Association of socioeconomic disadvantage and neighborhood disparities with clinical outcomes in multiple sclerosis patients

Abbatemarco, Justin R.; Carlson, Alise K; Ontaneda, Daniel; McGinley, Marisa; Bermel, Robert; Husak, Scott; Bruckman, David; Schold, Jesse D.; Miller, Deborah

doi:10.1016/j.msard.2022.103734

Cited by 11 publications

(4 citation statements)

References 28 publications

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“…Damage accrual within these areas, as well as maladaptive functional rewiring (Petracca et al, 2018 could partly account for the observed disability gradient. The role of social differences however, recently reported specifically for processing speed and manual dexterity outcomes (Abbatemarco et al, 2022), should not be overlooked.…”

Section: Discussionmentioning

confidence: 97%

Disability outcomes in early-stage African American and White people with multiple sclerosis

Petracca

Palladino²,

Droby³

et al. 2023

Multiple Sclerosis and Related Disorders

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Section: Discussionmentioning

confidence: 97%

Disability outcomes in early-stage African American and White people with multiple sclerosis

Petracca

Palladino²,

Droby³

et al. 2023

Multiple Sclerosis and Related Disorders

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“…17 Their analysis was performed separately for White and Black patients, whereas all groups in our sample were included in regression models so as to compare the strength of associations between race and ethnicity with EDSS and that of SDOH indicators. Abbatemarco et al 18 reported that higher ADI was associated with poorer outcomes and that Black patients represented a higher proportion of residents of the lowest ADI quartiles, but outcomes were not reported by race, and the role of ADI in racial disparities was not explored. None of these previous reports included a Hispanic patient subgroup.…”

Section: Discussionmentioning

confidence: 99%

“…15,16 The present study utilizes regression modeling to determine the degree to which racial and ethnic differences in MSAD are attenuated by the inclusion of SDOH indicators, including NLI. Other studies [17][18][19] have used a combination of individual-level data and NLI to show associations of MSAD with SDOH, but the work presented here is novel in that it specifically interrogates the relationships between SDOH and MSAD disparities.…”

Section: Introductionmentioning

confidence: 99%

Social determinants of health and disparate disability accumulation in a cohort of Black, Hispanic, and White patients with multiple sclerosis

Orlando,

Pérez,

Agyei

et al. 2023

Mult Scler

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Background: Black and Hispanic patients with multiple sclerosis (MS) have been shown to accumulate greater multiple sclerosis–associated disability (MSAD) than White patients. Disparities in social determinants of health (SDOH) among these groups have also been reported. Objective: To determine the extent to which associations of race and ethnicity with MSAD may be attributable to differences in SDOH. Methods: Retrospective chart analysis of patients at an academic MS center grouped by self-identified Black ( n = 95), Hispanic ( n = 93), and White ( n = 98) race/ethnicity. Individual patient addresses were geocoded and matched with neighborhood-level area deprivation index (ADI) and social vulnerability index (SVI). Results: Average Expanded Disability Status Scale (EDSS) scores at last-recorded evaluations of White patients (1.7 ± 2.0) were significantly lower than Black (2.8 ± 2.4, p = 0.001) and Hispanic (2.6 ± 2.6, p = 0.020) patients. Neither Black race nor Hispanic ethnicity was significantly associated with EDSS in multivariable linear regression models that included individual-level SDOH indicators and either ADI or SVI. Conclusion: Black race and Hispanic ethnicity are not significantly associated with EDSS in models that include individual and neighborhood-level SDOH indicators. Further research should elucidate mechanisms by which structural inequities affect MS disease course.

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“…There is increasing evidence that social risk factors are associated with poor health and worse health outcomes, 2 , 3 , 4 , 5 , 6 and the debate over adjusting performance metrics for social risk factors is gaining interest. Social risk adjustment advocates argue that excluding these factors from performance metrics can overly penalize hospitals and centers serving populations with high social risk and adjustment can help address this concern.…”

Section: Introductionmentioning

confidence: 99%

Population Characteristics and Organ Procurement Organization Performance Metrics

Lopez,

Mohan,

Schold

2023

JAMA Netw Open

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ImportanceIn 2020, the Centers for Medicare &amp; Medicaid Services (CMS) issued a final rule updating the Organ Procurement Organization (OPO) Conditions for Coverage. This rule evaluates OPO performance based on an unadjusted donation rate and an age-adjusted transplant rate; however, neither considers other underlying population differences.ObjectiveTo evaluate whether adjusting for age and/or area deprivation index yields the same tier assignments as the cause, age, and location consistent (CALC) tier used by CMS.Design, Setting, and ParticipantsThis retrospective cross-sectional study examined the performance of 58 OPOs from 2018 to 2020 across the entire US. A total of 12 041 778 death records were examined from the 2017 to 2020 National Center for Health Statistics’ Restricted Vital Statistics Detailed Multiple Cause of Death files; 399 530 of these met the definition of potential deceased donor. Information about 42 572 solid organ donors from the Scientific Registry of Transplant Recipients was also used. Statistical analysis was performed from January 2017 to December 2020.ExposureArea deprivation of donation service areas and age of potential donors.Main Outcome and MeasuresOPO performance as measured by donation and transplant rates.ResultsA total of 399 530 potential deceased donors and 42 572 actual solid donor organs were assigned to 1 of 58 OPOs. Age and ADI adjustment resulted in 19.0% (11 of 58) to 31.0% (18 of 58) reclassification of tier ratings for the OPOs, with 46.6% of OPOs (27 of 58) changing tier ranking at least once during the 3-year period. Between 6.9% (4 of 58) and 12.1% (7 of 58) moved into tier 1 and up to 8.6% (5 of 58) moved into tier 3.Conclusions and RelevanceThis cross-sectional study of population characteristics and OPO performance metrics found that adjusting for area deprivation and age significantly changed OPO measured performance and tier classifications. These findings suggest that underlying population characteristics may alter processes of care and characterize donation and transplant rates independent of OPO performance. Risk adjustment accounting for population characteristics warrants consideration in prospective policy and further evaluation of quality metrics.

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Association of socioeconomic disadvantage and neighborhood disparities with clinical outcomes in multiple sclerosis patients

Cited by 11 publications

References 28 publications

Disability outcomes in early-stage African American and White people with multiple sclerosis

Disability outcomes in early-stage African American and White people with multiple sclerosis

Social determinants of health and disparate disability accumulation in a cohort of Black, Hispanic, and White patients with multiple sclerosis

Population Characteristics and Organ Procurement Organization Performance Metrics

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