The social deprivation index and deep brain stimulation: A cohort study

Abstract

Background and objectives: Deep brain stimulation (DBS) is an important treatment option for patients with movement disorders; however, prior studies have demonstrated inequitable access to this important treatment. We used the Social Deprivation Index (SDI), an index of neighborhood affluence, to examine the distribution of DBS cases and to determine the association between the SDI and outcomes.

Methods: This was a retrospective cohort study of all patients who have undergone DBS implantation within the University of Pennsylvania Health System (UPHS) from January 1st, 2013, to April 1st, 2024. SDI values associated with each ZIP code range from zero (no distress/prosperous) to 100 (highest distress) and were dichotomized into low (<50) and high (50-100) categories.

Results: The prevalence of DBS cases performed at UPHS across low SDI ZIP codes was 4.8 per 100,000 (95 % CI (confidence interval) 4.4 - 5.2), compared to 2.4 per 100,000 people (95 % CI 2.1 - 2.7) across high SDI ZIP codes, equivalent to a rate ratio of 2.0 (95 % CI 1.7 - 2.3, p < 0.001). Adjusting for age, sex, insurance type, comorbidities, and indication for DBS, people living in more deprived regions had higher odds of readmission, but this was not statistically significant (OR 2.22, 95 % CI 0.91 - 5.45, p-value 0.08).

Conclusion: In our single-center study, most people who received DBS at our institution resided in more affluent neighborhoods. In the future, the SDI could be used to effectively target outreach efforts to geographic areas with decreased access to DBS.

Keywords: Deep brain stimulation; Neurosurgery; Social deprivation index.