Unexpected Tie Between Education and Diagnostic Delays in MS

TORONTO — Higher levels of education might be expected to help patients obtain a timely multiple sclerosis (MS) diagnosis, but new research suggested otherwise. Patients with more education had greater odds of diagnostic delay.Results of a single-center, retrospective cross-sectional study showed that limited access to MS specialists, neurologists, and MRI facilities was associated with significant delays in MS diagnosis, with limited access to MS specialists showing the strongest association.Marisa McGinley, DOThe study illustrates that diagnostic delays aren’t entirely explained by clinical or biological factors and that barriers exist within the healthcare system, said study investigator Marisa McGinley, DO, a neurologist at Cleveland Clinic’s Mellen Center in Ohio, told Medscape Medical News.The findings were presented on October 21 at the 10th Joint European Committee for Treatment and Research in Multiple Sclerosis-Americas Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS-ACTRIMS) 2026.Investigating Diagnostic DelaysPrevious research has linked delays in MS diagnosis to clinical factors and barriers to specialized care. However, the relationship between geographic access to neurologists, MS specialists, and MRI facilities and diagnostic delays has not been examined directly.To explore whether limited access to these resources contributes to diagnostic delays, the researchers analyzed data from 8259 adults with clinician-confirmed MS who had visited the Cleveland Clinic’s MS center at least once between January 1, 2015, and June 30, 2025.The study population had a mean age of 55.5 years; 73% of the participants were female, and 82% were White. Investigators mapped the locations of neurologists, MS specialists, and MRI facilities and assessed geographic access based on driving distances, population density, and healthcare resource density, the latter reflecting the potential strain on services.The primary outcome was diagnostic delay of 6 months or longer, defined as the interval between patient-reported age at symptom onset and age at MS diagnosis.A sensitivity analysis examined delays of 12 months or longer. Researchers adjusted for age at symptom onset, sex, race, ethnicity, education, insurance type, MS course at onset, number of comorbidities, diagnostic period, and Area Deprivation Index (ADI), a measure of neighborhood socioeconomic disadvantage.Approximately 26% of the participants had public insurance, 15% lived in rural areas, and 15% were in the highest quintile of the ADI.Most (91%) patients had relapsing-remitting MS with a mean disease duration of 21.9 years. About 56% were diagnosed before 2010, 28% were diagnosed between 2011 and 2017, and 16% were diagnosed in 2018 or later.Across geographic areas, the mean number of neurologists was 14.5 per 100,000 population compared with 0.81 MS specialists and 2.54 MRI locations.“If we can understand some of the healthcare system barriers, we can hopefully identify the issues and develop some interventions to actually help reduce delays,” said McGinley.Overall, 55% of patients experienced a diagnostic delay of at least 6 months, with a median delay of 3 years.After adjusting for potential confounders, for the covariates, greater access to neurologists (odds ratio [OR], 0.92; 95% CI, 0.87-0.98), MS specialists (OR, 0.76; 95% CI, 0.67-0.86), and MRI facilities (OR, 0.87; 95% CI, 0.79-0.95) was significantly associated with lower odds of diagnostic delay (P .05 for all).McGinley said she was somewhat surprised by the lack of an association between the ADI and diagnostic delay, given concerns that patients from underrepresented minority groups or socioeconomically disadvantaged communities may face greater barriers to accessing care.Expanding Access to CareAlthough the study did not compare access between patients with MS and those with other neurologic disorders, McGinley pointed to previous research showing that patients with MS face the longest wait times for their first neurology appointment.One potential solution, said McGinley, is to develop teleneurology networks to reach patients in regions with limited healthcare resources. She noted that one positive outcome of the COVID pandemic was the expansion of telemedicine, which created new opportunities to deliver remote care.Another potential approach, she said, would be to establish networks of specialists who collaborate with frontline primary care providers in rural and underserved communities.One of the study’s limitations was that it only included patients from the Cleveland Clinic, although this health system has a large referral network that, in addition to Ohio, includes Indiana, Michigan, Pennsylvania, and West Virginia. It also operates satellite facilities in Nevada and Florida.Despite the study’s limitations, McGinley emphasized the importance of addressing gaps in access to specialized care.Offering an outside perspective on the results, Jiwon Oh, MD, PhD, an associate professor and the medical director of the Barlo Multiple Sclerosis Program at St. Michael’s Hospital in the University of Toronto in Toronto, Ontario, Canada, described the data as “powerful.”“Diagnostic delays happen all the time, and of course, like most things, it’s multifactorial. But very clearly, access to specialists and the necessary resources, namely MRI, is a big piece of this,” she told Medscape Medical News.The study provides a clearer picture of the extent of the access problem and offers a foundation to explore potential solutions, she added.McGinley reported receiving research support from the National Institutes of Health and Agency for Healthcare Research and Quality. She also reported receiving research funding from EMD Serono and Genentech and consulting fees from Genentech. No other disclosures were reported.