Black Patients with Movement Disorders Less Likely to Receive Treatment with Deep Brain Stimulation
Objective:
To identify existing racial disparities in Deep Brain Stimulation (DBS) utilization in those hospitalized for Parkinson Disease (PD), Essential Tremor (ET), and dystonia.
Background:
DBS is an effective surgical treatment option for those with PD, ET, and dystonia. Racial disparities in DBS utilization in patients with PD have been documented demonstrating that Black patients receive DBS at disproportionately lower rates compared to White patients. To our knowledge, no studies have investigated if this pattern of disuse persists in other movement disorders with FDA-approval for DBS: ET and dystonia.
Design/Methods:
The Nationwide Inpatient Sample (NIS) database from the Healthcare Cost and Utilization Project was queried for all hospitalizations from 2012-2018 with a primary diagnosis of PD, ET, or dystonia. A total of 21,964, 3,307, and 1,439 discharges were recorded for PD, ET, and dystonia, respectively. Within that sample, treatment with DBS was identified. The sex, race, age, payment method, income quartile, year of treatment, and mortality score of patients were extracted. Hospital characteristics included hospital size, urban/rural setting, teaching status, and geographic region. A multivariate logistic regression was performed to identify predictors for use of DBS.
Results:
Between the years 2012-2018, Black patients with PD, ET, and dystonia were all significantly less likely to receive DBS than White patients. Compared to White patients, Black patients with PD were nearly 8 times less likely to receive DBS (OR=0.13, CI=0.1-0.17, p<0.0001), and Black patients with ET and dystonia were 4-5 times less likely to receive DBS (OR=0.21, CI=0.14-0.32, p<0.0001; OR=0.22, CI=0.1-0.49, p=0.0002; respectively). Importantly, when controlling for all patient and hospital level characteristics, these racial disparities remained.
Conclusions:
Our analysis using the NIS database shows that Black patients with a diagnosis of PD, ET, or dystonia were less likely to be treated with DBS than White patients were between 2012 and 2018.