338 Disparate Use of Deep Brain Stimulation for Parkinson's Disease in Black Patients is Driven by Barriers to Access that Arise Before Surgical Referral. (1st April 2022)

• Record Type: Journal Article
• Authors: Skelton, Henry M.; Grogan, Dayton; Laxpati, Nealen; Miocinovic, Svjetlana; Gross, Robert E.; Yong, Nicholas A.
• Is Part Of: Neurosurgery. Volume 68(2022)Supplement 1
• Page Start: 78
• Page End: 78
• Publication Date: 2022-04-01
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/NEU.0000000000001880_338
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : INTRODUCTION: Deep brain stimulation (DBS) is an effective therapy for Parkinson's disease (PD) that can provide substantial improvements in quality of life for patients inadequately controlled with medication. However, there is severe racial disparity in its use, with Black PD patients being much less likely to be treated with DBS than White patients. We hypothesized that the extensive process of patient selection and workup limits access to DBS, and we analyzed the records of a major movement disorder and DBS center to determine if this barrier to access was apparent. METHODS: We reviewed a database that includes every patient considered for DBS between 2016 and February of 2021. We cross-tabulated the patients by race, as documented in the medical record, and progression to surgical intervention. We determined whether there was a significant difference in the proportion of patients who were not treated with DBS via Fisher's exact test. RESULTS: Out of 211 PD patients evaluated by a DBS movement specialist and referred for preoperative workup since 2016, 10 (5%) were indicated to be Black, compared to 160 (76%) White, 7 (3%) Asian, and 34 (16%) Unknown. Of those, 7/10 (70%) Black patients were treated with surgery, compared to 123/160 (77%) White, 5/7 (71%) Asian, and 23/34 (68%) Unknown (p = 0.61, Fisher's Exact Test). CONCLUSION: While very few Black patients were referred to DBS Clinic, there was no significant difference between racial groups in the likelihood of receiving surgery once referred. This suggests that the disparity arises before preoperative workup, with potential candidates for treatment never reaching DBS clinic. Future work should attempt to identify factors driving this disparity, with particular attention paid to referral patterns. Notably, these results do not exclude the possibility that the general burden of preoperative evaluation and postoperative management might influence decisions on whether to refer patients.