How Multiple Sclerosis Symptoms Vary by Age, Sex, and Race/Ethnicity

Little is known about how symptom severity in the various neurologic domains commonly affected by multiple sclerosis (MS) varies by age, sex, and race/ethnicity. This was a retrospective study of patients with MS attending 2 tertiary centers in the New York City metropolitan area, who self-identifie...

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Published inNeurology. Clinical practice Vol. 11; no. 4; pp. 335 - 341
Main Authors Kister, Ilya, Bacon, Tamar, Cutter, Gary R.
Format Journal Article
LanguageEnglish
Published United States Lippincott Williams & Wilkins 01.08.2021
Online AccessGet full text
ISSN2163-0402
2163-0933
DOI10.1212/CPJ.0000000000001105

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Abstract Little is known about how symptom severity in the various neurologic domains commonly affected by multiple sclerosis (MS) varies by age, sex, and race/ethnicity. This was a retrospective study of patients with MS attending 2 tertiary centers in the New York City metropolitan area, who self-identified as White, African American (AA), or Hispanic American (HA). Disability was rated with Patient-Determined Disability Steps (PDDS) and symptom severity, with SymptoMScreen (SyMS), a validated battery for assessing symptoms in 12 domains. Analyses comparing race, sex, and age groups were performed using analysis of variance models and Tukey honestly significant difference tests to control the overall type I error. A multivariable model was constructed to predict good self-rated health (SRH) that included demographic variables, PDDS, and SyMS domain scores. The sample consisted of 2,622 patients with MS (age 46.4 years; 73.6% female; 66.4% White, 21.7% AA, and 11.9% HA). Men had higher adjusted PDDS than women ( = 0.012), but similar total SyMS scores. Women reported higher fatigue and anxiety scores, whereas men had higher walking and dexterity scores. AAs and HAs had higher symptom domain scores than Whites in each of the 12 domains and worse SRH. In a multivariable logistic model, only pain, walking, depression, fatigue, and global disability (PDDS), but not sex or race/ethnicity, predicted good SRH. AA and HA race/ethnicity was associated with higher overall disability, higher symptom severity in each of the 12 domains commonly affected by MS, and worse SRH relative to Whites. However, only symptom severity and disability, and not demographic variables, predicted good SRH.
AbstractList Little is known about how symptom severity in the various neurologic domains commonly affected by multiple sclerosis (MS) varies by age, sex, and race/ethnicity.OBJECTIVELittle is known about how symptom severity in the various neurologic domains commonly affected by multiple sclerosis (MS) varies by age, sex, and race/ethnicity.This was a retrospective study of patients with MS attending 2 tertiary centers in the New York City metropolitan area, who self-identified as White, African American (AA), or Hispanic American (HA). Disability was rated with Patient-Determined Disability Steps (PDDS) and symptom severity, with SymptoMScreen (SyMS), a validated battery for assessing symptoms in 12 domains. Analyses comparing race, sex, and age groups were performed using analysis of variance models and Tukey honestly significant difference tests to control the overall type I error. A multivariable model was constructed to predict good self-rated health (SRH) that included demographic variables, PDDS, and SyMS domain scores.METHODSThis was a retrospective study of patients with MS attending 2 tertiary centers in the New York City metropolitan area, who self-identified as White, African American (AA), or Hispanic American (HA). Disability was rated with Patient-Determined Disability Steps (PDDS) and symptom severity, with SymptoMScreen (SyMS), a validated battery for assessing symptoms in 12 domains. Analyses comparing race, sex, and age groups were performed using analysis of variance models and Tukey honestly significant difference tests to control the overall type I error. A multivariable model was constructed to predict good self-rated health (SRH) that included demographic variables, PDDS, and SyMS domain scores.The sample consisted of 2,622 patients with MS (age 46.4 years; 73.6% female; 66.4% White, 21.7% AA, and 11.9% HA). Men had higher adjusted PDDS than women (p = 0.012), but similar total SyMS scores. Women reported higher fatigue and anxiety scores, whereas men had higher walking and dexterity scores. AAs and HAs had higher symptom domain scores than Whites in each of the 12 domains and worse SRH. In a multivariable logistic model, only pain, walking, depression, fatigue, and global disability (PDDS), but not sex or race/ethnicity, predicted good SRH.RESULTSThe sample consisted of 2,622 patients with MS (age 46.4 years; 73.6% female; 66.4% White, 21.7% AA, and 11.9% HA). Men had higher adjusted PDDS than women (p = 0.012), but similar total SyMS scores. Women reported higher fatigue and anxiety scores, whereas men had higher walking and dexterity scores. AAs and HAs had higher symptom domain scores than Whites in each of the 12 domains and worse SRH. In a multivariable logistic model, only pain, walking, depression, fatigue, and global disability (PDDS), but not sex or race/ethnicity, predicted good SRH.AA and HA race/ethnicity was associated with higher overall disability, higher symptom severity in each of the 12 domains commonly affected by MS, and worse SRH relative to Whites. However, only symptom severity and disability, and not demographic variables, predicted good SRH.CONCLUSIONSAA and HA race/ethnicity was associated with higher overall disability, higher symptom severity in each of the 12 domains commonly affected by MS, and worse SRH relative to Whites. However, only symptom severity and disability, and not demographic variables, predicted good SRH.
