A study in the USA on walking performance in people with MS, has found that Black people living with MS tend to have higher disability outcomes. This may include slower walking and shorter walking distances than their White counterparts.
The study, entitled Walking performance is worse in Black than White people with multiple sclerosis, showed that more research is needed into what is driving poorer health outcomes for Black people with MS. The researchers stress that this is important as Black people with MS tend to have more severe disability when they are first diagnosed.
The research team took into account factors including age, gender, physical activity, disease progression, and access to healthcare. However, they found a consistent difference between Black and White people with MS, suggesting that those factors were not enough on their own to explain the higher rate of disability.
The researchers suggest that further research should look at rehabilitation opportunities for improving walking performance in Black people with MS. They argue that rehabilitation is one of the most powerful approaches for restoring walking performance in MS.
The researchers enrolled 105 Black people with MS and 246 White people with MS to complete two walking tests. The Black participants had slightly higher EDSS scores (5.4 vs. 5.2 points) compared to their White counterparts. The research team looked at the results of a 25-foot timed walk (T25FW) to look at speed of walking, and a six-minute walk (6MW) to measure the distance the participants could walk in that time.
Black participants walked on average 1.16 feet per second slower on the T25FW test than the White participants. On the 6MW test, Black participants walked about 119 feet less than White participants (842.3 vs. 961.5 feet).
The differences in walking speed and distance were statistically significant, suggesting that demographic factors and clinical factors such as symptoms or disease progression were not sufficient to explain the results. This is also consistent with previous research, which shows that Black people with MS perform worse on walking tests regardless of social determinants of health, such as education or income.
There is growing evidence that many Black people experience MS differently from White people, having more severe symptoms and faster disability progression. Cultural factors for this cannot be ruled out and were included in this study. It is important to note that although this study was based in the USA, similar experiences may be seen in the UK.
Broad research into the experience of racialised people in medical settings consistently shows a higher likelihood of experiencing discrimination or facing barriers to health care and consequently having worse health outcomes. For example, the NHS Race Health Observatory reported in 2022 that Black women were more likely to have pain dismissed due to the ‘strong Black woman’ stereotype.
The Marmot Review published in 2020 reported on the impact of social inequality on health in the last decade. As the report states ‘Inequalities in health arise because of inequalities in society – in the conditions in which people are born, grow, live, work and age.’ Social inequalities can affect people’s trust and engagement with medicine, and the quality of the care received.
This was evident during the pandemic where people from some racialised communities were more at risk of severe disease, but also less likely to receive vaccines. A lack of awareness of MS within some racialised communities, coupled with delays in seeking medical advice or delays in referral to specialists could result in a delay in diagnosis. However, there is evidence that discrimination (whether conscious or subconscious) plays a role in the speed of diagnosis and treatment for racialised people. These combined reasons may explain the worse outcomes for Black people with MS as they may be further along their MS journey when they reach the neurologist.
