Persistent Racial Disparities in Deep Brain Stimulation for Parkinson's Disease

Abstract

We sought to determine whether racial and socioeconomic disparities in the utilization of deep brain stimulation (DBS) for Parkinson's disease (PD) have improved over time. We examined DBS utilization and analyzed factors associated with placement of DBS. The odds of DBS placement increased across the study period, whereas White patients with PD were 5 times more likely than Black patients to undergo DBS. Individuals, regardless of racial background, with 2 or more comorbidities were 14 times less likely to undergo DBS. Privately insured patients were 1.6 times more likely to undergo DBS. Despite increasing DBS utilization, significant disparities persist in access to DBS. ANN NEUROL 2022;92:246-254.

FIGURE 1

ICD codes used to define PD cohort and DBS cases (A). National estimates of patient characteristics summed or averaged across 2002 through 2018 (B). Patient characteristics are summarized by estimated mean (sample SD), median [IQR], or estimated N (estimated %) for continuous normal, continuous skewed, and categorical variables, respectively. Note that White patients predominated among both patients with PD without (82.1%) and with DBS (84.9%). Black patients composed 6.4% of PD admissions not undergoing DBS and 1.3% of those admitted for DBS placement. National estimates of PD admissions (all PD admission, including for DBS) over time (C) and national estimates of DBS procedures over time (D) in thousands. DBS = deep brain stimulation; ICD‐9 = International Disease Classification Ninth Revision; ICD‐10 = International Disease Classification Tenth Revision; IQR = interquartile range; PD = Parkinson's disease.

FIGURE 2

Changes in primary insurance for Medicare/Medicaid (A), private insurance (B), and other (C) over time in patients undergoing DBS. For A to C, data are displayed per 100,000 of the overall US population with that respective insurance type while those in the “other” category are shown per 100,000 uninsured individuals over the study period. Note that quantitatively, these time trends are characterized by slopes per year of 2.39, 0.08, and 0.77 for Medicare/Medicaid, private insurance, and other insurers, respectively. Results to a multi‐variable survey logistic regression model assessing the odds of DBS (D) adjusted for the year. Note that “other” types of insurance include patients that self‐pay; those that incur no hospital charges; or those that have their hospital admission paid via Worker's Compensation, Title V, or other government programs. Effect of sex on DBS by race after adjusting for year, 2 or more comorbidities, age, payer, and zip code income quartile (E). DBS = deep brain stimulation; CI = confidence interval; OR = odds ratio; PD = Parkinson's disease.

FIGURE 3

Descriptive statistics showing comorbidity by race, N (%), (A). Assessment of the effect of race on likelihood of DBS by comorbidities after adjusting for year, sex, age, payer, and zip code income quartile (B). DBS = deep brain stimulation; OR = odds ratio.

FIGURE 4

Results of a multivariable survey logistic regression model assess the association between race and DBS over time for Black patients, White patients, and other (A). Direct comparison of odds of undergoing DBS based on race across years (B), note that the model adjusted for 2 or more Elixhauser comorbidities, age, sex, insurance type, and zip code income quartile. Post hoc survey chi‐squared analysis to test if insurance type for those who received DBS differs across the study period by race (C). DBS = deep brain stimulation; CI = confidence interval; OR = odds ratio.