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Racial, Ethnic, and Socioeconomic Disparities in Pediatric Aquaporin-4-Positive Neuromyelitis Optica Spectrum
Kelsey E Poisson1, Linda Nguyen2, Paul S Horn3
1Division of Neurology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio.
Insights
Black/African American children with aquaporin-4-positive neuromyelitis optica spectrum disorder (AQP4+ NMOSD) face worse outcomes, including higher disability and healthcare use. Socioeconomic factors also significantly impact pediatric AQP4+ NMOSD patient results.
Area of Science:
- Neurology
- Immunology
- Pediatrics
Background:
- Pediatric aquaporin-4-positive neuromyelitis optica spectrum disorder (AQP4+ NMOSD) is rare, accounting for only 5% of cases.
- Limited data exist on racial, ethnic, and socioeconomic disparities in pediatric AQP4+ NMOSD outcomes.
- Previous studies suggest poorer outcomes in Black/African American (AA) adults with NMOSD.
Purpose of the Study:
- To evaluate racial, ethnic, and socioeconomic disparities in pediatric AQP4+ NMOSD outcomes.
- To assess differences in clinical outcomes and healthcare utilization based on race, ethnicity, and socioeconomic status.
- To identify factors influencing disease severity and healthcare access in children with AQP4+ NMOSD.
Main Methods:
- Retrospective study of 38 pediatric patients with AQP4+ NMOSD diagnosed between 2009 and 2021 at three tertiary care centers.
- Patient addresses were linked to US Census data for socioeconomic status assessment.
- Demographic characteristics, clinical outcomes (including Expanded Disability Status Scale - EDSS), and healthcare utilization were analyzed for two years post-diagnosis.
Main Results:
- Black/AA children exhibited significantly higher EDSS scores (2.46 vs. 0.33), more hospital admissions (2.37), and additional inpatient days (28.40) compared to non-Hispanic White children within two years of diagnosis.
- Children with public insurance reported higher relapse rates than those with private insurance (P=0.046).
- Higher EDSS scores at two years and most recent follow-up correlated with lower median income, higher deprivation index, and increased poverty indicators in residential areas.
Conclusions:
- Significant racial, ethnic, and socioeconomic disparities exist in clinical outcomes and healthcare utilization for pediatric AQP4+ NMOSD.
- Further research, including prospective and household-level data, is necessary.
- Understanding the interplay of genetics, structural racism, and social determinants of health is crucial for developing targeted interventions to improve care for this vulnerable population.
Background:
Only 5% of aquaporin-4-positive neuromyelitis optica spectrum disorder (AQP4+ NMOSD) cases emerge during childhood. Poorer outcomes have been suggested in black/African American (AA) adults with NMOSD; however, conflicting and limited data exist for pediatric-onset NMOSD. This study evaluates racial, ethnic, and socioeconomic disparities in pediatric AQP4+ NMOSD outcomes.
Methods:
Thirty-eight pediatric patients with AQP4+ NMOSD cared for at three pediatric tertiary care centers between 2009 and 2021 were identified. Patient addresses connected to socioeconomic measures available from the US Census. Demographic characteristics, pertinent clinical outcomes, and health care utilization in the two years following diagnosis were captured.
Results:
Compared with non-Hispanic White children, Black/AA children had a significantly higher Expanded Disability Status Scale (EDSS) (2.46 vs 0.33, P = 0.003), 2.37 more hospital admissions (P = 0.002), and 28.40 additional inpatient days (P = 0.002) in the two years following their NMOSD diagnosis. Additionally, children with public insurance had higher relapse rates than those with private insurance (P = 0.046). At two years and at the most recent follow-up, a significantly higher EDSS was correlated with children living in census tracts with a lower median income, higher deprivation index, and higher proportion of population on assisted income, in poverty, and with vacant housing (all P < 0.05).
Conclusions:
We identified racial, ethnic, and socioeconomic disparities in clinical outcomes and health care utilization in pediatric AQP4+ NMOSD. Further prospective and household-level data are needed to dissect the interplay of genetics, structural racism, and social determinants of health so that interventions to optimize care and outcomes for this population may be developed.
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