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Studies Find Disparities in Use of Deep Brain Stimulation
- Jan 29 2014
Two new studies report that African American people with Parkinson’s disease (PD) are less likely than their white counterparts to receive treatment with deep brain stimulation (DBS). In addition, women had a lower chance of receiving DBS than men. The results were published online in Neurology on December 11 and in JAMA Neurology on January 6.
Deep brain stimulation (DBS) is a surgical treatment that controls Parkinson’s symptoms by delivering a small electric current to structures of the brain. It is appropriate for some people whose PD causes disabling tremors, or who experience wearing off spells and dyskinesias, the involuntary movements that can develop with long-term levodopa therapy. The technique has been available for Parkinson’s since 2002. For people with these severe PD symptoms who are otherwise in good general health, DBS has been shown to improve movement.
Even though DBS is generally covered by insurance providers, including Medicare and Medicaid, it does entail significant out-of-pocket expenses, many visits to the doctor, and tests, both before and after the procedure. The authors of both studies wanted to find out whether these and other factors created barriers to access to DBS. So they examined demographic, clinical, socioeconomic and other aspects of the medical records of people with PD who received DBS in the United States.
The authors of the Neurology study, led by Allison W. Willis, M.D., at the University of Pennsylvania, analyzed the medical records from 2007 to 2009 of more than 657,000 Medicare beneficiaries with PD aged 65 or older, of whom 8,420 received DBS. For the JAMA Neurology study, researchers led by Andrew K. Chan, B.S., at Columbia University, used data from 2001 to 2009 from the Nationwide Inpatient Sample. This database contains discharge information for all patients at more than 1,000 US hospitals, collected through a collaboration among the federal and state governments and industry. These records showed about 2.4 million hospital discharges for people with PD of all ages in the time period studied, of which 18,312 were for DBS.
Among Medicare beneficiaries:
- The greatest disparities in the use of DBS were associated with race: African American and Asian people with PD were, respectively, 80 percent and 45 percent, less likely to receive DBS than white beneficiaries.
- Women received DBS 30 percent less frequently than men.
- People with PD who went to doctors treating minority populations were less likely to receive DBS, regardless of individual race.
- People who lived in areas with high measures of socioeconomic status had greater odds of receiving DBS.
- African Americans with PD tended to be treated at large urban teaching hospitals, in areas with many neurologists — factors that might suggest access to DBS — yet they received disproportionately 83 percent fewer DBS procedures than non-African Americans.
- African Americans with PD were more likely to use Medicaid.
What Does It Mean?
Although DBS is an effective treatment, many variables influence whether a person with PD actually can undergo the surgery. These two studies emphasize race and gender as a point of discrepancy in prescribing DBS. Other factors that may influence a person’s ability to have access to DBS may include low socioeconomic status, lack of access to medical specialists, and cultural biases or beliefs. It is important to note that both studies were based on hospital billing coding and did not take into account the medical facts specific to each patient: it is possible that individuals who did not receive surgery had more advanced Parkinson’s or dementia, independent of race or gender.
Prospective studies based on clinical data are necessary to explain these reported treatment differences in utilization of this advanced treatment for PD. It seems clear, however, that African American individuals and Asian individuals in the Medicare database experience barriers to accessing many types of health care in the United States, including DBS. A better understanding of these disparities can inform policy and improve PD care.
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References: Chan AK, McGovern RA, Brown LT, Sheehy JP, Zacharia BE, Mikell CB, Bruce SS, Ford B, McKhann GM (2014) Disparities in Access to Deep Brain Stimulation Surgery for Parkinson Disease: Interaction Between African American Race and Medicaid Use. JAMA Neurol. DOI: 10.1001/jamaneurol.2013.5798 http://dx.doi.org/10.1001/jamaneurol.2013.5798
Willis AW, Schootman M, Kung N, Wang X-Y, Perlmutter JS, Racette BA (2014) Disparities in deep brain stimulation surgery among insured elders with Parkinson disease. Neurology 82:163–171. DOI: 10.1212/WNL.0000000000000017 http://dx.doi.org/10.1212/WNL.0000000000000017
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Source Date: Jan 29 2014