Impact of Geographic and Person-Centered Barriers on Clinical Outcomes of Latino Patients With Multiple Sclerosis and Related Disorders
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Background
Social and geographic barriers contribute to worse outcomes in patients with multiple sclerosis (MS) and related disorders, but these factors remain poorly characterized among Latino patients. We evaluated associations between distance to specialty care, neighborhood deprivation, insurance status, and clinical outcomes among Latinos with MS and related disorders.
Methods
We conducted a retrospective study of Latino adults with MS, neuromyelitis optica spectrum disorder, and myelin oligodendrocyte glycoprotein antibody-associated disease. Demographic, clinical, and socioeconomic variables were abstracted from the medical record. Distance to care was defined as residence ≥50 vs. <50 miles from clinic and neighborhood deprivation as Area Deprivation Index (ADI) state rank. We used unadjusted and multivariable regression to evaluate associations with Expanded Disability Status Scale (EDSS) score, annualized relapse rate (ARR), and disease-modifying therapy (DMT) non-adherence.
Results
Among 99 Latino patients, 84 had MS, 11 MOGAD, and 4 NMOSD; 46.5% lived ≥50 miles from clinic. Living ≥50 miles from clinic was associated with higher EDSS scores in unadjusted analyses, but not after covariate adjustment. In multivariable analyses, Medicaid insurance was associated with higher EDSS compared with commercial insurance (β=1.071, p=0.031) and higher ARR (β=0.230, p=0.022). Higher ADI showed a non-significant trend toward higher EDSS (β=0.147 per 1-decile increase, p=0.068). DMT non-adherence was not significantly associated with covariates.
Conclusions
In this cohort of Latinos with CNS demyelinating diseases, Medicaid insurance was associated with greater disability level and higher relapse activity. These findings suggest that insurance status should be considered when designing strategies to improve access to neuroimmunology care.