Little is known about how symptom severity in the various neurologic domains commonly affected by multiple sclerosis (MS) varies by age, sex, and race/ethnicity. This was a retrospective study of patients with MS attending 2 tertiary centers in the New York City metropolitan area, who self-identified as White, African American (AA), or Hispanic American (HA). Disability was rated with Patient-Determined Disability Steps (PDDS) and symptom severity, with SymptoMScreen (SyMS), a validated battery for assessing symptoms in 12 domains. Analyses comparing race, sex, and age groups were performed using analysis of variance models and Tukey honestly significant difference tests to control the overall type I error. A multivariable model was constructed to predict good self-rated health (SRH) that included demographic variables, PDDS, and SyMS domain scores. The sample consisted of 2,622 patients with MS (age 46.4 years; 73.6% female; 66.4% White, 21.7% AA, and 11.9% HA). Men had higher adjusted PDDS than women ( = 0.012), but similar total SyMS scores. Women reported higher fatigue and anxiety scores, whereas men had higher walking and dexterity scores. AAs and HAs had higher symptom domain scores than Whites in each of the 12 domains and worse SRH. In a multivariable logistic model, only pain, walking, depression, fatigue, and global disability (PDDS), but not sex or race/ethnicity, predicted good SRH. AA and HA race/ethnicity was associated with higher overall disability, higher symptom severity in each of the 12 domains commonly affected by MS, and worse SRH relative to Whites. However, only symptom severity and disability, and not demographic variables, predicted good SRH.
Author Cutter, Gary R.
Bacon, Tamar
Kister, Ilya
AuthorAffiliation NYU Multiple Sclerosis Comprehensive Care Center (IK, TB), NYU Langone Medical Center, NY; and Department of Biostatistics (GRC), UAB School of Public Health, Birmingham, AL
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Cites_doi 10.1177/1756285611403646
10.1111/ene.13571
10.1080/23279095.2015.1125905
10.1093/brain/awt281
10.1212/WNL.0b013e3181e8e72a
10.1212/CPJ.0000000000000112
10.1016/j.msard.2020.102429
10.1016/S2215-0366(16)30358-3
10.1212/01.wnl.0000306411.46934.ef
10.1177/1352458516679894
10.7224/1537-2073.2012-053
10.1212/WNL.0b013e3182918cc2
10.1007/s40120-020-00176-6
10.1212/WNL.45.2.251
10.3233/NRE-2009-0525
10.1007/s11910-019-1000-5
10.1093/brain/awy245
10.1177/1352458519887328
10.1016/j.msard.2019.01.031
10.1186/s40246-014-0023-x
10.1590/0004-282X20160118
10.1186/s12913-018-3584-x
10.1186/1471-2377-13-37
10.1093/brain/aws099
10.1177/1352458512450351
10.3389/fneur.2020.00616
10.1046/j.1468-1331.2003.00519.x
10.1191/1352458505ms1215oa
10.1212/WNL.0b013e3181cff6fb
10.1371/journal.pone.0043061
10.1016/j.msard.2020.102693
10.1098/rstb.1999.0510
10.1136/jnnp.2008.145805
10.1212/01.wnl.0000208505.81912.82
10.1016/j.msard.2018.12.043
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Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.
