MS: A Perspective on the African American Experience Mary D. Hughes, MD Medical Director,...
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Transcript of MS: A Perspective on the African American Experience Mary D. Hughes, MD Medical Director,...
![Page 1: MS: A Perspective on the African American Experience Mary D. Hughes, MD Medical Director, Neuroscience Associates University Medical Group Greenville Hospital.](https://reader036.fdocuments.in/reader036/viewer/2022062422/56649ea75503460f94baa961/html5/thumbnails/1.jpg)
MS: A Perspective on the African American Experience
Mary D. Hughes, MDMedical Director, Neuroscience Associates
University Medical Group Greenville Hospital System
![Page 2: MS: A Perspective on the African American Experience Mary D. Hughes, MD Medical Director, Neuroscience Associates University Medical Group Greenville Hospital.](https://reader036.fdocuments.in/reader036/viewer/2022062422/56649ea75503460f94baa961/html5/thumbnails/2.jpg)
Why have this teleconference?
![Page 3: MS: A Perspective on the African American Experience Mary D. Hughes, MD Medical Director, Neuroscience Associates University Medical Group Greenville Hospital.](https://reader036.fdocuments.in/reader036/viewer/2022062422/56649ea75503460f94baa961/html5/thumbnails/3.jpg)
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%
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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
![Page 5: MS: A Perspective on the African American Experience Mary D. Hughes, MD Medical Director, Neuroscience Associates University Medical Group Greenville Hospital.](https://reader036.fdocuments.in/reader036/viewer/2022062422/56649ea75503460f94baa961/html5/thumbnails/5.jpg)
Diseases that we know are different
• Diabetes
• Hypertension
• Heart disease
• Stroke
• Osteoporosis
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Mistrust of the Health care system
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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
![Page 8: MS: A Perspective on the African American Experience Mary D. Hughes, MD Medical Director, Neuroscience Associates University Medical Group Greenville Hospital.](https://reader036.fdocuments.in/reader036/viewer/2022062422/56649ea75503460f94baa961/html5/thumbnails/8.jpg)
Disparities in the Experience of Health Care
• Patient–physician communication
• Cultural competence in health care services
• Quality of clinical care
• Access to care
![Page 9: MS: A Perspective on the African American Experience Mary D. Hughes, MD Medical Director, Neuroscience Associates University Medical Group Greenville Hospital.](https://reader036.fdocuments.in/reader036/viewer/2022062422/56649ea75503460f94baa961/html5/thumbnails/9.jpg)
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
![Page 10: MS: A Perspective on the African American Experience Mary D. Hughes, MD Medical Director, Neuroscience Associates University Medical Group Greenville Hospital.](https://reader036.fdocuments.in/reader036/viewer/2022062422/56649ea75503460f94baa961/html5/thumbnails/10.jpg)
Environmentalfactors
Abnormal immunologic response
Genetic predisposition
Infectious agent
MS
Potential Triggers for Multiple Sclerosis
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So what do we know about MS across different Ethnic
backgrounds?
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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
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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
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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
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MS in Africa?
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Multiple Sclerosis: epidemic in Kenya
Adams, AMEast African Medical Journal
1989
Review of 66 patients
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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
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MS: Does ethnicity matter?
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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
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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
![Page 21: MS: A Perspective on the African American Experience Mary D. Hughes, MD Medical Director, Neuroscience Associates University Medical Group Greenville Hospital.](https://reader036.fdocuments.in/reader036/viewer/2022062422/56649ea75503460f94baa961/html5/thumbnails/21.jpg)
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
![Page 22: MS: A Perspective on the African American Experience Mary D. Hughes, MD Medical Director, Neuroscience Associates University Medical Group Greenville Hospital.](https://reader036.fdocuments.in/reader036/viewer/2022062422/56649ea75503460f94baa961/html5/thumbnails/22.jpg)
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
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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
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Optic Neuritis in African Americans
“In the AA patients, MS occurred more frequently in a ‘neuromyelitis optica’ form.”
Phillip, PArchives of Neurology, 1998
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Is it in the Genes?
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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
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My Inspiration