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Updated: Aug 20, 2026
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Clinical characteristics of African Americans vs Caucasian Americans with multiple sclerosis
B A C Cree1, O Khan, D Bourdette
1Multiple Sclerosis Center, Department of Neurology, University of California San Francisco, 350 Parnassus Ave., Suite 908, San Francisco, CA 94117, USA. bcree@itsa.ucsf.edu
Background:
African American (AA) individuals are thought to develop multiple sclerosis (MS) less frequently than Caucasian American (CA) individuals.
Objective:
To compare the clinical characteristics of AA and CA patients with MS.
Methods:
The clinical features of MS were compared in a large retrospective cohort of AA (n = 375) and CA (n = 427) subjects.
Results:
The proportion of women to men was similar in AA and CA subjects (81% [AA] vs 77% [CA]; p = 0.122). There were no differences in the proportions of subjects with relapsing-remitting, secondary progressive, primary progressive, and progressive relapsing MS. The median time to diagnosis was 1 year after symptom onset in AA subjects and 2 years after symptom onset in CA subjects (p = 0.0013). The age at onset was approximately 2.5 years later in AA than CA subjects (33.7 vs 31.1 years; p = 0.0001). AA subjects presented with multisite signs and symptoms at disease onset more often than CA subjects (p = 0.018). Clinical involvement restricted to the optic nerves and spinal cord (opticospinal MS) occurred in 16.8% of AA patients compared with 7.9% of CA patients (p < 0.001). Transverse myelitis also occurred more frequently in AA subjects (28 vs 18%; p = 0.001). Survival analysis revealed that AA subjects were at higher risk for development of ambulatory disability than CA subjects. After adjusting for baseline variations and differences in therapeutic interventions, AAs were at 1.67-fold greater risk for requiring a cane to ambulate than CA patients (p < 0.001). There was a trend suggesting that AAs were also at greater risk for development of wheelchair dependency (p = 0.099). Adjusted Cox proportional hazard models showed that this effect was in part attributable to the older age at onset in AAs (p < 0.001).
Conclusions:
Compared with multiple sclerosis (MS) in Caucasian Americans, African American patients with MS have a greater likelihood of developing opticospinal MS and transverse myelitis and have a more aggressive disease course.
Insights
African American patients with multiple sclerosis (MS) experience a more aggressive disease course, with higher risks of opticospinal MS and transverse myelitis compared to Caucasian Americans.
Area of Science:
- Neurology
- Immunology
- Epidemiology
Background:
- Multiple sclerosis (MS) is less common in African American (AA) individuals than Caucasian American (CA) individuals.
- Understanding clinical differences in MS between AA and CA populations is crucial for targeted treatment and research.
Purpose of the Study:
- To compare the clinical characteristics and disease progression of MS in African American and Caucasian American patients.
Main Methods:
- A retrospective cohort study compared clinical features of MS in 375 AA and 427 CA subjects.
- Analysis included disease onset, clinical presentation, and disability progression.
Main Results:
- AA patients were diagnosed later (1 vs 2 years median) and had a later age of onset (33.7 vs 31.1 years).
- AA patients more frequently presented with multisite symptoms, opticospinal MS (16.8% vs 7.9%), and transverse myelitis (28% vs 18%).
- AA patients showed a higher risk of ambulatory disability, including requiring a cane (1.67-fold greater risk).
Conclusions:
- African American patients with MS exhibit a more aggressive disease course than Caucasian American patients.
- Higher incidence of opticospinal MS and transverse myelitis in AA individuals contributes to poorer outcomes.
- Delayed diagnosis and older age at onset in AA patients may influence disease severity.
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