Hemming J Patrick, Gruber-Baldini Ann L, Anderson Karen E, Fishman Paul S, Reich Stephen G, Weiner William J, Shulman Lisa M
Department of Neurology, School of Medicine, University of Maryland, Baltimore, 21201, USA.
Arch Neurol. 2011 Apr;68(4):498-503. doi: 10.1001/archneurol.2010.326. Epub 2010 Dec 13.
To assess potential racial and socioeconomic disparities in patients with parkinsonism treated at a tertiary Movement Disorders Center.
Patients with parkinsonism were evaluated for demographics (age, race, annual income, and educational level), medical comorbidities, medication regimen, disability (Older Americans Resources and Services subscale), presence of Parkinson disease, and disease severity (Unified Parkinson Disease Rating Scale). Disability and disease severity measures were compared by race, income, and educational level using analysis of variance for continuous variables and χ(2) tests for dichotomous variables.
The sample included 1159 patients with parkinsonism (93.4% white, 6.1% African American, 61.2% who earned more than $50,000 annually, 62.7% who completed college, and 79.2% with a diagnosis of Parkinson disease). Cross-sectional analyses by race, income, and educational level showed greater disability and disease severity in African American compared with white patients (African American vs white Older Americans Resources and Services subscale total score, 29.8 vs 25.3, P = .005; Unified Parkinson's Disease Rating Scale total score, 53.0 vs 42.8; P < .001). African Americans were less likely to be prescribed dopaminergic medications, particularly newer agents (African Americans 20.6% vs whites: 41.1%; P = .01). Lower income and lower educational level were independently associated with greater disease severity and disability (P < .003).
Racial and socioeconomic disparities exist among patients with parkinsonism being treated at a tertiary Movement Disorders Center. African Americans and those with lower socioeconomic status have greater disease severity and disability than whites. These disparities may be because of problems in diagnosis, access to care, physician referrals, and patient attitudes regarding the appropriate threshold for seeking treatment at a specialized center. Understanding and correction of these disparities may improve outcomes.
评估在一家三级运动障碍中心接受治疗的帕金森综合征患者中潜在的种族和社会经济差异。
对帕金森综合征患者进行人口统计学特征（年龄、种族、年收入和教育水平）、合并症、药物治疗方案、残疾情况（美国老年人资源与服务分量表）、帕金森病的存在情况以及疾病严重程度（统一帕金森病评定量表）的评估。使用连续变量的方差分析和二分变量的χ²检验，按种族、收入和教育水平比较残疾情况和疾病严重程度指标。
样本包括1159例帕金森综合征患者（93.4%为白人，6.1%为非裔美国人，61.2%年收入超过50,000美元，62.7%完成大学学业，79.2%诊断为帕金森病）。按种族、收入和教育水平进行的横断面分析显示，与白人患者相比，非裔美国人的残疾情况和疾病严重程度更高（非裔美国人与白人的美国老年人资源与服务分量表总分，29.8对25.3，P = 0.005；统一帕金森病评定量表总分，53.0对42.8；P < 0.001）。非裔美国人接受多巴胺能药物治疗的可能性较小，尤其是新型药物（非裔美国人20.6%对白人：41.1%；P = 0.01）。低收入和低教育水平与更高的疾病严重程度和残疾情况独立相关（P < 0.003）。
在一家三级运动障碍中心接受治疗的帕金森综合征患者中存在种族和社会经济差异。非裔美国人以及社会经济地位较低者比白人的疾病严重程度更高且残疾情况更严重。这些差异可能是由于诊断、获得医疗服务、医生转诊以及患者对于在专科中心寻求治疗的合适阈值方面的态度等问题导致的。了解并纠正这些差异可能会改善治疗结果。
