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New research highlights the association between social determinants of health (SDOH) and brain magnetic resonance imaging (MRI) outcomes in pediatric-onset multiple sclerosis (POMS). The findings, published in Neurology, reveal how socioeconomic and demographic factors are linked to more severe disease markers, raising concerns about disparities in disease progression.
Study Identifies Predictors of MRI Lesion Severity
A retrospective cohort study, led by Ruby Ross, M.D., of the New York University Grossman School of Medicine, analyzed brain MRIs from 138 patients with POMS. Participants had an average age of 19.86 years and a median disease duration of four years at the time of imaging. The study measured brain volumes, including total white matter lesion volume, black hole volume, and whole brain, white matter, and gray matter volumes. Researchers explored links between these MRI outcomes and SDOH variables such as race, ethnicity, parental education, insurance type, and social vulnerability index (SVI), a composite measure of social disadvantage.
The strongest individual predictor of larger total white matter lesion and black hole volumes was a high SVI. However, when all SDOH variables were analyzed together, public health insurance emerged as the most significant predictor, reducing the influence of SVI. Importantly, the study found no differences in disease-modifying treatment timing or efficacy between socially advantaged and disadvantaged groups, suggesting that these disparities were not due to treatment delays or suboptimal therapy.
Why These Findings Matter
This study underscores how social disadvantage in childhood may influence the severity of chronic conditions such as MS. Larger white matter lesions and black holes on MRI, as seen in patients with higher SVI scores and those with public health insurance, are associated with worse clinical outcomes in MS, including greater disability.
"Our findings suggest that childhood social disadvantage can have lasting effects on MS severity," the authors wrote. These results point to the need for more research and strategies aimed at mitigating the influence of social and economic disparities on disease progression in pediatric MS. Addressing these disparities may require earlier interventions or targeted support for at-risk populations.
By identifying and understanding these social factors, healthcare systems may be better equipped to improve outcomes for patients with pediatric MS, particularly those from disadvantaged backgrounds.