Allison W Willis1, Mario Schootman, Nathan Kung, Xiao-Yu Wang, Joel S Perlmutter, Brad A Racette. 1. From the Departments of Neurology and Epidemiology and Biostatistics and the Center for Clinical Epidemiology and Biostatistics (A.W.W.), University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (X.-Y.W., J.S.P., N.K., B.A.R.), and Departments of Radiology and Neurobiology and Programs in Physical Therapy and Occupational Therapy (J.S.P.), Washington University School of Medicine, St. Louis; and Departments of Epidemiology and Health Services Research and Medicine (M.S.), St. Louis University, MO.
Abstract
OBJECTIVE: To identify sociodemographic, clinical, and physician/practice factors associated with deep brain stimulation (DBS). DBS is a proven surgical therapy for Parkinson disease (PD), but is recommended only for patients with excellent health, results in significant out-of-pocket costs, and requires substantial physician involvement. METHODS: Retrospective cohort study of more than 657,000 Medicare beneficiaries with PD. Multivariable logistic regression models examined the association between demographic, clinical, socioeconomic status (SES), and physician/practice factors, and DBS therapy. RESULTS: There were significant disparities in the use of DBS therapy among Medicare beneficiaries with PD. The greatest disparities were associated with race: black (adjusted odds ratio [AOR] 0.20, 95% confidence interval [CI] 0.16-0.25) and Asian (AOR 0.55, 95% CI 0.44-0.70) beneficiaries were considerably less likely to receive DBS than white beneficiaries. Women (AOR 0.79, 95% CI 0.75-0.83) also had lower odds of receiving DBS compared with men. Eighteen percent of procedures were performed on patients with PD who had cognitive impairment/dementia, a reported contraindication to DBS. Beneficiaries treated in minority-serving PD practices were less likely to receive DBS, regardless of individual race (AOR 0.76, 95% CI 0.66-0.87). Even after adjustment for demographic and clinical covariates, high neighborhood SES was associated with 1.4-fold higher odds of receiving DBS (AOR 1.42, 95% CI 1.33-1.53). CONCLUSIONS: Among elderly Medicare beneficiaries with PD, race, sex, and neighborhood SES are strong independent predictors of DBS receipt. Racial disparities are amplified when adjusting for physician/clinic characteristics. Future investigations of the demographic differences in clinical need/usefulness of DBS, ease of DBS attainment, and actual/opportunity DBS costs are needed to inform policies to reduce DBS disparities and improve PD quality of care.
OBJECTIVE: To identify sociodemographic, clinical, and physician/practice factors associated with deep brain stimulation (DBS). DBS is a proven surgical therapy for Parkinson disease (PD), but is recommended only for patients with excellent health, results in significant out-of-pocket costs, and requires substantial physician involvement. METHODS: Retrospective cohort study of more than 657,000 Medicare beneficiaries with PD. Multivariable logistic regression models examined the association between demographic, clinical, socioeconomic status (SES), and physician/practice factors, and DBS therapy. RESULTS: There were significant disparities in the use of DBS therapy among Medicare beneficiaries with PD. The greatest disparities were associated with race: black (adjusted odds ratio [AOR] 0.20, 95% confidence interval [CI] 0.16-0.25) and Asian (AOR 0.55, 95% CI 0.44-0.70) beneficiaries were considerably less likely to receive DBS than white beneficiaries. Women (AOR 0.79, 95% CI 0.75-0.83) also had lower odds of receiving DBS compared with men. Eighteen percent of procedures were performed on patients with PD who had cognitive impairment/dementia, a reported contraindication to DBS. Beneficiaries treated in minority-serving PD practices were less likely to receive DBS, regardless of individual race (AOR 0.76, 95% CI 0.66-0.87). Even after adjustment for demographic and clinical covariates, high neighborhood SES was associated with 1.4-fold higher odds of receiving DBS (AOR 1.42, 95% CI 1.33-1.53). CONCLUSIONS: Among elderly Medicare beneficiaries with PD, race, sex, and neighborhood SES are strong independent predictors of DBS receipt. Racial disparities are amplified when adjusting for physician/clinic characteristics. Future investigations of the demographic differences in clinical need/usefulness of DBS, ease of DBS attainment, and actual/opportunity DBS costs are needed to inform policies to reduce DBS disparities and improve PD quality of care.
