Unraveling the Influence of Social Determinants on Neurological Diseases

Photo Credit: Drazen Zigic

SDOH play a pivotal role in shaping the landscape of neurologic diseases and outcomes.

According to research presented during ACTRIMS Forum 2024, historical assumptions about the prevalence of multiple sclerosis (MS) among racial and ethnic groups have been challenged. While it was previously believed to be more common among Caucasian people, contemporary studies have revealed higher risks among African American and Hispanic people, with increased disability accumulation compared with Caucasian people.¹

The underlying causes of this discrepancy remain unclear but are likely multifaceted, prompting investigations into the influence of social determinants of health (SDOH) on MS disability.¹

The Impact of SDOH on Neurological Diseases

SDOH play a pivotal role in shaping the landscape of neurologic diseases and outcomes, according to research published in Neurology on August 15, 2023. However, overall comprehension of the intricate biopsychosocial mechanisms remains unclear.²

Predominant epidemiological research has illuminated the impact of education, schooling, and geographical factors on cognition, dementia, and cerebrovascular diseases later in life. Nevertheless, deeper exploration is indispensable to unravel the complex interplay of SDOH in neurologic diseases. The dearth of validated SDOH screening tools in neurologically-affected populations and the absence of standardized common data elements impede cross-study comparisons and population-wide interventions.²

The efficacy of individual versus systemic interventions in ameliorating neurologic health disparities remains uncertain, wrote the researchers.² It is imperative to identify which SDOH warrant intervention and for physicians to devise effective strategies for mitigation in their patient population. Subsequent research should discern the timing, scope, and implementers of interventions to optimize neurologic outcomes, the researchers wrote.²

Advancing SDOH understanding and their impact on neurologic health necessitates a multifaceted approach encompassing rigorous research, community engagement, and systemic interventions.²

“It remains to be seen whether individual-level health or behavioral interventions or place-level, systemic or policy interventions to reduce population burden will be most effective in reducing inequities in neurologic disease and outcomes,” the research team wrote.²

Examining the Link Between SDOH and MS

The research presented at ACTRIMS, led by Madeline Rodriguez, MD, and colleagues, aimed to assess the feasibility of SDOH assessments and compare these factors across different racial and ethnic groups among patients with MS. The authors evaluated the impact of SDOH on patient-reported disease severity.¹

Researchers conducted a retrospective chart review at a tertiary academic clinic, including 100 patients with MS. Patients were queried about SDOH factors such as physical exercise, financial strain, transportation needs, and food insecurity following their clinical visits.¹

Results showed high patient acceptance of SDOH questioning, with only minimal refusals to answer. Investigators found that there was considerable diversity across racial and ethnic backgrounds in responses concerning physical activity and financial strain. The study authors concluded that collecting SDOH data after clinic visits was feasible and well-received by patients.¹

Further analysis is underway to understand individual SDOH contributions to disability, with plans for more detailed statistical examination. The authors noted that unifying SDOH measurements across centers may help mitigate future discrepancies in research findings.¹