Race and ancestry influence the course of multiple sclerosis (MS).
Objectives:
Explore clinical characteristics of MS and neuromyelitis optica spectrum disorder (NMOSD) in Asian American patients.
Methods:
Chart review was performed for 282 adults with demyelinating disease who self-identified as Asian at a single North American MS center. Demographics and clinical characteristics were compared to non-Asian MS patients and by region of Asian ancestry.
Results:
Region of ancestry was known for 181 patients. Most (94.7%) preferred English, but fewer East Asian patients did (80%, p = 0.0001). South Asian patients had higher neighborhood household income (p = 0.002). Diagnoses included MS (76.2%) and NMOSD (13.8%). More patients with NMOSD than MS were East and Southeast Asian (p = 0.004). For MS patients, optic nerve and spinal cord involvement were similar across regions of ancestry. Asian MS patients were younger at symptom onset and diagnosis than non-Asian MS patients. MS Severity Scale scores were similar to non-Asian MS patients but worse among Southeast Asians (p = 0.006).
Conclusions:
MS severity was similar between Asian American patients and non-Asian patients. Region of ancestry was associated with differences in sociodemographics and MS severity. Further research is needed to uncover genetic, socioeconomic, or environmental factors causing these differences.
GBD 2016 Multiple Sclerosis Collaborators. Global, regional, and national burden of multiple sclerosis 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol2019; 18(3): 269–285.
2.
Langer-GouldAMGonzalesEGSmithJB, et al. Racial and ethnic disparities in multiple sclerosis prevalence. Neurology2022; 98(18): e1818–e1827.
3.
CreeBACKhanOBourdetteD, et al. Clinical characteristics of African Americans vs Caucasian Americans with multiple sclerosis. Neurology2004; 63(11): 2039–2045.
4.
Rivas-RodríguezEAmezcuaL. Ethnic considerations and multiple sclerosis disease variability in the United States. Neurol Clin2018; 36(1): 151–162.
5.
DobsonRJitlalMMarshallCR, et al. Ethnic and socioeconomic associations with multiple sclerosis risk. Ann Neurol2020; 87(4): 599–608.
6.
LeTKChaLGeeG, et al. Asian American self-reported discrimination in healthcare and having a usual source of care. J Racial Ethn Health Disparities2023; 10(1): 259–270.
7.
ShahNSKandulaNR. Addressing Asian American misrepresentation and underrepresentation in research. Ethn Dis2020; 30(3): 513–516.
8.
KiraJKanaiTNishimuraY, et al. Western versus Asian types of multiple sclerosis: Immunogenetically and clinically distinct disorders. Ann Neurol1996; 40(4): 569–574.
9.
TsaiCPYuanCLYuHY, et al. Multiple sclerosis in Taiwan. J Chin Med Assoc2004; 67(10): 500–505.
10.
KiraJ. Neuromyelitis optica and Asian phenotype of multiple sclerosis. Ann N Y Acad Sci2008; 1142(1): 58–71.
11.
ChongH. Multiple sclerosis in South East Asia and diagnostic criteria for Asians. Neurology Asia2008; 13(2): 145–146.
12.
SirithoSNakashimaITakahashiT, et al. AQP4 antibody-positive Thai cases: Clinical features and diagnostic problems. Neurology2011; 77(9): 827–834.
13.
ChengQMiaoLZhangJ, et al. Clinical features of patients with multiple sclerosis from a survey in Shanghai, China. Mult Scler2008; 14(5): 671–678.
14.
KimSHHuhSYKimW, et al. Clinical characteristics and outcome of multiple sclerosis in Korea: Does multiple sclerosis in Korea really differ from that in the Caucasian populations?Mult Scler2013; 19(11): 1493–1498.
15.
ZhangYXuYXuT, et al. Prediction of long-term disability in Chinese patients with multiple sclerosis: A prospective cohort study. Mult Scler Relat Disord2020; 46: 102461.
16.
PiccoloLKumarGNakashimaI, et al. Multiple sclerosis in Japan appears to be a milder disease compared to the UK. J Neurol2015; 262(4): 831–836.
17.
AlborCdu SautoyTKali VananN, et al. Ethnicity and prevalence of multiple sclerosis in east London. Mult Scler2017; 23(1): 36–42.
18.
DeanGElianM. Age at immigration to England of Asian and Caribbean immigrants and the risk of developing multiple sclerosis. J Neurol Neurosurg Psychiatry1997; 63(5): 565–568.
19.
NicholasRSKostadimaVHanspalM, et al. MS in South Asians in England: Early disease onset and novel pattern of myelin autoimmunity. BMC Neurol2015; 15(1): 72.
KurtzkeJF. Rating neurologic impairment in multiple sclerosis: An Expanded Disability Status Scale (EDSS). Neurology1983; 33(11): 1444–1452.
22.
RoxburghRHSRSeamanSRMastermanT, et al. Multiple Sclerosis Severity Score: Using disability and disease duration to rate disease severity. Neurology2005; 64(7): 1144–1151.
23.
KisterIKantarciOH. Multiple Sclerosis Severity Score: Concept and applications. Mult Scler2020; 26(5): 548–553.
24.
CalocerFDejardinOKwiatkowskiA, et al. Socioeconomic deprivation increases the risk of disability in multiple sclerosis patients. Mult Scler Relat Disord2020; 40: 101930.
25.
BriggsFBSThompsonNRConwayDS. Prognostic factors of disability in relapsing remitting multiple sclerosis. Mult Scler Relat Disord2019; 30: 9–16.
26.
HeydarpourPManouchehriniaABeikiO, et al. Smoking and worsening disability in multiple sclerosis: A meta-analysis. Acta Neurol Scand2018; 138(1): 62–69.
27.
SundströmPNyströmL. Smoking worsens the prognosis in multiple sclerosis. Mult Scler2008; 14(8): 1031–1035.
28.
BravemanPGottliebL. The social determinants of health: It’s time to consider the causes of the causes. Public Health Rep2014; 129(Suppl. 2): 19–31.
29.
KimWKeefeRH. Barriers to healthcare among Asian Americans. Soc Work Public Health2010; 25(3): 286–295.
30.
MatveevaOBogieJFJHendriksJJA, et al. Western lifestyle and immunopathology of multiple sclerosis: Western lifestyle and MS. Ann N Y Acad Sci2018; 1417(1): 71–86.
31.
FitzgeraldKCTyryTSalterA, et al. A survey of dietary characteristics in a large population of people with multiple sclerosis. Mult Scler Relat Disord2018; 22: 12–18.
32.
Van der MeiIAFPonsonbyALDwyerT, et al. Past exposure to sun, skin phenotype, and risk of multiple sclerosis: Case-control study. BMJ2003; 327(7410): 316–310.
33.
HensonLJ. Health literacy and outcomes in multiple sclerosis. Continuum2016; 22(3): 947–950.
34.
KurashigeL. Two faces of exclusion: The untold history of anti-Asian racism in the United States. Chapel Hill, NC: The University of North Carolina Press, 2020.
35.
TesslerHChoiMKaoG. The anxiety of being Asian American: Hate crimes and negative biases during the COVID-19 pandemic. Am J Crim Justice2020; 45(4): 636–646.
