Objective:

Systematically survey the literature on sources of disparity in the clinical provision of deep brain stimulation (DBS) therapy; assess literature quality; synthesize and integrate findings to identify broad trends and knowledge gaps and generate hypotheses for future research.

Background:

DBS is used to treat a variety of neurologic and psychiatric conditions, such as Parkinson’s disease, epilepsy, and obsessive-compulsive disorder. However, despite strong evidence supporting its efficacy and inclusion in standardized treatment guidelines, there exist inequalities in the implementation, access, and use of DBS.

Design/Methods:

We conducted a systematic literature search in PubMed, Embase, and Web of Science. There were no restrictions on publication period or location of study. Any English study that assessed how social determinants of health (including socioeconomic status, race, gender, primary language, and educational level) were associated with disparities in the provisioning of DBS were included for analysis. We conducted a qualitative analysis using Grounded Theory methodology to identify and map themes in the methodology of these studies and interpretation of findings. Critical appraisal of evidence quality and risk of bias was also conducted using several validated tools.

Results:

The search identified 1960 studies that underwent title/abstract screening. 148 studies underwent full-text review, which resulted in 50 studies meeting inclusion criteria for data extraction. Preliminary findings indicate that individuals who reported female gender, Black or African American race, low socioeconomic status, or non-private insurance were associated with decreased access or utilization of DBS therapy. Studies were appraised to be generally of moderate to low quality. Qualitative analysis of methodologies and interpretation reveals synthetic themes not apparent in individual studies.

Conclusions:

Gender, race, socioeconomic status, and insurance status are associated with disparities in the clinical provision of DBS. Shared methodologies weaken the findings of this body of this literature. Qualitative synthesis may re-orient hypotheses for future research in DBS disparities.