Living with MS: An AfricanAmerican Perspective

1
Living with MS An African-American Perspective

• Mary D. Hughes, M.D.
• Medical Director, Augusta MS Center
• Medical College of Georgia

2
Issues

• Health Care disparities
• Access
• Treatment
• Differences in Disease Course
• Differences in treatment recommendations

3
Access to health care differs

• Womens Health
• Less likely to receive care
• More likely to receive it late
• Immunization rates
• Pneumonia vaccine rates 26 versus 50
• Flu vaccine rates 47 versus 66

4
Diseases that we know are different

• Diabetes
• Hypertension
• Heart disease
• Stroke
• Osteoporosis

5
So what do we know about MS in African Americans?
6
Multiple Sclerosis in the Negro
Alter, M Archives of Neurology, 1962

• The evidence for a difference in susceptibility
  between white and Negro races is conflicting.
• As to the possibility that MS in Negroes is
  atypical, little can be said because there are so
  few reports describing the disease in this race.

7
Multiple Sclerosis in the Negro
Alter, M Archives of Neurology, 1962

• The clinical features of the disease as noted in
  the present series do not suggest that the
  disease in Negro is peculiar or different as
  compared to non-Negroes.

8
Epidemiology of multiple sclerosis in US
veteransVII. Risk factors for MS
Kurtzke, J. Neurology 1997

• Among black male WWII subjects, MS risk was
  significantly higher among those with more
  education, higher socioeconomic status, and
  higher service test score

9
Epidemiology of multiple sclerosis in US
veteransVII. Risk factors for MS
Kurtzke, J. Neurology 1997

• .there were insufficient numbers of black women
  and women of other races to permit their study.

10
Tuskegee Syphilis Experiment

• The United States government did something that
  was wrong-deeply, profoundly, morally wrong. It
  was an outrage to our commitment to integrity and
  equality for all our citizens. Clearly racist.

President Clintons apology May 1997
11
This is a NO-Treatment Study by your Public
Health Service
12
MS in Africa?
13
Multiple Sclerosis epidemic in Kenya

• Adams, AM
• East African Medical Journal
• 1989

Review of 6 patients
14
Optic Neuritis in African Americans
Phillip, P Archives of Neurology, 1998

• The AA study patients with a single episode of
  demyelinating optic neuritis had visual acuities
  more severely affected at onset and after 1 year
  of follow-up compared with the white study
  patients and with patients in the ONTT.

15
Optic Neuritis in African Americans
Phillip, P Archives of Neurology, 1998

• In the AA patients, MS occurred more frequently
  in a neuromyelitis optica form.

16
Racial Differences in Disease Severity in
Patients with Multiple Sclerosis

• Alshami, D Jeffrey, D.
• Abstract P04.034
• AAN, 1998

Retrospective study 50 patients 25 B 25 W
17
Racial Differences in Disease Severity in
Patients with Multiple Sclerosis
18
Racial Differences in Disease Severity in
Patients with Multiple Sclerosis
19
Racial Differences in Disease Severity in
Patients with Multiple Sclerosis
20
Multiple SclerosisSeverity and Progression Rate
in African Americans Compared with Whites

• Kaufman et al.
• Am J Phys Med Rehabil
• 2003

• Case-controlled, Retrospective record review
• More AA experience pyramidal system involvement
  early in MS, leading to greater disability
• Once patients reached moderate difficulty in
  walking the rate of progression was the same for
  both groups

21
Multiple Sclerosis characteristics in African
American patients in the New York State MS
Consortium
Weistock-Guttman,B et al. Multiple Sclerosis 2003
Number of patients on DMT was similar in both
groups
22
EDSS versus Years since Diagnosis
n320 AA n5071 Non-AA
23
Mean Disease Duration and EDSSCerebral Function
Score
24
Multiple Sclerosis Disease Activity in Patients
of Different Ethnic Origin Data from the
Evidence Trial

• P01.120
• Cree, C et al.
• AAN 2004

Subgroup Analysis
25
(No Transcript)
26
(No Transcript)
27
(No Transcript)
28
(No Transcript)
29
Issues

• Health Care disparities
• Access
• Treatment
• Differences in Disease Course
• Differences in treatment recommendations

30
Thank You