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Racial and Ethnic Disease Phenotype Differences Are Driven by Genetics: No
1Los Angeles Medical Center, Department of Neurology, Southern California Permanente Medical Group, Los Angeles, CA, USA.
Multiple Sclerosis (Houndmills, Basingstoke, England)
|December 11, 2024
Summary
Multiple sclerosis (MS) affects Black individuals most, with faster disability and higher mortality. These disparities stem from social factors like embodied racism, not genetics, highlighting environmental influences on MS.
Area of Science:
- Neuroimmunology
- Social Epidemiology
- Health Disparities
Background:
- Multiple sclerosis (MS) exhibits significant variations in incidence, prevalence, and prognosis across racial and ethnic groups in the United States.
- Black individuals experience the highest MS incidence and prevalence (especially under 35), with faster disability accrual and earlier mortality compared to White individuals.
- While MS is less common in Hispanic and Asian/Pacific Islander populations than White individuals, similar prevalence is observed in younger Hispanic and White individuals (under 25).
Purpose of the Study:
- To investigate the reasons behind observed racial and ethnic disparities in multiple sclerosis (MS) susceptibility and prognosis in the USA.
- To critically evaluate the role of genetics versus environmental and social factors in explaining these health inequities.
- To propose embodied racism as a primary explanation for differential MS outcomes.
Main Methods:
- Review and synthesis of existing epidemiological data on MS incidence, prevalence, and outcomes stratified by race and ethnicity.
- Analysis of the biological and social definitions of race and ethnicity in the context of MS.
- Examination of known MS environmental risk factors, including Epstein-Barr virus (EBV) infection and pediatric obesity.
Main Results:
- MS susceptibility and prognosis are not genetically determined, as race and ethnicity are social constructs, not biological distinctions.
- Environmental factors, such as Epstein-Barr virus (EBV) infection and pediatric obesity, are major contributors to MS susceptibility.
- Embodied racism presents a more plausible explanation for the observed disparities in MS outcomes among different racial and ethnic groups.
Conclusions:
- Observed racial and ethnic differences in multiple sclerosis are primarily driven by social determinants and environmental exposures, not genetic predispositions.
- Embodied racism is identified as a significant factor contributing to the disproportionately higher burden of MS and its complications in Black communities.
- Future research and interventions should focus on addressing systemic inequities and environmental factors to mitigate MS disparities.
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