Medical Student University of California, Los Angeles Los Angeles, California, United States
Disclosure(s):
Ziad Rifi: No financial relationships to disclose
Introduction: Deep Brain Stimulation (DBS) is a highly efficacious therapy for medication-refractory movement disorders. Non-disease related factors (sex, race, age, language, or socioeconomic status) may affect the likelihood of movement disorders patients receiving DBS therapy, leading to unwarranted disease morbidity. We aimed to assess potential disparities in access to DBS care in this patient population.
Methods: De-identified patient data was collected from our institutional electronic medical records. National data was collected via The ACT Network database. Movement disorders patients were identified with ICD-coded diagnoses for Parkinson’s disease, Essential tremor, or unspecified tremor. The institutional cohort was further narrowed by patients seen in movement disorders clinic. Demographic data was collected and compared between patients treated with DBS (+DBS) and those not treated (-DBS) using chi-squared test.
Results: 3,999 and 334,090 patients were identified in the institutional and national cohorts, of which 11% and 3.4% received DBS therapy, respectively. Female (36.2% +DBS vs. 42.5% -DBS, p < .05) and racial minority (non-white) patients (26.5% +DBS vs. 35.2% -DBS, p < .01) were significantly underrepresented in the +DBS group relative to their proportion in the population. These findings were replicated in the national cohort. The UCLA DBS cohort (4.2% >85yo) skewed to an older population relative to the national cohort (1.5% >85yo). At UCLA, non-English speakers were overrepresented in the +DBS group relative to their proportion in the population (12.9% +DBS vs. 9.1% -DBS, p < .01).
Conclusion : Our findings suggest that non-disease related factors, including sex, race, age, and language, may affect the likelihood of movement disorders patients receiving DBS therapy. Some of the observed differences may be due to implicit bias or uneven patient outreach, whereas others may be related to institutional experience or local patient population composition. Overall, knowledge of these patterns and barriers can help inform targeted interventions to improve DBS access for future movement disorders patients.
