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Oral Presentation

Stereotactic and Functional

Disparities in Access to DBS Surgery in Parkinson’s Disease Patients in a Minnesota Academic Health Care System

Sunday, May 5, 2024
4:49 PM – 4:54 PM CT
Location:  S401ab
Disclosure(s):
Jennifer McKay, B.S.: No financial relationships to disclose
Introduction: Deep Brain Stimulation (DBS) has been shown in multiple trials to improve Parkinson Disease patients’ motor symptoms and quality of life. However, DBS access is not equitable. Prior studies using national datasets demonstrate health inequities in PD patients’ ability to access DBS, but interventions addressing disparities must be informed by community and institutional data.

Methods: A retrospective study of PD patients was conducted using an MHealth Fairview inpatient admissions database from 2011- 2022. Patients with a primary admitting diagnosis of PD were included and DBS billing codes were used to identify surgery patients. Demographic and clinical data were extracted including race, insurance type, area deprivation index (ADI), and geographic location. Logistic regression analysis was performed and geospatial maps were created that revealed interactions between race, ADI, and geography.

Results: Univariate analysis showed that surgical PD patients were younger, healthier, whiter, and private insurance holders. Logistic regression analysis showed that black PD patients were 8 times less likely than white patients to undergo surgery (OR: 0.12, CI: [0.03 – 0.44]). PD patients within ADI quartile 2 (less disadvantaged) were more likely to get surgery than other quartiles, regardless of geography (OR: 2.16, CI: [1.26 – 3.71]). Geographically, rural areas were over-represented in surgical patients compared to urban areas.

Conclusion : Race, medical comorbidities, geography, ADI, and age were all significant predictors of surgical status. Our findings recapitulate many classic findings of neuromodulation patients in national data sets: younger, white patients with fewer comorbidities are more likely to receive surgery. Rural patients were over-represented in the surgical dataset, but this did not extend to socioeconomic status. Only relatively advantaged PD patients from both rural and urban areas underwent DBS. Non-surgical black PD patients were seen at expected frequencies based on state demographics, but were severely underrepresented in surgical populations. This likely represents a deficit in local surgical referrals for black PD patients.