Ethnic and socioeconomic dispensing patterns of disease-modifying therapies for multiple sclerosis in Aotearoa New Zealand

Abstract

Introduction: Evidence supports early initiation of high-efficacy disease-modifying therapies (DMTs) in multiple sclerosis (MS). Funding eligibility criteria are relatively strict in Aotearoa New Zealand, which may promote disparities. We tested for treatment inequities by socioeconomic position (SEP) and ethnicity. Methods: We identified 5334 adults diagnosed with MS prior to March 2021 using health data in the Integrated Data Infrastructure. We modelled dispensing patterns between November 2014 and February 2021 using ordered logistic regression, controlling for age, gender, timing of first MS record, cancer or infection hospitalisations, mobility related disability, and time in Aotearoa. Results: Being highly educated, receiving high incomes, and living in less deprived areas were associated with greater odds of receiving higher efficacy DMTs. Māori and Asian ethnic groups had 0.67 (0.50–0.90) and 0.63 (0.39–0.98) times lower odds of receiving DMTs of a higher efficacy level than non-Māori and non-Asians, respectively, while European ethnic groups had 1.60 (1.17–2.22) times greater odds than non-Europeans. Pacific peoples ethnic groups had 0.33 (0.14–0.78) times lower odds of receiving any DMTs than non-Pacific. Dispensing patterns did not differ for the Middle Eastern, Latin American, African ethnic group or by occupational position. Rurality did not explain observed dispensing inequities. Conclusions: People with low SEP and marginalised ethnic groups have worse access to high efficacy DMTs. Community-informed practices to improve cultural safety, increase access to neurology care, and reduce barriers to treatments should be prioritised to advance equitable MS care.