Background: Over two million people have PD in the United States. DBS is an important treatment for PD patients whose motor symptoms do not respond adequately to pharmacotherapy. It is unknown if there are socio-cultural disparities influencing access to DBS. This study aimed to identify socio-cultural factors that affect when DBS is initially discussed with patients in a tertiary Movement Disorders center, and how these factors impact a patient’s decision to proceed with the surgical work-up and surgery.  

Methods: We identified all PD patients referred for neuropsychological assessment as part of their initial pre-surgical DBS workup between January 1, 2011 and March 27, 2019. Retrospective chart review was then conducted. Cross-sectional analysis using t-tests and linear regression model was performed. 

Results: One hundred seventy-two DBS candidates were identified for review (mean age 66.0, SD=9.6, 34% female). Sixty-six percent identified the US as their origin country, 69 percent identified English as their dominant language, and 74 percent were non-Hispanic white.  Forty percent had a commercial insurance plan at time of surgery. The overall linear regression model including race, insurance type, and gender showed these variables were significant predictors of UPDRS-III score “off” medication at the time of pre-surgical evaluation (F=8.05, p<0.001).  When analyzed separately, race (p<0.001) and insurance type (p=0.035) were significant independent predictors of the UPDRS-III score, however gender alone was not. Patients with commercial insurance plans had lower UPDRS-III scores and non-Hispanic white patients had lower UPDRS-III scores at time of evaluation. 

Conclusions: Non-Hispanic white PD patients and those with commercial insurance plans are more likely to be referred for DBS at an earlier stage of disease compared to other racial/ethnic groups.

Cultural Disparities in Deep Brain Stimulation (DBS) Decision Making in Patients with Parkinson Disease (PD)

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