Sarica Can, Conner Christopher R, Yamamoto Kazuaki, Yang Andrew, Germann Jürgen, Lannon Melissa M, Samuel Nardin, Colditz Michael, Santyr Brendan, Chow Clement T, Iorio-Morin Christian, Aguirre-Padilla David H, Lang Stefan Thomas, Vetkas Artur, Cheyuo Cletus, Loh Aaron, Darmani Ghazaleh, Flouty Oliver, Milano Vanessa, Paff Michelle, Hodaie Mojgan, Kalia Suneil K, Munhoz Renato P, Fasano Alfonso, Lozano Andres M
Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Krembil Research Institute, University Health Network, Toronto, ON, Canada.
Lancet Reg Health Am. 2023 Sep 20;26:100599. doi: 10.1016/j.lana.2023.100599. eCollection 2023 Oct.
Deep brain stimulation (DBS) is an approved treatment option for Parkinson's Disease (PD), essential tremor (ET), dystonia, obsessive-compulsive disorder and epilepsy in the United States. There are disparities in access to DBS, and clear understanding of the contextual factors driving them is important. Previous studies aimed at understanding these factors have been limited by single indications or small cohort sizes. The aim of this study is to provide an updated and comprehensive analysis of DBS utilization for multiple indications to better understand the factors driving disparities in access.
The United States based National Inpatient Sample (NIS) database was utilized to analyze the surgical volume and trends of procedures based on indication, using relevant ICD codes. Predictors of DBS use were analyzed using a logistic regression model. DBS-implanted patients in each indication were compared based on the patient-, hospital-, and outcome-related variables.
Our analysis of 104,356 DBS discharges from 1993 to 2017 revealed that the most frequent indications for DBS were PD (67%), ET (24%), and dystonia (4%). Although the number of DBS procedures has consistently increased over the years, radiofrequency ablation utilization has significantly decreased to only a few patients per year since 2003. Negative predictors for DBS utilization in PD and ET cohorts included age increase and female sex, while African American status was a negative predictor across all cohorts. Significant differences in patient-, hospital-, and outcome-related variables between DBS indications were also determined.
Demographic and socioeconomic-based disparities in DBS use are evident. Although racial disparities are present across all indications, other disparities such as age, sex, wealth, and insurance status are only relevant in certain indications.
This work was supported by Alan & Susan Hudson Cornerstone Chair in Neurosurgery at University Health Network.
在美国，深部脑刺激（DBS）是帕金森病（PD）、特发性震颤（ET）、肌张力障碍、强迫症和癫痫的一种已获批准的治疗选择。在DBS的可及性方面存在差异，清楚了解导致这些差异的背景因素很重要。以往旨在了解这些因素的研究受到单一适应症或小样本队列规模的限制。本研究的目的是对多种适应症的DBS使用情况进行更新且全面的分析，以更好地理解导致可及性差异的因素。
利用基于美国的国家住院样本（NIS）数据库，使用相关国际疾病分类代码，分析基于适应症的手术量和手术趋势。使用逻辑回归模型分析DBS使用的预测因素。根据患者、医院和结局相关变量，对各适应症中植入DBS的患者进行比较。
我们对1993年至2017年104356例DBS出院病例的分析显示，DBS最常见的适应症是帕金森病（67%）、特发性震颤（24%）和肌张力障碍（4%）。尽管多年来DBS手术数量持续增加，但自2003年以来，射频消融的使用已显著减少至每年仅少数患者。帕金森病和特发性震颤队列中DBS使用的负面预测因素包括年龄增长和女性性别，而在所有队列中，非裔美国人身份都是负面预测因素。还确定了DBS适应症之间在患者、医院和结局相关变量方面的显著差异。
在DBS使用方面，基于人口统计学和社会经济的差异很明显。尽管在所有适应症中都存在种族差异，但年龄、性别、财富和保险状况等其他差异仅在某些适应症中相关。
这项工作得到了大学健康网络艾伦与苏珊·哈德森神经外科基石主席的支持。
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