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NASHVILLE, Tennessee — Large numbers of patients with multiple sclerosis (MS) who live outside large urban centers have little, or no, access to neurologic care, new research showed.

Funded by the National MS Society (NMSS), the data reveal that "about a quarter of the US population live in what we defined as an MS care desert," said Bari Talente, executive vice president of advocacy and healthcare access for the organization. Talente added that many patients living in "MS care deserts" are also far from a neurologist of any kind.

Conducted in collaboration with Deloitte Consulting, the study was presented as a late-breaker on May 30 at the Consortium of Multiple Sclerosis Centers (CMSC) 2024 Annual Meeting.

Deloitte maintains the US health dataset HealthPrism, which includes 335 million individuals. This study is the first step in characterizing the problem. Talente said the next step is finding solutions.

The database, she said, includes data on economic and social characteristics. For example, access to the internet is a measurable variable, but because some regions of the country still have limited access, telehealth is not a uniform solution, she noted.

In the continental United States, 23% of the population lives in an MS care desert as defined by neurologist density and travel times. The threshold for an underserved area on the basis of neurologists was < 2.32/100,000 individuals in any given county. Drive time thresholds varied, but the definition of an MS desert is defined as more than 60 minutes from an urban center.

The fact that the majority of MS patients have full or partial access to MS care contrasts with a color-coded US map that displays full access, partial access, or MS care deserts. Vast areas of the continental United States are solid orange, indicating an MS care desert. Areas colored in yellow, signaling partial access, or blue, revealing full access, are concentrated in the Northeast, in Florida, and in urban islands across the West.

General Neurologist Gap

A map indicating the availability of general neurologists shows most of the Eastern United States is colored in yellow, indicating partial access. In the Midwest, the map is largely yellow with islands of yellow and blue. The West Coast, like the East Coast, is also predominantly yellow and blue. However, the rural West is predominately orange.

When large central metropolitan counties are compared with rural areas, the mean density of neurologists is nearly five times higher (10.8 vs 2.15/100,000 population). Full access to a neurologist is approximately seven times higher in urban areas relative to rural areas (97% vs 13%).

Evaluated from the opposite perspective, only a small proportion of patients with MS in urban centers have no access to specialty care. According to the data from this study, led by Andreina Barnola, MD, MPH, director of Health Equity Initiatives at the NMSS, the proportions climb steeply with lower population density, reaching 60% in small metro areas and 83% in rural areas.

A chronic illness, MS, requires lifelong attention. Over the past decades, MS specialty centers have been able to provide increasingly sophisticated interventions to sustain the quality of life and reduce some of the risk from medical complications associated with MS-induced organ dysfunction. Talente suggested that the magnitude of the problem will only increase with the growing shortage of neurologists.

In another study published this year, similar data were generated using a different methodology. With data on 2022 practice locations, the study showed that 17,827 (25.2%) of the 70,858 census tracts in the United States had no MS centers within 60 miles.

Among other findings, the study also documented lower access among Hispanic groups relative to other ethnic/racial groups and among individuals with disabilities.

The lead author of that study, which was also presented at the CMSC conference, Marisa P. McGinley, DO, an assistant professor of neurology at the Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, said that the "clear geographic disparities in access to neurologists and MS specialty centers" are an important clinical challenge and that the solutions are not simple.

"Telemedicine has the potential to reduce some of these geographic barriers, but other solutions developed in partnership with people with MS and other healthcare professionals are needed," McGinley said.

Talente also suggested that innovative solutions are needed. Given the impracticality of creating MS specialty centers in rural areas, she suggested that one possibility is to provide tools to general neurologists, or even to primary care physicians, that will enable a higher level of care.

None of the investigators associated with the NMMS study reported any potential conflicts of interest. McGinley reported financial relationships with Biogen, EMD Serono, Genzyme, Genentech, Novartis, and Octave Bioscience.