A Systematic Review of Health Disparities Research in Deep Brain Stimulation Surgery for Parkinson's Disease
Joseph Melott1, Adeel Memon1, Kate Gelman1, Rebecca Billings2, Michelle Fullard3, Corina Catiul2, Svjetlana Miocinovic4, Amy Amara3
1West Virginia University, 2University of Alabama at Birmingham, 3University of Colorado, 4Emory University
Objective:
This systematic review investigates the current research to identify gaps in deep brain stimulation (DBS) utilization in Parkinson’s disease (PD) patients based on demographic variables.
Background:
DBS is an effective treatment option for PD. It has benefits shown to exceed those of medication alone. However, a limited number of eligible PD patients receive DBS surgery. To expand the inclusiveness of DBS, we aimed to examine health disparities in this treatment.
Design/Methods:
A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines of the databases Embase (via Elsevier), PubMed, Cochrane Library, and Web of Science. Only peer-reviewed studies focusing on health disparities or inequalities of DBS amongst PD patients were considered.
Results:
The search yielded a total of 1679 studies with 18 studies meeting full-text inclusion criteria. Three main disparity categories were identified: race, socioeconomic, and gender.
Our review revealed that DBS treatment is disproportionately utilized in Black individuals. There has been little improvement in this racial disparity since 2002 and has been attributed to a lack of DBS referral in part due to low income and poor insurance statuses.
Socioeconomic disparities were identified throughout the world, mostly due to lack of insurance, access to specialists, income, and education. Largely due to geographic location of the patient, these disparities exist in countries with free public healthcare systems.
When observing gender of the patient, it is evident that the rate of DBS in males exceeds that of females. Even when factoring the increased prevalence of PD in males, this disparity persists.
Conclusions:
The influence of many demographic factors on DBS utilization in PD were illustrated by this study. As rates of PD continue to rise, these findings should aid in future efforts of achieving more equitable care. Further research should be conducted to better understand these disparities and present potential solutions.