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Black Patients Are 7 Times Less Likely to Receive Deep Brain Stimulation for Movement Disorders

Black patients were far less likely to receive deep brain stimulation for treatment for essential tremor (ET), Parkinson's disease (PD), or dystonia, according to an abstract presented in April at the AAN Annual Meeting.

The study authors said the reasons for the disparity were not clear, and they hope to find ways to address the gap.

The study looked at hospital discharges from the Nationwide Inpatient Sample (NIS) database from 2012-2018, specifically looking at PD (21,964), ET (3,307), and dystonia (1,439), and analyzed which patients were treated with DBS. Of those hospitalized, 58.8 percent of White patients received DBS implantation compared with only 17.5 percent of Black patients (OR=0.188, CI=0.124-0.285). Additionally, only 33.3 percent of Hispanic patients who were hospitalized ​​received DBS implantation (OR=0.438, CI=0.277-0.695).

Lead author Daphne Robakis, MD, assistant professor of neurology at the State University of New York—Downstate, said the researchers found the amount of disparity so disconcerting that they redid the analysis to ensure it was correct. 

“We also found that Black patients with Medicaid were also less likely to get DBS than White patients with Medicaid," she said.

Dr. Robakis said a mortality risk analysis also did not explain the disparity in DBS use.

Black and Hispanic patients were neither sicker nor had greater mortality risks that would make them poor  candidates for the procedure, Dr. Robakis said, noting that the mortality risk assessment is not without flaws. 

Ludy Shih, MD, MMSc, FAAN, FANA, director of the deep brain stimulation program for Boston University Medical Campus, said one challenge might simply be access to medical centers and doctors who have expertise in DBS procedures. Getting patients' families and caregivers involved and establishing trust with the patients is important, she said. It's equally critical for doctors who work with patients with PD and ET to acknowledge and be aware that medical disparities do exist, as they might not typically review their own statistics to see if their Black and Hispanic patients receive similar care to their White patients, Dr. Shih said.

“It makes sense that trusting your clinician to help make this decision with you plays a big role, because patients don't have the ability to draw on a past experience to know whether this surgery is right for them or not," she said. She added that if someone is struggling with the decision, she'll give them time and get a sense of whether it's appropriate to bring up the procedure again.

“I'll ask if maybe they've given it some thought, or maybe there's a new way of doing the DBS procedure that addresses their prior concerns or reservations," Dr. Shih said.

She also would like to see a qualitative and quantitative or larger study looking at specific centers in geographic regions of the US that serve higher proportions of individuals from different racial and ethnic groups—including Hispanic, Asian, and Black patients— to see which variables play a role in this decision.

Dr. Robakis agreed that awareness of the problem is a start, and building rapport with both patients and families is imperative. But she added that physicians also need to practice humility to address the problem itself.

“On the physician side, if every patient that you have who's Black says they don't want [DBS], the concern is that you're going to start not offering the deep ​brain stimulation to Black patients," she said. “And then you're just making the disparity worse. Even though there may be patients who are good candidates for it, you're thinking, 'This patient is never going to agree to it.'"

​Dr. Robakis has received compensation for serving on a scientific advisory or data safety monitoring board for Amneal Pharmaceuticals. Dr. Shih had no disclosures.

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