Treatment disparities in Parkinson's disease

Dahodwala, Nabila; Xie, Ming; Noll, Elizabeth; Siderowf, Andrew; Mandell, David S.

doi:10.1002/ana.21774

Cited by 67 publications

(53 citation statements)

References 18 publications

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“…Nonetheless, cognitive impairment is a stated (but apparently not absolute) contraindication to DBS, and reduced use would be expected in groups with high dementia incidence. Black patients with PD have also been found to have more postural instability on initial presentation, 17 a motor symptom which may not respond well to DBS, and may be viewed as a relative contraindication to DBS. 18 Future prospective studies of these groups are needed to understand how differences in clinical phenotype contribute to patterns of care.…”

Section: Patient Characteristics Standard Medicare Codes Identifiedmentioning

confidence: 99%

Disparities in deep brain stimulation surgery among insured elders with Parkinson disease

Willis¹,

et al. 2014

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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. Parkinson disease (PD) is a progressive neurodegenerative disease affecting more than 2 million Americans. Levodopa and dopamine receptor agonists are the mainstays of motor symptom treatment.1 However, disease progression is associated with "motor fluctuations," temporal shortening of medication response and drug-related involuntary movements. Deep brain stimulation (DBS) is an important treatment option for those with PD who have nonresponsive motor fluctuations or debilitating tremor. Several randomized controlled trials (RCTs) have demonstrated that DBS provides sustained improvement in motor symptoms, activities of daily living, and quality of life. [2][3][4][5] PD is a disease of aging and of the aged; however, elderly patients with PD are not well represented in DBS clinical trials, and DBS use in the elderly has not been studied. 6,7 RCT-based guidelinesFrom the

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Section: Patient Characteristics Standard Medicare Codes Identifiedmentioning

confidence: 99%

Disparities in deep brain stimulation surgery among insured elders with Parkinson disease

Willis¹,

et al. 2014

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“…A study in 2006 estimated that the 5-year risk of L-dopa induced dyskinesias was 50% in patients with disease onset between 50 -59 years and 16% in those with onset after 70 years [17].…”

Section: Discussionmentioning

confidence: 99%

Medication Side Effect Profiles in PD Patients in a Safety-Net Hospital

Sisniega¹,

Madhusudhan²,

Rahmani³

et al. 2017

APD

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Background: Compulsive behavior, dyskinesias, motor fluctuations, and hallucinations are common Parkinson's disease (PD) medication side effects.These are yet to be examined in relation to race and level of education. The goal of this analysis was to identify socioeconomic or clinical variables that are associated with compulsive behavior, dyskinesias, motor fluctuations, and hallucinations in patients in a safety-net hospital. Methods: A movement disorder patient database containing 452 patients with idiopathic PD was analyzed for differences in PD medication side effects using univariate and multivariate logistic regression analysis. Race, sex, and level of education were evaluated as possible confounders. Results: A greater proportion of the patients in this study were Caucasian males. The only variable associated with compulsive behavior was age, with higher age having a protective effect (p = 0.0336). Disease duration (defined as time since the onset of symptoms), diagnosis duration (time since formal diagnosis), and level of education were significantly associated with dyskinesia inunivariate analysis (p =< 0.0001, <0.0001, 0.1236 respectively). However, diagnosis duration was the only variable significantly associated with dyskinesia in multivariate analysis (p = 0.0038), in addition to a borderline significant association when comparing individuals with graduate degree to those who had completed high school education or less (p = 0.0599), with a protective effect of higher education. Disease duration, diagnosis duration, and use of monoamineoxidase inhibitors were also significantly associated with motor fluctuations in the univariate analysis, while only diagnosis duration was significantly associated with motor fluctuations in multivariate analysis (p = 0.0035) with longer diagnosis duration associated with higher risk of motor fluctuations. Age, disease duration, and diagnosis duration were associated with an increased risk of hallucinations

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“…Several of the studies observed treatment disparities in PD treatment among African-Americans compared to Caucasians [6][7][8]. The lack of treatment for PD can lead to increased morbidity, decreased quality of life and cause more rapid progression to disability [8].…”

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confidence: 99%

“…The lack of treatment for PD can lead to increased morbidity, decreased quality of life and cause more rapid progression to disability [8]. After controlling for demographics, age, sex, geography and initial visit with a neurologist, about only one third of African-Americans with PD were started on any therapy, including physical therapy.…”

mentioning

confidence: 99%

“…After controlling for demographics, age, sex, geography and initial visit with a neurologist, about only one third of African-Americans with PD were started on any therapy, including physical therapy. While authors were unable to determine the cause of the treatment disparities, the findings raised the possibility of problems with the quality of provider communication [8]. African-Americans were also less likely to receive Deep Brain Stimulation treatment for refractory PD despite being at a tertiary center with a comprehensive neurology and neurosurgery team [6].…”

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confidence: 99%

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