Multiple Sclerosis Diagnostic Delays Linked to Specialist, MRI Access

— Geographic gaps in care play a significant role

Disparities in geographic access to neurologists, specialists, and MRI facilities contributed significantly to diagnostic delays in multiple sclerosis (MS), a retrospective study showed.

In a sample of nearly 8,300 patients, 55% had a diagnostic delay of at least 6 months and a median delay of 3 years, reported Marisa McGinley, DO, of the Cleveland Clinic Mellen Center, at MSToronto2026, the joint meeting of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMSopens in a new tab or window) and the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS).

The odds of diagnostic delay of 6 months or more were higher for people who had greater geospatial distance to neurologists (OR 0.92, 95% CI 0.87-0.98), MS specialists (OR 0.76, 95% CI 0.67-0.86), or MRI facilities (OR 0.87, 95% CI 0.79-0.95), McGinley said. Models that evaluated diagnostic delays of 12 months or more showed similar associations.

Variables tied to greater odds of diagnostic delay included higher education, public versus private insurance, progressive MS course at presentation, and a higher number of comorbidities (P<0.05 for all). Older age at symptom onset was associated with lower odds of diagnostic delay (P<0.05).

This is the first study to demonstrate that disparities in geographic access to medical resources affect time to MS diagnosis, McGinley noted.

"We think a lot about diagnostic delay in MS and how we can modify the diagnostic criteria to help with that," she said. "But we have an incomplete understanding of why there are delays," she told MedPage Today.

A recent study reported that the average wait timeopens in a new tab or window for a new neurology visit in the U.S. among commercially insured people was nearly 50 days. People with MS had longer wait times than all other neurology patients.

"We know there's a strain on resources," McGinley said, noting that the new McDonald diagnostic criteriaopens in a new tab or window could exacerbate this by adding more complexities to the process. "But nobody's actually quantified access to resources and how that impacts diagnostic delay," she observed.

In their study, McGinley and colleagues evaluated adult MS patients who completed at least one visit at a single academic MS center from January 2015 through June 2025. They used locations of neurologists, MS specialists, and MRI facilities to compute geospatial accessibility for U.S. census tracts.

"Geospatial access accounts for both driving distance and also the population density and density of resources," she noted. "Our primary outcome was a delay of greater than 6 months, but we also did a sensitivity analysis at 12 months. We looked specifically at the interval from the age of symptom onset to the age at diagnosis, and we computed multivariable logistic regression models to evaluate the association between geographic access to these three resources and the presence of a diagnostic delay."

The analysis accounted for demographic factors, MS disease characteristics, and diagnostic epochs that aligned with McDonald criteria revisions (2010 or earlier, 2011-2017, and 2018 or later), among other variables. Overall, 56% of patients were diagnosed before 2010, 28% between 2011 and 2017, and 16% after 2018.

The study included 8,259 patients with an average age of 55.5 years. Most were female (73%), white (82%), and had relapsing remitting MS at time of diagnosis (91%). The mean age at symptom onset was 33.6 years and the mean age at diagnosis was 37.2. Overall, 26% had public insurance and 15% lived in rural areas.

Sex, race, ethnicity, rurality, area deprivation index, and diagnostic epoch were not associated with diagnostic delay (P>0.05 for all), McGinley said.

In the U.S., the mean number of neurologists per 100,000 population is 14.50. The mean numbers of MS specialists and MRI locations per 100,000 population are 0.81 and 2.54, she added.

"Notably, access to MS specialists was the least throughout the United States, and it had the greatest association with diagnostic delay odds reduction," McGinley pointed out. "We hope these types of studies will help contribute to understanding of what proportion of diagnostic delays are secondary to healthcare system barriers as opposed to other factors, and hopefully provide a framework for developing interventions to mitigate barriers."