ms: a perspective on the african american experience mary d. hughes, md medical director,...
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MS: A Perspective on the African American Experience
Mary D. Hughes, MDMedical 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
Environmentalfactors
Abnormal immunologic response
Genetic predisposition
Infectious agent
MS
Potential Triggers for Multiple Sclerosis
So what do we know about MS across different Ethnic
backgrounds?
Epidemiology of multiple sclerosis in US veterans:VII. Risk factors for MS
“….there were insufficient numbers of black women and women of other races to permit their study.”
Kurtzke, J.Neurology 1997
Epidemiology of multiple sclerosis in US veterans:VII. Risk factors for MS
“Among black male WWII subjects, MS risk was significantly higher among those with more education, higher socioeconomic status, and higher service test score…”
Kurtzke, J.Neurology 1997
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, AMEast African Medical Journal
1989
Review of 66 patients
Demyelinating disorder of the central nervous system occurring in black South Africans
“To date there are only 12 reported black patients from South Africa and Zimbabwe with possible MS.”
G Modi, et al.
J Neurol Neurosurg Psychiatry 2001
MS: Does ethnicity matter?
Evidence Trial
Race AA CA
Number of patients 36 616
Baseline lesions 2.3 2.6
Mean attack Rate in prior 2 years
2.4 2.6
Relapse free 48 weeks 47% 57%
Mean Relapses .73 .57
Cree et al. Annals of Neurology 2003
Evidence Trial
Race AA CA
Number of patients 36 616
Baseline lesions 2.3 2.6
Mean attack Rate in prior 2 years
2.4 2.6
Relapse free 48 weeks 47% 57%
Mean Relapses .73 .57
Cree et al. Annals of Neurology 2003
Evidence Trial
Race AA CA
Number of patients 36 616
Baseline lesions 2.3 2.6
Mean attack Rate in prior 2 years
2.4 2.6
Relapse free 48 weeks 47% 57%
Mean Relapses .73 .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
“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.”
Phillip, PArchives of Neurology, 1998
Optic Neuritis in African Americans
“In the AA patients, MS occurred more frequently in a ‘neuromyelitis optica’ form.”
Phillip, PArchives of Neurology, 1998
Is it in the Genes?
Mapping Of Genes
Am. J. Hum. Genet. 74:979–1000, 2004
Proportion of European Ancestry is ~ 20% for African Americans and ~60% for Hispanic American Populations
My Inspiration