Place of birth, age of immigration, and disability in Hispanics with multiple sclerosis

Background: Hispanics in the US are a diverse community where their knowledge and risk for developing disability in multiple sclerosis (MS) may relate to their level of acculturation. Objective: To compare the risk of disability in Hispanics with MS in the US by place of birth and age of immigration. Methods: We conducted a cross-sectional study of 304 Hispanics with MS residing in Southern California. Place of birth and age of immigration were used as proxies to acculturation. Individuals were classified as US-born, early and late-immigrant (<15 and >= 15 years at immigration to the US, respectively). Risk of disability (expanded disability status scale >= 6) was adjusted for age at symptom onset, sex, socioeconomic status, and disease duration, using logistic regression. Results: Late-immigrants were older at symptom onset (34.2 +/- 11.9 vs. 31.9 +/- 12.9 vs. 28.5 +/- 9.7 years, p<0.001) and had more disability (28% vs. 9% vs. 18%, p=0.04) compared to early-immigrant and US-born respectively. There was no difference between groups by female sex, type of MS, ethnicity, chronic medical conditions, and disease duration while differences were noted by socioeconomic status. Being late-immigrant was independently associated with increased disability (adjusted OR 2.3 95% Cls 1.07-4.82; p=0.03) compared to US-born. Conclusion: Later immigration to the US in Hispanics with MS is associated with greater disability. These findings may reflect differences in social, environmental and cultural factors that may act as barriers for accessibility and utilization of health services. An in-depth assessment of the perceptions and attitudes about MS are warranted in this population. (C) 2014 Elsevier B.V. All rights reserved.