Black and hispanic patients with movement disorders less likely to undergo deep brain stimulation

Andrew Dorritie; Mohammad Faysel; Angelika Gruessner; Daphne Robakis

doi:10.1016/j.parkreldis.2023.105811

Black and hispanic patients with movement disorders less likely to undergo deep brain stimulation

Parkinsonism Relat Disord. 2023 Oct:115:105811. doi: 10.1016/j.parkreldis.2023.105811. Epub 2023 Aug 20.

Authors

Andrew Dorritie¹, Mohammad Faysel², Angelika Gruessner³, Daphne Robakis⁴

Affiliations

¹ College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
² Health Informatics Program, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
³ Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
⁴ Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA. Electronic address: Daphne.Robakis@downstate.edu.

PMID: 37657299
DOI: 10.1016/j.parkreldis.2023.105811

Abstract

Background: DBS is an effective surgical treatment for ET, PD, and dystonia. Racial disparities in DBS utilization in PD have been documented demonstrating that Black patients receive DBS at lower rates than White patients. To our knowledge, no studies have investigated if this pattern of non-use persists in other movement disorders with FDA-approval.

Objective: To identify racial and ethnic disparities in DBS utilization in those hospitalized for ET, PD, and dystonia.

Methods: The NIS database was queried for US hospitalizations from 2012 to 2018 with a primary diagnosis of ET, PD, or dystonia, and a total of 3,363, 21,963, and 1,835 discharges were recorded, respectively. Within that sample, treatment with DBS was identified. Sex, race, age, payment method, income quartile, year, mortality risk, hospital size, urban/rural setting, teaching status, and geographic region were extracted. A multivariate logistic regression was performed to identify predictors for use and non-use of DBS.

Results: Between 2012 and 2018, Black patients with PD, ET, and dystonia were less likely to receive DBS than White patients. Black patients with PD were 7 times less likely to receive DBS (OR = 0.145, CI = 0.111-0.189), and Black patients with ET and dystonia were 5 times less likely to receive DBS than White patients (OR = 0.188, CI = 0.124-0.285; OR = 0.186, CI = 0.084-0.414). Compared to White patients, Hispanic patients with PD (OR = 0.631, OR = 0.539-0.740) and ET (OR = 0.438, CI = 0.277-0.695) were less likely to undergo DBS. When controlling for patient and hospital level characteristics, racial and ethnic disparities remained.

Conclusions: Our data suggest that Black patients with a diagnosis of ET, PD, or dystonia and Hispanic patients with a diagnosis of ET or PD were less likely to be treated with DBS than White patients between 2012 and 2018.

Keywords: Deep brain stimulation; Dystonia; Essential tremor; Health care disparities; Parkinson disease; Tremor.