People who develop multiple sclerosis as children and grow up in less-advantaged neighborhoods may have a larger volume of inflammation and brain tissue loss on imaging than those who grow up in more-advantaged neighborhoods, according to a new study.

In addition to neighborhood location, worse brain imaging outcomes were also seen among people who self-identified as Black or Latino, those from families where the parents had lower education levels, and those who had public health insurance, which is used as a marker of low-household income.

MS rarely develops in children. About 5 percent of people with MS are diagnosed before age 18. The study by researchers at the New York University Grossman School of Medicine involved 138 people with an average age of 20 who were diagnosed with MS before age 18, known as pediatric onset MS. They had been diagnosed with MS for an average of four years. All had brain scans to measure areas of brain inflammation and injury due to MS and brain volume loss. 

Researchers collected information on social factors that may affect a person’s health, including self-reported race and ethnicity, type of health insurance, parents’ education level, and the degree of neighborhood advantage or disadvantage. Social factors linked to disadvantage correlated with greater volume of inflammatory lesions in the white matter of the brain and also with greater black hole volume, which is a sign of irreversible loss of brain tissue. Together, the identified social factors accounted for 26 percent of the difference in white matter lesion volume and 23 percent of the difference in black hole volume among participants.

Once all factors were taken into account, having public health insurance was the strongest predictor of having greater amounts of inflammation and tissue loss. People with public health insurance had average white matter lesion volume that was larger than people with private insurance. They also had average black hole volumes larger than those with private insurance.

The researchers found the differences were not explained by how soon children were seen by a neurologist, how quickly they were started on medication for MS, or how effective their medications were at slowing their disease progress.

A limitation of the study is that researchers used the address of the children at the time of their diagnosis but did not have information on any prior addresses. Additionally, only a few types of social factors were studied.

The findings were published in the journal Neurology.