SDOHs Tied To Poor Autoimmune Disease Outcomes Among Minorities

According to a study by the Keck School of Medicine at the University of Southern California (USC), minority populations in the United States with autoimmune diseases, including multiple sclerosis (MS), experience poor outcomes due to social determinants of health.

“For Blacks and Latinos with MS or other autoimmune diseases, access to neurological specialists is rare and diagnostic tools are limited,” lead researcher Lilyana Amezcua, MD, said in a press release.

“Our study shows that, before we look at biological factors as the cause of the disparities we see in health outcomes, we should first assess the role of SDOH and how we might modify them to make a difference.”

To examine the role of the social determinants of health (SDOH), researchers conducted a narrative review of medical literature from three major bibliographic databases of life science and biomedical information, paying attention to studies published between January 2014 and March 2021.

The team searched through thousands of journals for terms related to race, ethnicity, disparity, and inequity related to autoimmune diseases.

“Normally, one would expect there to have been much more data available for a survey like this, but racial and ethnic populations, particularly with regard to MS, are quite underrepresented. In prior studies, only about one percent of the literature reflects these minority populations. In clinical trials, less than 10 percent include African Americans or Latinos,” Amezcua said.

“This is a disservice to these communities because there are more than 20 disease-modifying treatments for MS.”

Despite a lack of information including minority populations, the data indicated that when it comes to diseases such as MS and neuromyelitis optica spectrum disorder (NMOSD), Black and Latinx populations are more likely to experience health disparities due to SDOH than White populations. Additionally, Black populations have a higher risk of developing MS and NMOSD and dying from it.

“The review also revealed significant inequities in accessing health care, leading to diagnostic delays, and underuse of services such as outpatient neurological care, case management, technology, equipment, nursing and modification services,” the press release stated.

For MS especially, the review indicated that SDOHs, including low income and low education, were associated with lower health services utilization among minority populations. Unemployment was also associated with poor outcomes from Black patients. Additionally, the study found that negative illness perception is another SDOH associated with racial and ethnic health disparities.

“Our analysis confirms the power of the health belief model – that what you think about your disease will lead you to take action, or not, in order to advocate for yourself as a patient,” Amezcua said.

“For many communities of color, there is a sense of fatalism about their ability to improve their MS, which only serves to reinforce the impact of the disease on their lives.”

Amezcua explained that previous USC studies have examined perceptions of illness, particularly MS, in the Latinx population and discovered differences between Latinx populations born in the US versus those who emigrated from other countries. Foreign-born Latinx individuals were more aligned with sociocultural factors that made them less likely to receive MS treatment. 

“What we learned from these studies is that education can change this,” Amezcua said, “and that perceptions are modifiable with the right intervention that promotes health literacy.”

According to the researchers, the results of this study highlight the need to identify a new approached to counteract the negative impact of SDOH on underrepresented populations.

“It underscores that, when it comes to autoimmune disorders, vulnerable populations suffer from the same inequities that other chronic conditions have highlighted,” said Lourdes Baezconde-Garbanati, a co-author of the study.

“Going forward, we as researchers need to do a better job of including SDOH in our research models, not only to consider how they affect disease in underrepresented populations, but also to create interventions that go beyond one disease.”