Unmasking the Masquerader: A Delayed Diagnosis of MS and Its 4.5 Years of Implications in an Older African American Male

Dong, Deanna; Carlson, Joshua P.; Ruberwa, Joseph; Snihur, Thomas; Al-Obaidi, Nawar; Bustillo, José

doi:10.1155/2019/5787206

Cited by 3 publications

(5 citation statements)

References 19 publications

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“…Several studies have shown that African Americans have significantly higher CNS lesion burden, more frequent relapses, worse ambulatory disability, worse post-relapse recoveries, and higher overall disability at diagnosis [5,10,19,29]. Overall, our findings did not confirm these prior observations and we believe that the similar socioeconomic background of this patient cohort, along with the small sample size, may have contributed to this.…”

Section: Discussioncontrasting

confidence: 94%

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Multiple Sclerosis in a Multi-Ethnic Population in Houston, Texas: A Retrospective Analysis

et al. 2020

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Multiple Sclerosis (MS) is a progressive neurodegenerative disease that affects more than 2 million people worldwide. Increasing knowledge about MS in different populations has advanced our understanding of disease epidemiology and variation in the natural history of MS among White and minority populations. In addition to differences in incidence, African American (AA) and Hispanic patients have greater disease burden and disability in earlier stages of disease compared to White patients. To further characterize MS in AA and Hispanic populations, we conducted a retrospective chart analysis of 112 patients treated at an MS center in Houston, Texas. Here, we describe similarities and differences in clinical presentation, MRI findings, treatment regimens, disability progression, and relapse rate. While we found several similarities between the groups regarding mean age, disability severity, and degree of brain atrophy at diagnosis, we also describe a few divergences. Interestingly, we found that patients who were evaluated by a neurologist at symptom onset had significantly decreased odds of greater disability [defined as Expanded Disability Status Scale (EDSS) > 4.5] at last presentation compared to patients who were not evaluated by a neurologist (OR: 0.04, 95% CI: 0.16–0.9). We also found that active smokers had significantly increased odds of greater disability both at diagnosis and at last clinical encounter compared to nonsmokers (OR: 2.44, 95% CI: 1.10–7.10, OR= 2.44, 95% CI: 1.35–6.12, p = 0.01, respectively). Additionally, we observed significant differences in treatment adherence between groups. Assessment of the degree of brain atrophy and progression over time, along with an enumeration of T1, T2, and gadolinium-enhancing brain lesions, did not reveal differences across groups.

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Section: Discussioncontrasting

confidence: 94%

“…Consistent with published reports, a greater proportion of NH-Black patients had early severe disability (defined in our study as an estimated EDSS score > 4.5) when compared to NH-White and Hispanic patients [29,30]. In our present study, treatment modality did not impact the risk of having an estimated EDSS score > 4.5 at the last visit.…”

Section: Discussionsupporting

confidence: 91%

Multiple Sclerosis in a Multi-Ethnic Population in Houston, Texas: A Retrospective Analysis

et al. 2020

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“…Consistent with published reports, NH-Black patients had a higher risk for early severe disability (defined in our study as an estimated EDSS > 4.5) when compared to NH-White and Hispanic patients [30,31]. In our present study, treatment modality did not impact the risk of having an estimated EDSS > 4.5 score at the last visit.…”

Section: Discussionsupporting

confidence: 91%

“…Several studies have shown that African Americans have significantly higher CNS lesion burden, more frequent relapses, worse ambulatory disability, worse postrelapse recoveries, and higher overall disability at diagnosis [5,10,20,30]. Although there appeared to be an increase in the degree of atrophy and MRI involvement in NH-Black compared to other groups, the trend observed in our study was not significant.…”

Section: Discussioncontrasting

confidence: 82%

Multiple Sclerosis in a Multi-Ethnic Population in Houston, Texas: A Retrospective Analysis

Mercado-Evans¹,

Dongarwar²,

Fisher³

et al. 2020

Preprint

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Multiple Sclerosis (MS) is a progressive neurodegenerative disease that affects more than 2 million people worldwide. Increasing knowledge about MS in different populations has advanced our understanding of disease epidemiology and variation in the natural history of MS among White and minority populations. In addition to differences in incidence, African American (AA) and Hispanic patients have greater disease burden and disability in earlier stages of disease compared to White patients. To further characterize MS in AA and Hispanic populations, we conducted a retrospective chart analysis of 112 patients treated at an MS center in Houston, Texas. Here, we describe differences in clinical presentation, MRI findings, treatment regimens, disability progression, and relapse rate. We found that patients who were evaluated by a neurologist at symptom onset had significantly decreased odds of greater disability [defined as Expanded Disability Status Scale (EDSS) &gt; 4.5] at last presentation compared to patients who were not evaluated by a neurologist (OR: 0.04, 95% CI: 0.16-0.9). We also found that active smokers had significantly increased odds of greater disability both at diagnosis and at last clinical encounter compared to nonsmokers (OR: 2.44, 95% CI: 1.10-7.10, OR= 2.44, 95% CI: 1.35-6.12, p= 0.01, respectively). Assessment of the degree of brain atrophy and progression over time along with enumeration of T1, T2, and gadolinium-enhancing brain lesions did not reveal differences across groups.

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“…Many participants felt that providers were reluctant to consider MS as a diagnosis because they were African-American, and several admitted that they were also surprised that Blacks could have MS. Their experience with delays in diagnosis is consistent with Dong, et al's report of delayed diagnosis leading to worse outcomes for African Americans. 20 In addition, given the presumed rarity of MS in African-Americans, our participants tended to encounter skepticism and lack of awareness and understanding from friends and families who knew little about MS and found it hard to believe that a Black person could have it.…”

Section: Discussionmentioning

confidence: 98%

Experiences of African American Women with Multiple Sclerosis

Stuifbergen¹,

Becker²,

Phillips³

et al. 2020

International Journal of MS Care

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Background: Despite growing understanding that African-Americans may have a more aggressive course of multiple sclerosis (MS) and experience disparities in diagnosis and treatment, fewer studies have examined how African-Americans experience MS and its impact on their lives. This study explored the experience of African American women living with MS in order to inform future research and practice. Methods: Face-to face semi-structured interviews were conducted with 19 African-American women. Inductive content analysis was used to identify major categories and sub-categories. Results: The analyses yielded three major categories: No one could believe I had MS; It's tough living with MS; and You have to keep going. Many women reported that the MS diagnosis was a surprise to them and their doctors because of the common belief that MS is a “Caucasian disease.” For this reason, many women felt their diagnosis had been delayed while their physicians initially focused on other diseases considered more typical in African-Americans. Living with losses related to social and family activities, independence and employment was especially challenging for them. Faith in God, coming to grips with the diagnosis and health promotion behaviors were key strategies for dealing with their MS. Women also spoke of pushing forward, working through MS challenges, and taking care of themselves, thus preserving their identity as strong Black women, a culturally important construct in the African-American community. Conclusions: Future research should explore the interactions of culture with coping strategies and the development of useful and valued resources and supports for African-Americans with MS.

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Unmasking the Masquerader: A Delayed Diagnosis of MS and Its 4.5 Years of Implications in an Older African American Male

Cited by 3 publications

References 19 publications

Multiple Sclerosis in a Multi-Ethnic Population in Houston, Texas: A Retrospective Analysis

Multiple Sclerosis in a Multi-Ethnic Population in Houston, Texas: A Retrospective Analysis

Multiple Sclerosis in a Multi-Ethnic Population in Houston, Texas: A Retrospective Analysis

Experiences of African American Women with Multiple Sclerosis

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