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A retrospective study of 8,259 adults with multiple sclerosis found that 55% experienced at least a six-month gap between symptom onset and diagnosis; the median delay was three years. Researchers reported associations between geographic access to neurologists, MS specialists and MRI facilities and the likelihood of delay, but the study does not establish that limited access caused delays.
A retrospective study of 8,259 adults with multiple sclerosis (MS) found that 55% had a diagnostic delay of at least six months, with a median delay of three years, and linked longer delays to geographic access to neurologists, MS specialists and MRI facilities. Marisa McGinley, DO, of the Cleveland Clinic Mellen Center, presented the findings at MSToronto2026, a joint ECTRIMS-ACTRIMS meeting.
The researchers examined adults who had at least one visit at a single academic MS center from January 2015 through June 2025. They compared the interval between reported symptom onset and diagnosis with geospatial access to neurologists, MS specialists and MRI facilities, using measures that accounted for driving distance, population density and the distribution of medical resources. The primary outcome was a delay of six months or more; a separate analysis examined delays of at least 12 months.
McGinley reported that poorer geographic access to each of the three resource types was associated with higher odds of a delay of six months or more. The reported odds ratios were 0.92 for neurologist access (95% CI 0.87-0.98), 0.76 for MS specialist access (95% CI 0.67-0.86), and 0.87 for MRI access (95% CI 0.79-0.95). The researchers said models using a 12-month delay threshold showed similar associations. The results describe associations, not proof that access differences caused an individual patient’s delay.
The sample had an average age of 55.5 years; 73% were female, 82% were white, and 91% had relapsing-remitting MS at diagnosis. Mean age was 33.6 at symptom onset and 37.2 at diagnosis. The analysis also found higher odds of delay among people with higher education, public rather than private insurance, a progressive disease course at presentation, or more comorbidities. Older age at symptom onset was associated with lower odds. Sex, race, ethnicity, rurality, area deprivation index and diagnostic epoch were not associated with delay in the reported analysis.
Access Gaps May Shape Diagnostic Timelines
The findings point to health-care access as one possible contributor to the time it takes to diagnose MS, alongside patient and disease characteristics. A delay can mean a longer period between symptoms and a confirmed diagnosis; however, this study did not test whether reducing travel distance or increasing specialist availability would shorten that interval or change health outcomes.
The researchers said access to MS specialists was the most limited of the three resource categories they assessed and had the strongest association with diagnostic-delay odds. McGinley cited U.S. averages of 14.50 neurologists, 0.81 MS specialists and 2.54 MRI locations per 100,000 people. Those national averages do not show how resources are distributed within every community, but the results support examining geographic availability when studying delays and planning possible interventions.
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How Researchers Measured Access
The study used locations of neurologists, MS specialists and MRI facilities to estimate access across U.S. census tracts. McGinley said the geospatial measure incorporated both driving distance and population density, rather than distance alone. The analysis adjusted for demographic factors, disease features and diagnostic periods aligned with revisions to the McDonald criteria: 2010 or earlier, 2011-2017, and 2018 or later.
In the sample, 56% received a diagnosis before 2010, 28% from 2011 through 2017 and 16% after 2018. McGinley also pointed to a separate study reporting an average wait of nearly 50 days for a new neurology appointment among commercially insured people in the United States, with people with MS waiting longer than other neurology patients. That figure is separate evidence cited by the presenter, not a measurement from this MS-center study.
“We have an incomplete understanding of why there are delays.”
— Marisa McGinley, DO, Cleveland Clinic Mellen Center, speaking to MedPage Today
Limits of the Access Findings
The research was retrospective and based on patients seen at one academic MS center. The report does not establish that the findings represent all people with MS, including those who never reached a specialist center. Although the models accounted for multiple patient and disease factors, an observational analysis cannot rule out other explanations for the associations.
The reported odds ratios are not direct estimates of how many months a patient might wait or how much an intervention would reduce a delay. The source material also does not provide detailed results for the 12-month analysis, exact measures of access for each patient, or evidence that improving local access changes diagnosis times. The researchers described the work as a first demonstration of a geographic-access link, but that is their characterization of the study rather than proof of causation.
Testing Ways to Reduce Delays
The study points to a need for further research to establish how much diagnostic delay is associated with health-system barriers and which changes could reduce those barriers. The researchers said they hope the work can help provide a framework for developing interventions. No specific intervention, follow-up study or implementation timeline was identified in the report.
For now, the next step is to assess whether the associations hold in other patient groups and settings, and whether changes in access to neurology appointments, MS expertise or MRI services affect the time from symptoms to diagnosis. The study itself does not show that any particular access program will shorten delays.
Key Questions
How common was a diagnostic delay in the study?
Fifty-five percent of the 8,259 patients had at least six months between symptom onset and diagnosis. The median delay was three years.
Which access measures were associated with delays?
The study reported associations involving geographic access to neurologists, MS specialists and MRI facilities. It did not prove that limited access caused delays.
Does the study show that rural patients faced longer delays?
No association between rurality and diagnostic delay was reported. The analysis assessed access geographically, and rurality itself was not associated with delay in the reported results.
Can the findings predict how long an individual will wait for diagnosis?
No. The study reports group-level associations and a median delay; it does not provide an individual prediction or estimate how much a particular access change would shorten a patient’s timeline.
What research is needed next?
Further studies would need to test whether the associations appear in other settings and whether specific changes to specialist or MRI access reduce time to diagnosis. The report did not identify a planned intervention or timeline.
Source: rss
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