“MS has long been believed to be more prevalent among White people than Black people, but recent research has found that Black people are actually at higher risk of developing MS than we previously knew,” explains Brooks C. Wingo, PhD. “Black patients with MS may present with different initial symptoms, and some data suggest that Black patients have a faster disease progression. Therefore, it is important to better understand how MS impacts Black patients so that we can treat them in the best possible way.”
For a paper published in the Archives of Physical Medicine and Rehabilitation, Dr. Wingo and colleagues aimed to ascertain the difference in obesity, type 2 diabetes (T2D), and hypertension in Black patients compared with White patients with MS. They conducted a cross-sectional database review of a large academic medical center research records database. The study included 3,191 patient cases (77% female; 34% Black), identified by MS diagnosis in the medical records.
Cardiometabolic Comorbidities Linked With Greater Disability
“We know that among patients with MS, having cardiometabolic comorbidities like obesity, T2D, and hypertension is associated with higher rates of disability and hospitalization,” Dr. Wingo says. “We also know that, in the general population, Blacks are at greater risk for developing these conditions, so we set out to see if the risks of the developing these conditions were different between Black patients and White patients.”
The most important finding was that Black patients were not only at higher risk of developing T2D or hypertension, but that the risk was more than two times greater compared to White patients, Dr. Wingo notes. “The Black patients in our sample were more than two times as likely to ever be diagnosed with T2D (OR, 2.15) or hypertension (OR, 2.44) compared with White patients,” she says. Not surprisingly, she noted, other takeaways were that obesity was also a significant predictor of developing T2D and hypertension, and that odds increase with age (Table).
Black Patients With MS at Particular Risk
“Clinicians should consider cardiometabolic comorbidities as an important factor in the overall health of people with MS,” Dr. Wingo says. “Obesity, T2D, and hypertension, and the lifestyle behaviors associated with many of these conditions (poor diet, physical inactivity, poor sleep quality), have been associated with disability in people with MS. Based on our findings, Black patients with MS are at particular risk of developing these conditions, so physicians should discuss healthy lifestyles with patients and refer recommend intervention when needed.”
The study team also points to social determinants that may contribute to a lack of access to healthcare for Black patients. “Environmental barriers to healthy lifestyle habits, cultural norms, and systemic racism are known to impact health and health-seeking behaviors in Black populations,” Dr. Wingo says. “Lack of awareness regarding the risk for MS in Black populations may further impede patients seeking care or with providers recognizing possible symptoms of MS in this group.”
Dr. Wingo and colleagues recognize some limitations in this study. “We only looked at the patient population of one hospital, and being located in the southeastern United States, our patient population may not translate to other areas of the US or other countries,” she says. “To address this, we need to do additional research on more geographically diverse patient groups. In addition, our study team only had access to patient medical records, with no access to any type of behavioral data.
“In summary, we hope to continue this line of research by examining differences in diet, exercise, and sleep in Black and White patients, as well as conduct longitudinal studies to examine if cardiometabolic conditions and lifestyle behaviors impact disease progression differently in different racial groups.”