Authors: Günther Deuschl; Carmen Schade-Brittinger; Paul Krack; Jens Volkmann; Helmut Schäfer; Kai Bötzel; Christine Daniels; Angela Deutschländer; Ulrich Dillmann; Wilhelm Eisner; Doreen Gruber; Wolfgang Hamel; Jan Herzog; Rüdiger Hilker; Stephan Klebe; Manja Kloss; Jan Koy; Martin Krause; Andreas Kupsch; Delia Lorenz; Stefan Lorenzl; H Maximilian Mehdorn; Jean Richard Moringlane; Wolfgang Oertel; Marcus O Pinsker; Heinz Reichmann; Alexander Reuss; Gerd-Helge Schneider; Alfons Schnitzler; Ulrich Steude; Volker Sturm; Lars Timmermann; Volker Tronnier; Thomas Trottenberg; Lars Wojtecki; Elisabeth Wolf; Werner Poewe; Jürgen Voges Journal: N Engl J Med Date: 2006-08-31 Impact factor: 91.245
Authors: J K Staley; S Krishnan-Sarin; S Zoghbi; G Tamagnan; M Fujita; J P Seibyl; P K Maciejewski; S O'Malley; R B Innis Journal: Synapse Date: 2001-09-15 Impact factor: 2.562
Authors: W M M Schüpbach; D Maltête; J L Houeto; S Tezenas du Montcel; L Mallet; M L Welter; M Gargiulo; C Béhar; A M Bonnet; V Czernecki; B Pidoux; S Navarro; D Dormont; P Cornu; Y Agid Journal: Neurology Date: 2006-12-06 Impact factor: 9.910
Authors: W A Rocca; J H Bower; D M Maraganore; J E Ahlskog; B R Grossardt; M de Andrade; L J Melton Journal: Neurology Date: 2007-08-29 Impact factor: 9.910
Authors: P Ragonese; M D'Amelio; G Salemi; P Aridon; M Gammino; A Epifanio; L Morgante; G Savettieri Journal: Neurology Date: 2004-06-08 Impact factor: 9.910
Authors: Frances M Weaver; Kenneth Follett; Matthew Stern; Kwan Hur; Crystal Harris; William J Marks; Johannes Rothlind; Oren Sagher; Domenic Reda; Claudia S Moy; Rajesh Pahwa; Kim Burchiel; Penelope Hogarth; Eugene C Lai; John E Duda; Kathryn Holloway; Ali Samii; Stacy Horn; Jeff Bronstein; Gatana Stoner; Jill Heemskerk; Grant D Huang Journal: JAMA Date: 2009-01-07 Impact factor: 56.272
Authors: Paul Krack; Alina Batir; Nadège Van Blercom; Stephan Chabardes; Valérie Fraix; Claire Ardouin; Adnan Koudsie; Patricia Dowsey Limousin; Abdelhamid Benazzouz; Jean François LeBas; Alim-Louis Benabid; Pierre Pollak Journal: N Engl J Med Date: 2003-11-13 Impact factor: 91.245
Authors: Michelle E Fullard; Dylan P Thibault; Veronica Todaro; Susan Foster; Lori Katz; Robin Morgan; Drew S Kern; Jason M Schwalb; Enrique Urrea Mendoza; Nabila Dahodwala; Lisa Shulman; Allison W Willis Journal: Parkinsonism Relat Disord Date: 2017-12-14 Impact factor: 4.891
Authors: Delaram Safarpour; Dylan P Thibault; Cori L DeSanto; Cynthia M Boyd; E Ray Dorsey; Brad A Racette; Allison W Willis Journal: Neurology Date: 2015-07-02 Impact factor: 9.910