A WashU anthropologist joins a study uncovering the surprising sources — and overlooked sufferers — of an increasingly common disease.
A new paper is challenging longstanding misconceptions about multiple sclerosis, a common autoimmune disease that affects roughly one million people in the United States. “For many years, MS was seen as a disease that affects mostly white women,” said co-author Theresa Gildner, an assistant professor of anthropology. “We’ve found that the disease is actually more common in Black women, and we have evidence that disparities in the environment and the health system are driving that trend.”
The perspective piece was published in the prestigious journal Nature Reviews Neurology. The lead author is Annette Langer-Gould, an MS specialist at the Los Angeles Medical Center.
The paper pointed to a previous study led by Langer-Gould that strongly contradicted common assumptions about the disease held by the general public and many medical professionals. The study of nearly 500 people found that Black participants had the highest rate of MS, roughly 1.5 times that of white participants. Moreover, results indicated that Black women exhibit a roughly 60% higher risk of developing MS compared to white women.
While it was once believed that MS is mostly an inherited condition rooted in genetics, recent studies of identical twins suggest that environmental factors account for up to 80% of the risk. The racial disparities highlighted in the new perspective piece underscore the importance of outside influences, Gildner explained.
For example, the disease is more common in people who are overweight and who lack sun exposure. These two risk factors are especially prevalent in minority communities, Gilder and co-authors note, partly because of a lack of access to nutritious food and green spaces for outdoor exercise. Also, people who are exposed to air pollution and certain pathogens early in life can develop unhealthy immune system responses that may set the stage for MS or other autoimmune diseases. “The causes of MS are complicated, but many of the factors put Black people at a disadvantage,” she said.
Gildner was asked to contribute to the perspective piece because much of her work centers on the intersection between living conditions and health. She has found high rates of parasitic and bacterial infections in people who live in flood-prone, relatively impoverished areas of the Mississippi Delta region and the Metro East area of Southern Illinois. She was a co-author of a 2023 study that showed how exposure to pathogens, chronic stress, and poverty compromised the immune systems of people living in the Delta.
“The causes of MS are complicated, but many of the factors put Black people at a disadvantage.” —Theresa Gildner
Minorities are also more likely to face barriers to quality health care that could help them manage MS, Gildner said. People who don’t have regular access to a doctor may go undiagnosed for years, missing out on a crucial window for early treatment that can help slow the progression of the disease. “It takes the right tests and scans to be diagnosed,” Gildner said. “Even if they make it over that hurdle, they may not be able to receive the type of follow-up care that makes treatments successful.”
In MS, consistent treatment and a commitment to lifestyle changes can be the key to managing the disease. “Medications that work well in a clinical trial may not have the same benefits in the real world,” Gildner said. “So much depends on getting quality, reliable medical care.”
Gildner hopes the new piece will encourage clinicians to think beyond the stereotypes of MS. “Some Black people aren’t getting diagnosed because doctors aren’t looking for it,” she said.
More fundamentally, the paper is a reminder that disparities in communities can greatly influence health outcomes, often to the detriment of minorities. “We see the same sort of trends in other diseases such as diabetes, heart disease, and hypertension,” Gildner said. “There are a lot of structural issues in our society. If more people understand that, we might have better chances for change.”
Header image: MRI scans are a key tool in diagnosing multiple sclerosis, helping doctors detect lesions in the brain and spinal cord. (Credit: Anna Shvets/Pexels)
