Racial Differences in Multiple Sclerosis
Black and White Americans Experience MS Differently
By Julie Stachowiak, Ph.D., About.com Guide Updated March 10, 2009
About.com Health's Disease and Condition content is reviewed by the Medical Review Board
Studies show that you are about twice as likely to have multiple sclerosis (MS) if you are white (of Northern European origin) than you are if you are African-American. However, it seems like risk for developing MS is not the only racial difference in multiple sclerosis.
Curious to learn more about the racial differences in MS, I checked out the article about epidemiology, risk factors, and clinical features of multiple sclerosis on UpToDate — an electronic reference used by many physicians who encounter patients with suspected MS or other neurological disorders.
See what UpToDate has to say, then read on for answers to questions you may have about what all of this means for you.
Prognostic Factors in MS: A Discussion of Race from UpToDate
“Racial differences may also exist for the clinical features and prognosis of MS, although this is less well established than for differences in the risk of developing MS. A retrospective study found that black Americans who develop MS have a later age of disease onset than white Americans (age 33.7 versus 31.1 years, respectively) and are more likely to develop ambulatory disability than white Americans with MS. Since the median time to both MS diagnosis and MS onset to treatment was significantly shorter for blacks compared with the whites in this study population, it is likely that the increased risk of disability for blacks is independent of health care access.
The same study noted that black Americans with MS were more likely to present with multifocal signs and symptoms, were more likely to have clinical involvement restricted to the optic nerves and spinal cord (opticospinal MS), and were more likely to develop transverse myelitis compared with white Americans with MS.”
More Details About Racial Differences in Multiple Sclerosis
This study referred to was a 2004 retrospective study appearing in the journal Neurology comparing 375 African-Americans to 427 Caucasian Americans. The groups were similar in terms of ratio of men to women and proportions of people with different types of MS. However, participants differed along racial lines in the following areas:
Time to Diagnosis: The groups differed in how long it took to get diagnosed after they started experiencing MS symptoms. Blacks were diagnosed about a year after symptom onset, while the white participants were diagnosed two years after their symptoms started. One theory is that the black patients were experiencing more severe symptoms, which led to a quicker diagnosis.
First Symptoms: Black patients tended to have more diverse symptoms at disease onset, caused by multiple lesions in different places in the central nervous system, than the white group did. However, about 18% of blacks had symptoms restricted to the optic nerves and spinal cord, while only 8% of the white participants had lesions limited to these areas. The white people in the study were more likely to have lesions on their brains.
Start Treatment Faster: Blacks started treatment with a disease-modifying therapy an average about 6 years after onset of symptoms, compared to 8 years elapsing between start of symptoms and initiation of treatment in the white group. Much like being diagnosed more quickly after symptom onset, it is hypothesized that perhaps the black participants were experiencing more severe or disabling symptoms and this led to their physicians recommending treatment earlier.
Interestingly, there were differences in the approach to treatment, as white participants had switched treatment more often. Also, 13 white participants had been treated with pulsed Solu-Medrol, while none of the black participants had received this type of treatment.
Mobility Differences: From this study, it appears that African Americans are somewhat more likely to develop mobility problems than white Americans. There was a 1.67-fold greater risk that black participants would eventually need a cane to walk. This also happened about 6 years earlier in the black group than in the white group (after 16 years vs. 22 years).
There seems to also be evidence that African Americans have a higher chance of becoming dependent on a wheelchair, however, a deeper analysis shows that part of the reason for this is because African Americans in the study were on average 2.5 years older at disease onset (being older at disease onset is predictive for more disability) than the white participants. The median time until wheelchair dependency (when it happened) was 8 years shorter for African Americans (30 years after disease onset) than for whites (38 years after disease onset).
Developing SPMS: Blacks also progressed from relapsing-remitting MS to secondary-progressive MS about three years more quickly than whites (18 years vs. 22 years).
Want to learn more? See UpToDate’s topic, "Epidemiology, risk factors, and clinical features of multiple sclerosis in adults," for additional in-depth, current and unbiased medical information on multiple sclerosis in adults, including expert physician recommendations.
