Race And Ethnicity In Multiple Sclerosis

Race and ethnicity are not the same. People of the same race share distinctive physical traits and ancestry. Ethnicity, on the other hand, is a shared experience, specifically cultural. DNA varies by less than 0.1% in any two people chosen at random. Further, at least 85% of the 350,000 known genes are present in all people.

 

African Americans in fact have higher incidence of MS than whites / Caucasians. Hispanic Americans seem to have lower incidence. People who migrate from a high risk to a low risk area in first two decades of life carry the high risk. This is more likely secondary to environmental factors, specifically vitamin D, and viral infections rather than genetic factors. Another important risk factor is obesity, especially in adolescent girls.

 

African Americans are older at onset and have a more severe course with resultant greater disability.

 

A Hispanic person can be of any race. In Hispanic Americans, age of onset appears to be younger than white but neuromyelitis optica much higher, with a prevalence of 19%, comparable to those in Asians. In whites, this disorder is seen in only 2% to 3%. Why should this be so? Likely, there is Asian ancestry in Hispanics from Central and South America.

 

Treatment of MS is greatly affected by race and ethnicity. African Americans are probably less responsive to interferons than whites. On the other hand, Tysabri may be effective in this group, as in Hispanic patients. B-cell therapies may be especially beneficial to African Americans because they have higher IgG index in their cerebrospinal fluid than whites. This, however, has never been tested adequately.

 

Access to healthcare is less in African Americans and Hispanics, especially low-income groups. About a third of patients in MS who are covered by Medicaid / Medi-Cal had never seen an MS specialist and were not receiving treatment-modifying drugs. Factors include mistrust of the healthcare delivery system (recall the Tuskegee syphilis study), less access to health insurance, greater belief in natural remedies, or as language and cultural barriers.

 

Tailoring treatment to a diverse group is a poorly met challenge at this time.

 

See Science of MS Management, summer 2016.

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