A University of Alberta study shows that rural Albertans living with multiple sclerosis are not as likely as urban patients to receive the best treatments to prevent relapses and slow down progression of the disease.
In recently published research in the journal Neurology, the team tracked records for 4,593 people living with multiple sclerosis from 2019 to 2020, 673 in rural areas and 3,920 in urban centres.
They found that rural patients were 17 per cent less likely to receive any therapy to control their MS and were 26 per cent less likely to be on one of the most highly effective treatments.
"When we don't treat people living with MS adequately and they are getting worse over time, they face losses and limitations," says principal investigator Penny Smyth, a clinical neurologist and professor in the Faculty of Medicine & Dentistry. "They might have to stop work early or take another type of job. They might have to take disability income. They may not be able to save for retirement, limiting what they can achieve."
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According to the U of A's Multiple Sclerosis Centre, MS is caused by a misfiring of the immune system. It attacks myelin, which insulates nerves in the brain, spinal cord and eyes. MS can lead to loss of balance, impaired speech, fatigue, even paralysis and early death. It's the most common neurological disability in young adults, and only 20 per cent of MS patients are still working 10 years after their diagnosis.
It was estimated in 2013 that 340 per 100,000 Albertans live with MS, compared with 290 per 100,000 across Canada, among the highest rates in the world.
Smyth explains that MS symptoms tend to come in waves, known as relapses, especially at the outset of the condition. It's now known that early treatment soon after diagnosis can tamp down the immune response, reduce inflammation and help prevent the disease's escalation. The older approach started with less intense treatment, then added therapies as new relapses occurred.
At the time of the study, the most effective drugs were often delivered by infusion, which meant regular trips to a big city to get treatment.
"Rural patients not only had to travel to see a neurologist, but when they started on a high-efficacy therapy, they had to travel to an infusion clinic in a metropolitan centre," explains Smyth. "Especially for those with lower socio-economic status, they might not be able to take time off work."
The team analyzed anonymized data such as how often patients visited the hospital, saw their doctor or were given prescriptions. The researchers did not have detailed medical records that would reveal whether patients took their medication or had MS attacks during the time frame of the study.
The results showed that patients with lower socio-economic status in rural areas based on factors from the Canadian Census such as education, employment status and average income were less likely to be on disease-modifying therapies.
Smyth says the research group plans to conduct further research into the barriers facing rural patients to better understand how geographic, economic, ethnic and other factors interact.
Smyth notes that more high-efficacy treatments are now available, such as oral drugs and injections that can be done at home, sparing patients from the need for infusions. She also says new technologies such as telehealth and integrated digital medical records make it easier for neurologists, family doctors and patients to communicate.
"We can now go back and forth and answer their questions, help them overcome their fears, and then get them on to therapy as quickly as possible," Smyth says.
"It's my goal as an MS care provider to be able to treat their disease so they can accomplish all the things in their lives that they would normally and live a good, long and healthy life."
The study was conceived by lead author and former neurology resident Erin Balcom, now a clinical MS fellow at the University of Toronto.
