Place and Race Disparities in MS Healthcare

Background: African Americans/Blacks with multiple sclerosis (MS) experience more aggressive disease courses and worse disability than Whites with the disease. Factors known to contribute to existing racial health disparities, such as place (i.e., one's built/physical environment), quality of and engagement in medical care, and health literacy—have not yet been studied in the MS population.

Objectives: To examine the role of place (i.e., one's built environment), health literacy, and perceptions of quality of patient-provider communication (PPC) in their engagement in health care among African American/Blacks and Whites with MS.

Methods: Mixed method design involving an online REDCap survey and a one-hour in-depth audio-recorded qualitative interview on participants' experiences with healthcare related to MS, demographic background, MS clinical characteristics, experiences of racial discrimination, health literacy, quality of PPC, and mistrust of the medical community. Participants' residential addresses were used to determine information about social determinants of health (SDOH) based on "place" using publicly available U.S. Census Bureau Data.

Results: Participants (N=300) were ___ Black/African American women, ___ White women, ___ Black/African American men, and ___ White men with MS. Black/African Americans reported worse MS disability status (per the PDDS), a higher number of unsuccessful visits with MS neurologists, a longer delay in diagnosis, lower likelihood of being on a disease modifying therapy (DMT) as well as to be receiving any type of ongoing MS care. Mistrust, experiences of discrimination, perceived quality of patient-provider communication, experiences of racial discrimination in the medical and other societal settings mediated the association between ___.

Conclusions: Healthcare factors like PPC, health literacy, mistrust, experiences of discrimination across medical settings, limited resources within one's neighborhood, etc. were associated with lower engagement in MS-related care. Patient engagement level is known to impact health outcomes, thereby indicating that SDOH factors of focus in this study are important to address to optimize patient outcomes particularly among African Americans/Blacks with MS.