title: Rapid disease course in African Americans with multiple sclerosis.
abstract: OBJECTIVE
  To investigate utility of a Multiple Sclerosis Severity Scale (MSSS)-based classification system for comparing African American (AA) and white American (WA) multiple sclerosis (MS) subpopulations in the New York State Multiple Sclerosis Consortium (NYSMSC) database. MSSS is a frequency-rank algorithm relating MS disability to disease duration in a large, untreated reference population. Design/
  
  
  METHODS
  Distributions of patients in 6 MSSS-based severity grades were calculated for AA and WA registrants.
  
  
  RESULTS
  There were 419 AA and 5,809 WA patients in the NYSMSC, who had EDSS recorded during years 1-30 since symptom onset. Median EDSS was not different in AA and WA (3.5 vs 3.0, p = 0.60), whereas median MSSS in AA was higher than in WA (6.0 vs 4.8, p = 0.001). AA patients were overrepresented in the 2 most severe grades (41.5% vs 29.3% for WA) and underrepresented in the 2 lowest grades (23.4% vs 35.4%; p < 0.001). In multivariable analysis (ordered logistic and median regression), MSSS for AA remained significantly higher than in WA after adjusting for age, gender, disease duration, disease type distribution, and treatment with disease-modifying therapies.
  
  
  CONCLUSIONS
  The 6-tiered MSSS grading system is a powerful tool for comparing rate of disease progression in subpopulations of interest. MSSS-based analysis demonstrates that African ancestry is a risk factor for a more rapidly disabling disease course.
authors.affiliation: Department of Neurology, NYU School of Medicine, Multiple Sclerosis Care Center, New York, NY 10003-3804, USA. ilya.kister@gmail.com
authors.forename: I
authors.initials: I
authors.lastname: Kister
authors.forename: E
authors.initials: E
authors.lastname: Chamot
authors.forename: J H
authors.initials: JH
authors.lastname: Bacon
authors.forename: P M
authors.initials: PM
authors.lastname: Niewczyk
authors.forename: R A
authors.initials: RA
authors.lastname: De Guzman
authors.forename: B
authors.initials: B
authors.lastname: Apatoff
authors.forename: P
authors.initials: P
authors.lastname: Coyle
authors.forename: A D
authors.initials: AD
authors.lastname: Goodman
authors.forename: M
authors.initials: M
authors.lastname: Gottesman
authors.forename: C
authors.initials: C
authors.lastname: Granger
authors.forename: B
authors.initials: B
authors.lastname: Jubelt
authors.forename: L
authors.initials: L
authors.lastname: Krupp
authors.forename: M
authors.initials: M
authors.lastname: Lenihan
authors.forename: F
authors.initials: F
authors.lastname: Lublin
authors.forename: C
authors.initials: C
authors.lastname: Mihai
authors.forename: A
authors.initials: A
authors.lastname: Miller
authors.forename: F E
authors.initials: FE
authors.lastname: Munschauer
authors.forename: A B
authors.initials: AB
authors.lastname: Perel
authors.forename: B E
authors.initials: BE
authors.lastname: Teter
authors.forename: B
authors.initials: B
authors.lastname: Weinstock-Guttman
authors.forename: R
authors.initials: R
authors.lastname: Zivadinov
authors.forename: J
authors.initials: J
authors.lastname: Herbert
mesh_terms: D000328:Adult; D001741:Black or African American / Q000208:ethnology*; D017668:Age of Onset; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000453:epidemiology* / Q000208:ethnology* / Q000503:physiopathology; D015999:Multivariate Analysis; D009518:New York / Q000453:epidemiology; D011379:Prognosis; D012720:Severity of Illness Index