Sources: Michael J Olek, DO. Epidemiology, risk factors, and clinical features of multiple sclerosis in adults. UpToDate. Accessed: February 2009.
Clinical characteristics of African Americans vs Caucasian Americans with multiple sclerosis
© 2004 American Academy of Neurology
B. A.C. Cree, MD, PhD, MCR, O. Khan, MD, D. Bourdette, MD, D. S. Goodin, MD, J. A. Cohen, MD, R. A. Marrie, MD, D. Glidden, PhD, B. Weinstock-Guttman, MD, D. Reich, PhD, N. Patterson, PhD, J. L. Haines, PhD, M. Pericak-Vance, PhD, C. DeLoa, BS, J. R. Oksenberg, PhD and S. L. Hauser, MD
From the Multiple Sclerosis Center, Department of Neurology, University of California San Francisco.
Address correspondence and reprint requests to Dr. B.A.C. Cree, Multiple Sclerosis Center, Department of Neurology, University of California San Francisco, 350 Parnassus Ave., Suite 908, San Francisco, CA 94117; e-mail: bcree at itsa.ucsf.edu
Background: African American (AA) individuals are thought to develop multiple sclerosis (MS) less frequently than Caucasian American (CA) individuals.
Objective: To compare the clinical characteristics of AA and CA patients with MS.
Methods: The clinical features of MS were compared in a large retrospective cohort of AA (n = 375) and CA (n = 427) subjects.
Results: The proportion of women to men was similar in AA and CA subjects (81% [AA] vs 77% [CA]; p = 0.122). There were no differences in the proportions of subjects with relapsing-remitting, secondary progressive, primary progressive, and progressive relapsing MS. The median time to diagnosis was 1 year after symptom onset in AA subjects and 2 years after symptom onset in CA subjects (p = 0.0013). The age at onset was approximately 2.5 years later in AA than CA subjects (33.7 vs 31.1 years; p = 0.0001). AA subjects presented with multisite signs and symptoms at disease onset more often than CA subjects (p = 0.018). Clinical involvement restricted to the optic nerves and spinal cord (opticospinal MS) occurred in 16.8% of AA patients compared with 7.9% of CA patients (p < 0.001). Transverse myelitis also occurred more frequently in AA subjects (28 vs 18%; p = 0.001). Survival analysis revealed that AA subjects were at higher risk for development of ambulatory disability than CA subjects. After adjusting for baseline variations and differences in therapeutic interventions, AAs were at 1.67-fold greater risk for requiring a cane to ambulate than CA patients (p < 0.001). There was a trend suggesting that AAs were also at greater risk for development of wheelchair dependency (p = 0.099). Adjusted Cox proportional hazard models showed that this effect was in part attributable to the older age at onset in AAs (p < 0.001).
Conclusions: Compared with multiple sclerosis (MS) in Caucasian Americans, African American patients with MS have a greater likelihood of developing opticospinal MS and transverse myelitis and have a more aggressive disease course.
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See also VitaminDWiki
- Overview Dark Skin and Vitamin D
- Overview MS and vitamin D
- Hispanics with MS had lower levels of vitamin D which did not vary seasonally – May 2012
- Increased risk of multiple sclerosis risk in African Americans due to genes – June 2013
- Forum discussion for African Americans with MS
M Obama's father was another African American with MS living in the North. suspect he was very low on vitamin D
from 2008 speech: My Dad was our rock. Although he was diagnosed with Multiple Sclerosis in his early thirties, he was our provider, our champion, our hero. As he got sicker, it got harder for him to walk, it took him longer to get dressed in the morning. But if he was in pain, he never let on. He never stopped smiling and laughing - even while struggling to button his shirt, even while using two canes to get himself across the room to give my Mom a kiss. He just woke up a little earlier, and worked a little harder.
Montel Williams has MS, has funded MS research, and is a big proponent of marijuana to reduce intensity of MS
Update 2012: Montell Williams was apparently on the Oprah show and agreed that Vitamin D helped MS