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Disparities in deep brain stimulation surgery among insured elders with Parkinson disease
Willis AW, Schootman M, Kung N, Wang XY, Perlmutter JS, Racette BA.. Neurology, 2013-12-11
Topic: Risk, prevention and care in population studies
Objective To identify sociodemographic, clinical, and physician/practice factors associated with deep brain stimulation (DBS). DBS is a proven surgical therapy for Parkinson disease (PD), but is recommended only for patients with excellent health, results in significant out-of-pocket costs, and requires substantial physician involvement. Methods Retrospective cohort study of more than 657,000 Medicare beneficiaries with PD. Multivariable logistic regression models examined the association between demographic, clinical, socioeconomic status (SES), and physician/practice factors, and DBS therapy. Results There were significant disparities in the use of DBS therapy among Medicare beneficiaries with PD. The greatest disparities were associated with race: black (adjusted odds ratio [AOR] 0.20, 95% confidence interval [CI] 0.16-0.25) and Asian (AOR 0.55, 95% CI 0.44-0.70) beneficiaries were considerably less likely to receive DBS than white beneficiaries. Women (AOR 0.79, 95% CI 0.75-0.83) also had lower odds of receiving DBS compared with men. Eighteen percent of procedures were performed on patients with PD who had cognitive impairment/dementia, a reported contraindication to DBS. Beneficiaries treated in minority-serving PD practices were less likely to receive DBS, regardless of individual race (AOR 0.76, 95% CI 0.66-0.87). Even after adjustment for demographic and clinical covariates, high neighborhood SES was associated with 1.4-fold higher odds of receiving DBS (AOR 1.42, 95% CI 1.33-1.53). Conclusions Among elderly Medicare beneficiaries with PD, race, sex, and neighborhood SES are strong independent predictors of DBS receipt. Racial disparities are amplified when adjusting for physician/clinic characteristics. Future investigations of the demographic differences in clinical need/usefulness of DBS, ease of DBS attainment, and actual/opportunity DBS costs are needed to inform policies to reduce DBS disparities and improve PD quality of care.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Willis, A. W., Schootman, M., Kung, N., Wang, X. Y., Perlmutter, J. S., & Racette, B. A. (2014). Disparities in deep brain stimulation surgery among insured elders with Parkinson disease. Neurology. https://doi.org/10.1212/wnl.0000000000000017
Vancouver
Willis AW, Schootman M, Kung N, Wang XY, Perlmutter JS, Racette BA. Disparities in deep brain stimulation surgery among insured elders with Parkinson disease. Neurology. 2014. doi:10.1212/wnl.0000000000000017. PMID: 24336138.
BibTeX
@article{willis2014-24336138,
author = {Willis, A. W. and Schootman, M. and Kung, N. and Wang, X. Y. and Perlmutter, J. S. and Racette, B. A.},
title = {{Disparities in deep brain stimulation surgery among insured elders with Parkinson disease}},
journal = {Neurology},
year = {2014},
doi = {10.1212/wnl.0000000000000017},
pmid = {24336138},
url = {https://doi.org/10.1212/wnl.0000000000000017}
}
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Key findings
- Objective To identify sociodemographic, clinical, and physician/practice factors associated with deep brain stimulation (DBS).
- DBS is a proven surgical therapy for Parkinson disease (PD), but is recommended only for patients with excellent health, results in significant out-of-pocket costs, and requires substantial physician involvement.
- Results There were significant disparities in the use of DBS therapy among Medicare beneficiaries with PD.
- The greatest disparities were associated with race: black (adjusted odds ratio [AOR] 0.20, 95% confidence interval [CI] 0.16-0.25) and Asian (AOR 0.55, 95% CI 0.44-0.70) beneficiaries were considerably less likely to receive DBS than white beneficiaries.
- Women (AOR 0.79, 95% CI 0.75-0.83) also had lower odds of receiving DBS compared with men.
Why it matters
Among Medicare beneficiaries with Parkinson disease, black, Asian and female patients were considerably less likely to receive deep brain stimulation surgery than white or male patients. The study also found that 18% of these surgeries were performed on patients with cognitive impairment or dementia, which is a reported contraindication.
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Study details
- Study designcohort study
- Effect sizeAOR 0.55; AOR 0.79; AOR 0.76
- Evidence strengthModerate
How this study scored 57/100
Published in a leading specialty journal, and it is a cohort study following people over time. Scored zero for sample size, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Neurology) |
| Journal's citation record | 4 / 4 | Neurology: journal h-index 525 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2014 — within 20 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 141 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 10.1 citations a year over 14 year(s) since 2014 |
| Impact for its field and year | 2 / 6 | Cited 2.9× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 1 other studies in this library |
| Still being cited | 2 / 4 | Cited 46 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Brad Alan Racette: h-index 51 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Washington University in St. Louis: institution h-index 1,962 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 24336138) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 57 / 100 | — |
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