ANA2022 Plenary Session Spotlight: Roy H. Hamilton, MD, MS, FANA / Neurologic Equity

Advancing Neurology by Advancing Equity

The ANA2022 Plenary Session, “Advancing Neurologic Equity: Challenges and Paths Forward” will take place Tuesday, October 25, 2022 from 12:45 to 2:30 pm. Register now to attend the Annual Meeting in Chicago.

Addressing disparities in neurologic disease and care is imperative if we are to reduce disease burden, enhance care, and advance neuroscience discovery. The final symposium at ANA2022 will outline the causes and consequences of neurologic disparities. Speakers will also share approaches to ameliorating disparities in order to advance more equitable, inclusive neurologic care.

We interviewed symposium chair Roy H. Hamilton, MD, MS, FANA, Professor of Neurology and Assistant Dean for Cultural Affairs and Diversity at the University of Pennsylvania’s Perelman School of Medicine. The symposium is co-chaired by Lesli E. Skolarus, MD, FANA, Professor of Neurology and Health Behavior and Health Education at the University of Michigan.

Why is it important to focus on disparities in neurology?

Many of our most common and most burdensome neurologic disorders disproportionately affect persons who belong to marginalized groups, including individuals from racial and ethnic minority groups and sexual and gender minorities. These individuals face challenges that increase their likelihood of developing a range of neurologic disorders and impose barriers on their ability to access neurologic care. They also give rise to inequities in how people are treated when they go to see health professionals. So addressing these kinds of disparities is important to ensuring excellent neurologic care as our population becomes increasingly diverse. It's really incumbent on any neurologist who sees patients to be aware of these kinds of inequities since they have such an enormous impact.

What are some examples of these disparities in neurology?

Social determinants of health may account for as much as half of the variance with respect to health outcomes and the burden of disease. There's no reason to suspect that that doesn't include neurologic disease. For instance, the risk of developing Alzheimer's disease in individuals who come from minoritized racial and ethnic groups may be up to double what we see in white populations. You can say the same thing about neurologic disorders like stroke. At the same time, these populations are often under-diagnosed, and when they are diagnosed, often undertreated. In addition, people from minoritized populations with cognitive disorders of aging are less likely to be treated with first-line agents when they present with clear evidence of dementia. You can also find evidence of similar issues with epilepsy, movement disorders like Parkinson’s disease, any many other neurologic disorders.

When I was a trainee, we were taught that multiple sclerosis was a disease of white persons of European ancestry, and that it was rare in individuals who come from other racial and ethnic backgrounds. Recent research, including evidence developed by session speaker Dr. Lilyana Amezcua, helped to demonstrate that certain minoritized racial and ethnic groups may be experiencing it with even greater frequency and severity. Similarly, neurologists are historically not accustomed to thinking there might be special neurologic considerations to take into account in patients who are members of sexual and gender minorities. Dr. Nicole Rosendale, another speaker, has been leading the charge in this under-reported area of research, showing that there are specific concerns that the clinical neurologist needs to be aware of.

Dr. Monica Rivera-Mindt is going to discuss the fact that individuals from minority populations are heavily underrepresented in clinical trials related to neurodegenerative diseases and disorders. This is a threat not just to equity—because these individuals don't have access to cutting edge and hopefully more efficacious treatments—but also to science, because our discoveries are not as generalizable to the broad population.

What do you hope attendees will take away from this session?

First, I hope that attendees view it as incumbent on themselves to be aware of all the factors that are contributing enormously to the diseases in question. I hope the clinicians are able to gain the perspective that allows them to see where their patient is coming from.

Second, I think that having a more acute awareness of the social determinants of health, as well as the barriers that patients face once they do see a clinician, will help clinicians reflect on, and maybe overcome, some aspects of bias.

And third, they’ll hear practical ways in which clinicians in our field can promote equity in the treatment of neurologic disorders.