Transcript MS: A Perspective on the African American Experience

MS: A Perspective on the
African American Experience
Mary D. Hughes, MD
Medical Director, Neuroscience Associates
University Medical Group
Greenville Hospital System
Why have this teleconference?
Access to health care differs
• Women’s Health
– Less likely to receive care
– More likely to receive it late
• Immunization rates
– Pneumonia vaccine rates 26 versus
50%
– Flu vaccine rates 47 versus 66%
Difference in Type of Health
care Accessed
• Increased reliance on alternative
medications and home remedies
• Increased usage of health professionals
such as chiropractors rather than
physicians
Diseases that we know are
different
•
•
•
•
•
Diabetes
Hypertension
Heart disease
Stroke
Osteoporosis
Mistrust of the Health care
system
Tuskegee Syphilis Experiment
“The United States government did
something that was wrong-deeply,
profoundly, morally wrong. It was an
outrage to our commitment to integrity
and equality for all our citizens….
Clearly racist.”
President Clinton’s apology
May 1997
Disparities in the Experience of
Health Care
• Patient–physician communication
• Cultural competence in health care
services
• Quality of clinical care
• Access to care
Demographic features of MS
• Gender
– Female predominance 4:1 in Relapsing Remitting
– 1:1 in Primary progressive
• Age
– Onset 15-50 90% , average 30
• Race
– Caucasian predominant (>90%)
• Frequency
– Varies dependent on geographic location
Potential Triggers for
Multiple Sclerosis
Genetic
predisposition
Infectious agent
Abnormal immunologic response
Environmental
factors
MS
So what do we know about
MS across different Ethnic
backgrounds?
Epidemiology of multiple sclerosis
in US veterans:
VII. Risk factors for MS
Kurtzke, J.
Neurology 1997
“….there were insufficient numbers of
black women and women of other
races to permit their study.”
Epidemiology of multiple sclerosis
in US veterans:
VII. Risk factors for MS
Kurtzke, J.
Neurology 1997
“Among black male WWII subjects,
MS risk was significantly higher
among those with more education,
higher socioeconomic status, and
higher service test score…”
Experience in FDA trials for
medications for MS
Of the 939 Patients who participated in a
Phase III study for Betaseron® in
secondary progressive MS patients there
were:
62 African American
15 Hispanic
MS in Africa?
Multiple Sclerosis: epidemic in
Kenya
Adams, AM
East African Medical
Journal
1989
Review of 6 patients
Demyelinating disorder of the central
nervous system occurring in black South
Africans
G Modi, et al.
J Neurol Neurosurg Psychiatry 2001
“To date there are only 12 reported black patients
from South Africa and Zimbabwe with possible MS.”
MS: Does ethnicity matter?
Evidence Trial
Race
Number of patients
Baseline lesions
Mean attack Rate in prior 2
years
Relapse free 48 weeks
Mean Relapses
AA
36
2.3
2.4
CA
616
2.6
2.6
47%
.73
57%
.57
Cree et al. Annals of Neurology 2003
Evidence Trial
Race
Number of patients
Baseline lesions
Mean attack Rate in prior 2
years
Relapse free 48 weeks
Mean Relapses
AA
36
2.3
2.4
CA
616
2.6
2.6
47%
.73
57%
.57
Cree et al. Annals of Neurology 2003
Evidence Trial
Race
Number of patients
Baseline lesions
Mean attack Rate in prior 2
years
Relapse free 48 weeks
Mean Relapses
AA
36
2.3
2.4
CA
616
2.6
2.6
47%
.73
57%
.57
Cree et al. Annals of Neurology 2003
Common symptoms of MS
• Blurred or double
vision
• Loss of vision in
one eye
• Slurred or slowed
speech
• Easy fatigability
• Problems with
thinking
• Poor balance
• Numbness or pins
and needles
• Poor bladder or
bowel control
• Difficulty with
walking
• Tremor
Optic Neuritis in African
Americans
Phillip, P
Archives of Neurology, 1998
“The AA study patients with a single
episode of demyelinating optic neuritis
had visual acuities more severely
affected at onset and after 1 year of
follow-up compared with the white study
patients and with patients in the ONTT.”
Optic Neuritis in African
Americans
Phillip, P
Archives of Neurology, 1998
“In the AA patients, MS occurred more
frequently in a ‘neuromyelitis optica’
form.”
Is it in the Genes?
Mapping Of Genes
Proportion of
European Ancestry
is ~ 20% for African
Americans and
~60% for Hispanic
American
Populations
Am. J. Hum. Genet. 74:979–1000, 2004
My Inspiration