Persistent differences in initial diagnostic trajectory for Black and Hispanic individuals presenting with multiple sclerosis between 2020 and 2023.

BACKGROUND: Racial and ethnic disparities in multiple sclerosis (MS) may begin during the initial diagnostic trajectory. OBJECTIVES: This single-center retrospective medical records analysis included adults with a new MS diagnosis seen between January 2020 and September 2023. Patients with Black, White non-Hispanic, and Hispanic race/ethnicity were compared for diagnostic trajectory, clinical presentation, and initial MS management. RESULTS: Compared to White patients (n = 86), Black (n = 39) and Hispanic (n = 61) patients had lower socioeconomic status (SES: education, employment, and area deprivation index (ADI), p < 0.05 for each), greater odds ratio (OR) of initial evaluation in urgent/acute care settings (Black: 2.85 (confidence interval (CI): 1.30-6.23); Hispanic: 2.52 (1.27-5.00)), and diagnostic magnetic resonance imaging (MRIs) in emergency rooms (Black: 5.43 (2.39-12.36); Hispanic: 4.76 (2.3-9.82)). Black patients had greater OR of weakness (3.4 (1.16-9.90)) and higher disability (EDSS 2.5+: 3.72 (1.52-9.39)) at presentation than White patients. The groups did not differ in treatment initiation. All differences persisted after including ADI as an SES measure. CONCLUSION: The more common presentation of Black and Hispanic individuals to acute care settings and more severe presenting symptoms in Black individuals, which persisted despite accounting for marked SES differences between groups, represent opportunities to improve education about MS within minoritized communities and in acute/primary care settings.