b'Similar ndings have been reported in the income and education levels, and less likelyHispanic population with evidence of more to have private insurance compared torapid disability accumulation. Caucasians. When socioeconomic status wasThe age when the rst MS symptoms occur factored in covariate analysis, the dierencealso diers between ethnic groups. Hispanics in disease severity between the racial groupsand African Americans have been reported was reduced, indicating some of the variabilityto develop MS at a younger age compared to in disease severity was due to socioeconomicCaucasians. This earlier age of onset coupled status. with a more rapid progression in disability Cultural factors such as distrust of theputstheseunder-representedgroupsata medical community, religious beliefs, andhigher risk for early disability.illness perception may also impose barriersEthnic/racial dierences in the presentation in access to healthcare and participation inof MS have also been reported in imaging. clinical trials by under-represented ethnic/Studies have shown African Americans are racial groups. Studies have shown Africanmore likely to have higher lesion volumes Americans and Hispanics are more likely toand more rapid brain and retinal tissue loss distrustthemedicalcommunityandlessthan Caucasians.In clinical studies, African likely to use preventative services comparedAmericans were more likely to exhibit rapid to their Caucasian counterparts respectively.neurodegeneration as measured by the MRI Historic events such as the Tuskegee Syphilisand OCT compared to Caucasians. A study Study may contribute to distrust within thethat looked into the prevalence of spinal cord African American community. These culturallesions in Hispanics revealed that up to 73 factors can contribute significantly to latepercent of Hispanic MS patients had spinal diagnosis and suboptimal management ofcord lesions. MS, which in turn worsens disease outcomesSoocciiooeeccoonnoommiicc//ccuullttuurraallffaaccttoorrss and prognosis.Sa MS is a complex and highly variable diseaseannddaacccceessssttooccaarreeHispanics and African Americans are often thataectsdierentracial/ethnicgroups.over-represented in groups that are socio- Patients with MS have variability in presentation,economically disadvantaged by poverty, and course, and prognosis, which may manifestmay face more barriers to accessing quality dierently in dierent ethnicities. Biological,healthcare. The higher burden of MS in these genetic, social, and cultural factors playgroups may be partly because of the effects important roles in the course and prognosisof socioeconomic and cultural factors that of MS. Individuals from under-representedexist within them. These groups have been groupsAfricanAmericanandHispanicreported to have less access to rehabilitation communitieshave a higher burden of MSservices,mentalhealthservices,andMS because of multiple factors and the need forsubspecialty services. In a study by the North earlier diagnosis and more aggressive treatmentAmerican Research Committee on Multiple cannot be overemphasized. More research isSclerosis registry, African Americans with MS needed in these groups to better understandwere not only more severely disabled from MS, the unique characteristics of MS and how tobut were also more likely to be in the lowest better mitigate the risk of disability.17 msfocusmagazine.org'