Objective: To investigate how social vulnerability affects clinical outcomes in Huntington disease (HD) gene expansion carriers (HDGECs).

Background: Social determinants of health (SDOH) are nonmedical factors that can influence clinical outcomes in neurologic disorders. A study of SDOH in HDGECs using individual indicators showed that individuals identified as Black (compared to White) and those with a lower educational level present with worse disease severity¹. Analysis of clinical outcomes in HD based on SDOH using neighborhood-level indicators (NLI) is missing and might contribute to understanding disease-modifying risk factors. This study aims to find an association between clinical outcomes and the social vulnerability index (SVI), which evaluates socioeconomic status (SVI1), household characteristics (SVI2), racial and ethnic minority status (SVI3), and housing type and transportation (SVI4) according to census tracts.

Method: Cross-sectional study of HDGECs from the UTHealth Houston Huntington Disease Society of America Center of Excellence. Motor, cognitive, behavioral, and functionality scores were obtained using clinical rating scales. The SVI was calculated based on the participant’s census tract. The associations between SVI (and its subgroups) and clinical variables were tested using Spearman correlation analysis. Group differences were tested according to the SVI quartiles. ANOVA or Kruskal-Wallis tests were used, depending on the data’s Gaussian distribution, followed by post-hoc tests, when appropriate.

Results: 131 participants were included in the analysis. Mean age was 45.6 years, and 59.1% were female. Patients with higher global SVI had lower education and worse scores on the Total Functional Capacity (TFC) (Fig. 1A) and Verbal Fluency Test (VFT) scales. The educational level was lower in those with higher percentiles in SVI1, SVI2, and SVI3. HDGECs at the >75th percentile in SVI2 had a lower TFC than <25th and 50-75th percentiles (Fig. 1B). Higher scores in SVI2 and SVI3 were associated with worse performance in the Trail Making Test A. Worse VFT is associated with SVI3 >75th percentile compared to 50-75th and 25-50th percentiles (Fig. 1C).

Conclusion: HDGECs with a higher social vulnerability risk present with worse cognitive and functionality scores. Understanding NLI can lead to the creation of public health policies to address modifiable risk factors and improve HDGECs’ quality of life.

Figure 1

References: 1. Mendizabal A, Singh AP, Perlman S, Brown A, Bordelon Y. Disparities in Huntington Disease Severity. Neurol Clin Pract. 2023;13(6):e200200. doi:10.1212/CPJ.0000000000200200

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MDS Abstracts - https://www.mdsabstracts.org/abstract/association-between-morbidity-and-social-vulnerability-in-patients-with-huntington-disease/