Gender, Race, and Socioeconomic Disparities on Surgical Device-aided Therapies (DATs) Among Medicare Beneficiaries with Advanced Parkinson’s Disease (aPD)
Joohi Jimenez Shahed1, Irene Malaty2, Michael Soileau3, Zach Baldwin4, Connie Yan4, Lakshmi Kandukuri4, Jill Schinkel5, Christie Teigland5, Zulkarnain Pulungan5, Megha Shah4, Pavnit Kukreja4, Aaron Hambrick4, Anand Shewale4, Hubert Fernandez6
1Icahn School of Medicine at Mount Sinai, 2University of Florida, 3Texas Movement Disorder Specialists, PLLC, 4AbbVie Inc., 5Inovalon Insights, 6Center for Neurological Restoration, Cleveland Clinic
Objective:
To determine the impact of demographic and clinical characteristics, geographic factors, and social determinants of health on initiation of a surgical device-aided therapy (DAT) among people with advanced Parkinson’s Disease (PwaPD).
Background:
Carbidopa-levodopa enteral suspension (CLES) and deep brain stimulation (DBS) are treatment options for PwaPD. While an individuals’ preference plays a significant role in choice of treatment, initiation of these surgical DATs may be potentially impacted by health disparities.
Design/Methods:
Adults diagnosed with PD and meeting aPD indicators were identified in 100% Medicare Fee-for-Service claims between 2018-2020. Multivariate logistic regression models were used to determine factors associated with DAT initiation vs non-DAT initiation. Subgroup analysis was conducted for DBS or CLES initiators. Observations were reweighted by sample size in sensitivity analyses.
Results:
Of 112,773 PwaPD, 2.2% received a DAT (DBS, n=1,861; CLES, n=589). Individuals who had rescue medication use, levodopa equivalent daily dose (LEDD) ≥1000 mg, or ≥1 neurologist visit were 3.0x, 1.9x, and 1.3x more likely to receive a DAT, respectively. Younger individuals (<75 vs 75-84 years) were 2-3x more likely to receive a DAT. Factors associated with a lower likelihood of DAT initiation were female gender, black race, moderate to severe comorbidity, and having lower income status (0.9x, 0.4x, 0.4-0.7x, 0.4x, respectively). In subgroup analyses, individuals who were married (4.1x) or living in a state with higher number of DAT facilities (1.3x to 1.5x) were more likely to initiate CLES, while completing up to high school education had lower likelihood (0.5x) of CLES initiation versus non-DAT initiation.
Conclusions:
Few PwaPD initiated a surgical DAT. Younger PwaPD or those with greater neurologist access were more likely to initiate a DAT. Increased attention should focus on women, racial minorities, or lower socioeconomic populations to minimize access disparities around efficacious DATs.