Black patients with generalized MG may face health inequities: Study
Group faces higher risk of symptoms worsening, new ones appearing
Black patients with generalized myasthenia gravis (gMG) face significantly higher risks of exacerbations compared with their white counterparts, according to a retrospective analysis of healthcare insurance claims from a U.S. database. Exacerbations refer to the worsening of existing symptoms or the appearance of new ones.
“Interventions aimed at addressing potential inequities should also be explored, and at-risk populations should be a focus for healthcare providers, disease management efforts, and patient support entities,” researchers wrote.
The study, “Association of Race and Social Determinants of Health With Exacerbations in Generalized Myasthenia Gravis,” was published in the journal Muscle & Nerve. The study was funded by Johnson & Johnson.
Black women may have higher incidence of MG compared to white women
MG occurs when the immune system produces self-reactive antibodies that disrupt the communication between nerves and muscles, causing weakness that worsens with activity. In most MG cases, these antibodies target acetylcholine receptor proteins (AChRs) on muscle cells. AChRs are protein receptors that bind and respond to acetylcholine, a chemical messenger released by nerve cells to stimulate muscle contraction.
Patients can often experience exacerbations, which can make it difficult to do everyday activities and may require hospital care.
Evidence shows that Black women may have a higher incidence of MG compared to white women, as well as compared to men from both racial groups, the researchers wrote. Disparities between ethnic groups have also been reported regarding healthcare use and treatment.
Identifying patients at higher risk for adverse outcomes is crucial for targeted healthcare and disease management, the researchers wrote.
Researchers at the Houston Methodist Hospital, along with Johnson & Johnson researchers, assessed the link between race/ethnicity and the occurrence of MG exacerbations in a diverse population of gMG patients in the U.S., while also examining the impact of social determinants of health (SDOH).
They conducted a retrospective analysis of healthcare insurance claims from the HealthVerity database filed between Jan. 1, 2017, and June 30, 2023.
To be included in the study, patients had to have a definite gMG diagnosis, be 18 or older, and have their ethnic group disclosed.
Black patients with gMG tended to be younger on average than white patients
After anonymizing the data, 10,981 patients who met all eligibility criteria were included in the analysis. More than half of them (63.8%) were white, 19.4% were Black, 12.0% were Hispanic, and 4.8% were Asian.
At the start of the analysis, Black patients with gMG tended to be younger on average than white patients. Additionally, a higher percentage of Black patients were women, and more Black patients were enrolled in Medicaid compared to their white counterparts. Black patients also had a greater occurrence of prior MG exacerbations.
During follow-up, analysis showed that Black patients had a 21% higher risk of MG exacerbations compared with white patients. The higher risk among Black patients persisted even after adjusting for income and health insurance coverage. No significant difference in the risk of exacerbation was found between Hispanic or Asian patients compared with white patients.
Asian patients had a lower rate of MG exacerbations compared with white patients. The researchers noted, however, that since “the number of Asian patients in the study was relatively low, this result should be interpreted with caution and requires further study.”
The researcher concluded that “the findings of this study may signify potential racial disparities as evidenced by a higher risk of MG exacerbation among Black patients with gMG, compared with White patients, even after controlling for select SDOH [social determinants of health] variables,” the researchers wrote
The researchers believe that these findings warrant “further investigation into the potential mechanisms and factors associated with varying clinical outcomes for patients with gMG who belong to different racial/ethnic groups.”
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