Inequities in the Use of Disease-Modifying Therapy Among Adults Living With Multiple Sclerosis in Urban and Rural Areas in Alberta, Canada.

Objectives: To compare disease-modifying therapy (DMT) use between people living with multiple sclerosis (pwMS) who resided in rural vs urban areas.

Methods: This retrospective cohort study used population-level individually linked administrative data to identify pwMS on April 1, 2019 (index date), in Alberta, Canada. DMT use was compared between pwMS who resided in rural vs urban areas during a 1-year postindex period. Structural equation modelling (SEM) and logistic regression (with 95% confidence intervals) were applied.

Results: PwMS (n = 4,593) who resided in rural areas (vs urban) were 17% less likely to have received a DMT (odds ratio: 0.83 [0.69-0.99]; SEM total β: -0.032, < 0.05), of which 39% of this disparity was explained by a lower socioeconomic status (SEM indirect β: -0.012 [ < 0.001]/total β: -0.032); 26% were less likely to have received an induction/higher efficacy therapy (odds ratio: 0.74 [0.57-0.95]), of which <1% of this disparity was explained by socioeconomic status (SEM indirect β: -0.0001 [ < 0.01]/total β: -0.040).

Discussion: PwMS residing in rural (vs urban) Alberta are less likely to receive any DMT, especially induction/higher-efficacy therapy; this inequality may be mediated by socioeconomic status and geography. Identifying and overcoming barriers to optimal clinical care in this patient population is needed.