Dorritie Andrew, Faysel Mohammad, Gruessner Angelika, Robakis Daphne
College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
Health Informatics Program, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
Parkinsonism Relat Disord. 2023 Oct;115:105811. doi: 10.1016/j.parkreldis.2023.105811. Epub 2023 Aug 20.
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.
To identify racial and ethnic disparities in DBS utilization in those hospitalized for ET, PD, and dystonia.
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.
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.
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.
脑深部电刺激术（DBS）是治疗特发性震颤（ET）、帕金森病（PD）和肌张力障碍的一种有效手术疗法。已有文献记载了帕金森病患者在DBS使用方面的种族差异，表明黑人患者接受DBS治疗的比例低于白人患者。据我们所知，尚无研究调查这种未使用模式在其他获得美国食品药品监督管理局（FDA）批准的运动障碍中是否持续存在。
确定因特发性震颤、帕金森病和肌张力障碍住院患者在DBS使用方面的种族和民族差异。
查询国家住院病人样本数据库（NIS）中2012年至2018年以特发性震颤、帕金森病或肌张力障碍为主要诊断的美国住院病例，分别记录到3363例、21963例和1835例出院病例。在该样本中，确定接受DBS治疗的情况。提取性别、种族、年龄、支付方式、收入四分位数、年份、死亡风险、医院规模、城乡环境、教学状况和地理区域等信息。进行多因素逻辑回归分析以确定DBS使用和未使用的预测因素。
2012年至2018年期间，患有帕金森病、特发性震颤和肌张力障碍的黑人患者接受DBS治疗的可能性低于白人患者。患有帕金森病的黑人患者接受DBS治疗的可能性低7倍（比值比[OR]=0.145，可信区间[CI]=0.111-0.189），患有特发性震颤和肌张力障碍的黑人患者接受DBS治疗的可能性比白人患者低5倍（OR=0.188，CI=0.124-0.285；OR=0.186，CI=0.084-0.414）。与白人患者相比，患有帕金森病（OR=0.631，OR=0.539-0.740）和特发性震颤（OR=0.438，CI=0.277-0.695）的西班牙裔患者接受DBS治疗的可能性较小。在控制患者和医院层面特征后，种族和民族差异仍然存在。
我们的数据表明，2012年至2018年期间，诊断为特发性震颤、帕金森病或肌张力障碍的黑人患者以及诊断为特发性震颤或帕金森病的西班牙裔患者接受DBS治疗的可能性低于白人患者。
