Disability and race in MS: Does socioeconomic disadvantage play a role?

BACKGROUND: Black individuals with multiple sclerosis (MS) experience greater disability than White individuals with MS, but the extent to which this disparity is driven by genetic versus environmental factors remains unclear. Social Determinants of Health (SDoH) are significant contributors to varied health outcomes due to their influence on healthcare access and disease management. OBJECTIVE: To evaluate whether socioeconomic disadvantage, measured using the Area Deprivation Index (ADI), attenuates the observed association between race and MS-related disability. METHODS: In this retrospective study of 1135 patients at a single MS center, we assessed whether accounting for SDoH using the ADI, a composite of neighborhood-level poverty, housing, education, and employment, would attenuate the association between Black race and MS-related disability. RESULTS: After adjusting for confounders such as age and vascular risk factors, we found that while Black patients initially had an 86% higher odds of disability, this difference was attenuated to 72% after adjusting for socioeconomic disadvantage using ADI. CONCLUSION: Adjusting for neighborhood-level socioeconomic disadvantage reduces, but does not eliminate, racial disparities in MS-related disability. Persistent differences highlight the need to further examine structural inequities, healthcare access, and additional social determinants contributing to MS outcomes.