Education Level Tied to Multiple Sclerosis Diagnosis Delays

TORONTO — New research suggested that higher levels of education were associated with greater odds of diagnostic delay in multiple sclerosis.

Findings shared by Medscape on October 21 at the 10th Joint European Committee for Treatment and Research in Multiple Sclerosis-Americas Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS-ACTRIMS) 2026 indicate that individuals with higher educational attainment encounter unforeseen obstacles in getting a prompt multiple sclerosis diagnosis.

While intuitive assumptions suggest that higher levels of education would help individuals use the healthcare system more efficiently, data from a large single-center study show the exact opposite. Investigators found that patients with greater educational attainment experienced higher odds of diagnostic delays.

Study Examines Geographic Access to Multiple Sclerosis Care

Beyond educational factors, the retrospective cross-sectional study examined how geographic access to specialized care influences timelines. Researchers reviewed files from 8,259 adults with clinically verified multiple sclerosis who went to the Cleveland Clinic’s MS center at least once between January 1, 2015, and June 30, 2025. The study population had a mean age of 55.5 years, with 73% female participants and 82% identifying as White. Approximately 26% of the participants relied on public insurance, 15% lived in rural areas, and 15% fell into the highest quintile of the Area Deprivation Index (ADI), which measures neighborhood socioeconomic disadvantage.

To measure availability, researchers mapped the physical locations of neurologists, multiple sclerosis specialists, and MRI facilities. They assessed geographic access based on population density, driving distances, and healthcare resource density. Across the studied regions, the mean density stood at 14.5 neurologists per 100,000 residents, compared with just 0.81 multiple sclerosis specialists and 2.54 MRI locations. The findings demonstrated that limited geographic access to these specific medical resources created significant bottlenecks.

Overall, 55% of the participants suffered a diagnostic delay of at least 6 months, with the median delay stretching to 3 years. When examining disease characteristics among the cohort, 91% of patients presented with relapsing-remitting multiple sclerosis, possessing a mean disease duration of 21.9 years. Looking at historical diagnostic periods, about 56% received their diagnoses before 2010, 28% between 2011 and 2017, and 16% in 2018 or later.

When controlling for potential confounding variables, greater geographic availability of neurologists (odds ratio [OR], 0.92; 95% CI, 0.87-0.98), multiple sclerosis specialists (odds ratio [OR], 0.76; 95% CI, 0.67-0.86), and MRI centers (odds ratio [OR], 0.87; 95% CI, 0.79-0.95) was linked to a notable decrease in the likelihood of delayed diagnoses. Conversely, risk factors for longer intervals included public insurance, a progressive disease course at initial presentation, a higher number of comorbidities, and higher levels of education. Interestingly, older age at symptom onset correlated with lower odds of diagnostic delay, while the ADI showed no statistically significant association.

Higher Education May Lead to Delayed Diagnosis

The unexpected link between higher education and delayed diagnosis has prompted several theories from researchers. Marisa McGinley, DO, a neurologist at Cleveland Clinic’s Mellen Center in Ohio, explained to Medscape Medical News that highly educated individuals might initially downplay early symptoms, attribute minor warning signs to less severe causes, or postpone medical evaluations due to competing lifestyle priorities. Such individuals frequently reside in more affluent neighborhoods located farther away from specialized urban medical centers.

If we can understand some of the healthcare system barriers, we can hopefully identify the issues and develop some interventions to actually help reduce delays, said Marisa McGinley, DO, study investigator and neurologist at Cleveland Clinic’s Mellen Center in Ohio, speaking to Medscape Medical News.

Medscape Medical News

To mitigate these systemic hurdles, researchers propose expanding teleneurology networks to reach isolated populations, a strategy supported by the rise in remote care delivery during the COVID-19 pandemic. Another proposed intervention involves building specialist networks that closely collaborate with frontline primary care doctors operating in rural and underserved regions. Although the Cleveland Clinic draws patients from a wide referral network spanning Ohio, Indiana, Michigan, Pennsylvania, West Virginia, Nevada, and Florida, the findings shed light on broader structural obstacles.

External perspective on the data highlights the widespread nature of the problem. Jiwon Oh, MD, PhD, associate professor and medical director of the Barlo Multiple Sclerosis Program at St. Michael’s Hospital in the University of Toronto in Toronto, Ontario, Canada, offered her evaluation of the findings to Medscape Medical News.

Diagnostic delays happen all the time, and of course, like most things, it’s multifactorial. But very clearly, access to specialists and the necessary resources, namely MRI, is a big piece of this, said Jiwon Oh, MD, PhD, associate professor and medical director of the Barlo Multiple Sclerosis Program at St. Michael’s Hospital in the University of Toronto in Toronto, Ontario, Canada, in an interview with Medscape Medical News.

Medscape Medical News