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References e_1_3_4_3_2
e_1_3_4_2_2
e_1_3_4_9_2
e_1_3_4_8_2
e_1_3_4_7_2
e_1_3_4_6_2
e_1_3_4_5_2
e_1_3_4_4_2
e_1_3_4_22_2
e_1_3_4_20_2
e_1_3_4_26_2
e_1_3_4_27_2
e_1_3_4_24_2
e_1_3_4_25_2
Minden SL (e_1_3_4_10_2) 2008; 70
Kalincik T (e_1_3_4_16_2) 2013; 136
Cipriani VP (e_1_3_4_23_2) 2019; 19
e_1_3_4_28_2
e_1_3_4_29_2
Gilli F (e_1_3_4_21_2) 2020; 11
e_1_3_4_30_2
e_1_3_4_11_2
e_1_3_4_34_2
e_1_3_4_12_2
Buchanan RJ (e_1_3_4_14_2) 2009; 25
e_1_3_4_33_2
e_1_3_4_32_2
Li SH (e_1_3_4_19_2) 2017; 4
e_1_3_4_31_2
e_1_3_4_15_2
e_1_3_4_13_2
e_1_3_4_36_2
e_1_3_4_35_2
e_1_3_4_17_2
e_1_3_4_18_2
References_xml – ident: e_1_3_4_3_2
  doi: 10.1177/1756285611403646
– ident: e_1_3_4_25_2
  doi: 10.1111/ene.13571
– ident: e_1_3_4_13_2
  doi: 10.1080/23279095.2015.1125905
– volume: 136
  start-page: 3609
  issue: 12
  year: 2013
  ident: e_1_3_4_16_2
  article-title: Sex as a determinant of relapse incidence and progressive course of multiple sclerosis
  publication-title: Brain
  doi: 10.1093/brain/awt281
– ident: e_1_3_4_24_2
  doi: 10.1212/WNL.0b013e3181e8e72a
– ident: e_1_3_4_7_2
  doi: 10.1212/CPJ.0000000000000112
– ident: e_1_3_4_28_2
  doi: 10.1016/j.msard.2020.102429
– volume: 4
  start-page: 73
  issue: 1
  year: 2017
  ident: e_1_3_4_19_2
  article-title: Why are women so vulnerable to anxiety, trauma-related and stress-related disorders? The potential role of sex hormones
  publication-title: Lancet Psychiatry
  doi: 10.1016/S2215-0366(16)30358-3
– volume: 70
  start-page: 1141
  issue: 13
  year: 2008
  ident: e_1_3_4_10_2
  article-title: Access to and utilization of neurologists by people with multiple sclerosis
  publication-title: Neurology
  doi: 10.1212/01.wnl.0000306411.46934.ef
– ident: e_1_3_4_30_2
  doi: 10.1177/1352458516679894
– ident: e_1_3_4_4_2
  doi: 10.7224/1537-2073.2012-053
– ident: e_1_3_4_5_2
  doi: 10.1212/WNL.0b013e3182918cc2
– ident: e_1_3_4_34_2
  doi: 10.1007/s40120-020-00176-6
– ident: e_1_3_4_11_2
  doi: 10.1212/WNL.45.2.251
– volume: 25
  start-page: 271
  issue: 4
  year: 2009
  ident: e_1_3_4_14_2
  article-title: Age-related comparisons of people with multiple sclerosis: demographic, disease, and treatment characteristics
  publication-title: NeuroRehabilitation
  doi: 10.3233/NRE-2009-0525
– volume: 19
  start-page: 87
  issue: 11
  year: 2019
  ident: e_1_3_4_23_2
  article-title: Clinical characteristics of multiple sclerosis in African-Americans
  publication-title: Curr Neurol Neurosci Rep
  doi: 10.1007/s11910-019-1000-5
– ident: e_1_3_4_29_2
  doi: 10.1093/brain/awy245
– ident: e_1_3_4_31_2
  doi: 10.1177/1352458519887328
– ident: e_1_3_4_33_2
  doi: 10.1016/j.msard.2019.01.031
– ident: e_1_3_4_32_2
  doi: 10.1186/s40246-014-0023-x
– ident: e_1_3_4_22_2
  doi: 10.1590/0004-282X20160118
– ident: e_1_3_4_8_2
  doi: 10.1186/s12913-018-3584-x
– ident: e_1_3_4_12_2
  doi: 10.1186/1471-2377-13-37
– ident: e_1_3_4_6_2
  doi: 10.1093/brain/aws099
– ident: e_1_3_4_15_2
  doi: 10.1177/1352458512450351
– volume: 11
  start-page: 616
  year: 2020
  ident: e_1_3_4_21_2
  article-title: SeXX matters in multiple sclerosis
  publication-title: Front Neurol
  doi: 10.3389/fneur.2020.00616
– ident: e_1_3_4_18_2
  doi: 10.1046/j.1468-1331.2003.00519.x
– ident: e_1_3_4_9_2
  doi: 10.1191/1352458505ms1215oa
– ident: e_1_3_4_26_2
  doi: 10.1212/WNL.0b013e3181cff6fb
– ident: e_1_3_4_27_2
  doi: 10.1371/journal.pone.0043061
– ident: e_1_3_4_20_2
  doi: 10.1016/j.msard.2020.102693
– ident: e_1_3_4_2_2
  doi: 10.1098/rstb.1999.0510
– ident: e_1_3_4_17_2
  doi: 10.1136/jnnp.2008.145805
– ident: e_1_3_4_35_2
  doi: 10.1212/01.wnl.0000208505.81912.82
– ident: e_1_3_4_36_2
  doi: 10.1016/j.msard.2018.12.043
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Snippet Little is known about how symptom severity in the various neurologic domains commonly affected by multiple sclerosis (MS) varies by age, sex, and...
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Title How Multiple Sclerosis Symptoms Vary by Age, Sex, and Race/Ethnicity
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