstrate how race and ethnicity - social constructs with a limited biological basis that are often assigned by systems of power - can influence biology through lived experiences, a phenomenon termed 'embodiment'. We review how downstream consequences of structural racism can lead to biological outcomes strongly associated with MS susceptibility, such as imbalanced immune system development, dysregulated immune responses to the Epstein-Barr virus and childhood obesity. We also consider how inequitable health-care access and quality, combined with the younger age of onset and higher comorbidity burdens, might explain racial and ethnic disparities in MS prognosis. Our proposed conceptual model offers a roadmap for generating knowledge and implementing interventions to narrow racial and ethnic disparities in MS susceptibility and outcomes.
在美国，多发性硬化症（MS）的发病率、患病率及预后存在差异，这往往对黑人和西班牙裔人群不利。尽管人们普遍误解MS是白人的疾病，但黑人的发病率却是最高的。与患有MS的白人相比，黑人和西班牙裔MS患者的残疾累积速度更快，且发病年龄更小，此外，黑人群体在成年早期和中期与MS相关的死亡率最高。这些差异常常被错误地解读为先天种族或族裔差异的证据。在这篇观点文章中，我们展示了种族和族裔——这些基于有限生物学基础的社会建构，通常由权力系统赋予——是如何通过生活经历影响生物学的，这一现象被称为“具身化”。我们回顾了结构性种族主义的下游后果如何导致与MS易感性密切相关的生物学结果，例如免疫系统发育失衡、对爱泼斯坦-巴尔病毒的免疫反应失调以及儿童肥胖。我们还探讨了不公平的医疗保健获取和质量，再加上发病年龄较小和合并症负担较高，可能如何解释MS预后中的种族和族裔差异。我们提出的概念模型为生成知识和实施干预措施提供了路线图，以缩小MS易感性和预后方面的种族和族裔差异。
