You are here

  • Home
  • Archive
  • Volume 95, Issue 12
  • Ethnicity and deprivation negatively impact the access to disease-modifying therapy for relapsing-remitting multiple sclerosis: a retrospective, single-centre study

Article Text

Article menu
Download PDFPDF
Multiple sclerosis
Original research
Ethnicity and deprivation negatively impact the access to disease-modifying therapy for relapsing-remitting multiple sclerosis: a retrospective, single-centre study
  1. Joyutpal Das1,2,
  2. Gagana Mallawaarachchi3,
  3. Jack Grimshaw3,
  4. Thomas Jackson3,
  5. Paul Talbot4,
  6. Nazar Sharaf4,
  7. Thaleia Kalatha4,
  8. Lindsay Lord4,
  9. Adrian Pace4,5,
  10. Tatiana Mihalova4,6,
  11. Calvin Heal7,
  12. David Rog4
  1. 1 Cardiovascular Department, The University of Manchester, Manchester, UK
  2. 2 Neuroscience Department, Salford Royal Hospital Manchester Centre for Clinical Neurosciences, Salford, UK
  3. 3 The University of Manchester, Manchester, UK
  4. 4 Salford Royal Hospital Manchester Centre for Clinical Neurosciences, Salford, UK
  5. 5 Gozo General Hospital, Victoria, Malta
  6. 6 Penta Hospitals, Bratislava, Poland
  7. 7 Centre for Biostatistics, University of Manchester, Manchester, UK
  1. Correspondence to Dr Joyutpal Das; joyutpal.das{at}postgrad.manchester.ac.uk

Abstract

Background A growing body of evidence suggests inequitable access to disease-modifying therapies (DMTs) for multiple sclerosis (MS) in publicly funded healthcare systems. This retrospective study examined the impact of ethnicity and deprivation on the access to DMTs.

Methods All adults diagnosed with relapsing-remitting MS between 2010 and 2020 were included. The impact of ethnicity and deprivation on being offered and starting any DMTs and high-efficacy DMTs were measured using binary, multinomial logistic and Cox regression models. These analyses were adjusted for sex, age at diagnosis and year of diagnosis.

Results 164/1648 people with MS (PwMS) were from non-white ethnicities. 461/1648 who were living in the most deprived areas, were less likely to be offered DMTs, with an OR of 0.66 (95% CI 0.47 to 0.93), less likely to start high-efficacy DMTs with an OR of 0.67 (95% CI 0.48 to 0.93) and more likely to experience a delay in starting high-efficacy DMTs with an HR of 0.76 (95% CI 0.63 to 0.92), when also adjusted for ethnicity. Although the offer of DMTs did not depend on ethnicity, PwMS from non-white ethnicities were more likely to decline DMTs, less likely to start any DMTs and high-efficacy DMTs with ORs of 0.60 (95% CI 0.39 to 0.93) and 0.61 (95% CI 0.38 to 0.98), respectively, and more likely to experience a delay in starting DMTs with an HR of 0.79 (95% CI 0.66 to 0.95), when also adjusted for deprivation.

Conclusions In a publicly funded healthcare system, the access to DMTs varied depending on ethnicities and levels of deprivation.

  • MULTIPLE SCLEROSIS
  • HEALTH POLICY & PRACTICE

Data availability statement

No data are available.

https://doi.org/10.1136/jnnp-2024-333338

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    No data are available.

    View Full Text

    Footnotes

    • Contributors Planning: JD and DR; Conduct: JD and DR and Reporting: all authors. Responsible for the overall content as the guarantor: JD.

      We would like to acknowledge the Greater Manchester MS specialist nurses for their contribution to managing the MS regional caseload during the period covered by this study; Christine Allen, Alison Bradford, Gill Carter, Danielle Cragg, Daniel Dunbar, Adele Dillon, Fran Jackson, Nina Jennings, William Lusher, Wendy Power, Melanie Sutcliffe, Karen Vernon (MS Nurse Consultant) and Denise Winterbottom.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests DR reports a relationship with Actelion, Biogen, Celgene, Hikma, Janssen, MedDay, Merck, Mitsubishi, Novartis, Roche, Sanofi, Teva, TG Therapeutics that includes consulting or advisory, funding grants and speaking and lecture fees.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.