Racial Differences in Multiple Sclerosis

Black and White Americans Experience MS Differently

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.


Michael J Olek, DO. Epidemiology, risk factors, and clinical features of multiple sclerosis in adults. UpToDate. Accessed: February 2009.

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