Relationships between neighborhood deprivation,race,and worsening outcomes among MS patients 55 years of age and older

Abstract

Background:

Many factors are associated with aging on multiple sclerosis progression. We assess associations of neighborhood resources and race with outcomes in aging people with multiple sclerosis (PwMS).

Purpose:

We evaluated if worsening outcomes differed by neighborhood resources and race for PwMS age >55.

Methods:

A longitudinal cohort study of 1456 PwMS (mean age 61.7 (standard deviation (SD): 5.5), 73% female, 87% White race) was conducted at tertiary MS centers between 2015 and 2021 with 3–5 years of follow-up. Predictors included area deprivation index (ADI) and race. Outcomes included 10 Neuro-QoL domains and three performance measures: manual dexterity test (MDT dominant hand), walking speed test (WST), and processing speed test (PST), with worsening defined using clinically meaningful changes.

Results:

In adjusted models, greater ADI (i.e. fewer resources) was associated with worsening MDT and WST (odds ratio (95% confidence interval (CI)) = 1.12 (1.05–1.19), 1.09 (1.02–1.16), respectively), and with worsening on Neuro-QoL domains of social roles, stigma, and fatigue. Patients of Black race had less worsening on social roles and depression, compared to patients of White race.

Conclusion:

Our study demonstrated an association between fewer neighborhood resources and worsening performance measures and self-reported outcomes. This study demonstrates that neighborhood deprivation, but less likely race, may play a role in worsening for PwMS >55 years.