Objective: We sought to analyze a national database to examine how rates of gastrostomy tube (GT) placement in Parkinson’s disease (PD) differ by race and geographic region.

Background: Racial disparities in the care of patients with neurologic disorders, and specifically PD, are well-recognized.  For example, Black and Hispanic patients have a lower likelihood of having outpatient neurology visits¹. In PD, Black patients are less likely to be treated with dopaminergic medication² and undergo deep brain stimulation³.
Medical practices vary by geographic region as well. Americans living in the Northeast are more likely to have seen an outpatient neurologist¹.  The per capita health utilization costs for PD differ by state⁴.
Even though GT placement for end-stage PD is not recommended, many patients still undergo this procedure.

Method: Secondary analysis of a large, national database was conducted using diagnosis codes for PD, and procedure codes for GT placement. Rates of GT placement in PD patients were then compared among different regions and races.

Results: The rates of GT placements were 28.5 per 1000 PD (pKPD) patients in White, 10.2 pKPD in Black, and 25.2 pKPD patients in Asian (χ²(2)= 56.86, P<0.001). The rates of GT placements were 27.6 pKPD in Northeast, 26.6 pKPD in West, 22.4 pKPD in Midwest, and 21.8 pKPD in South (χ²(3)= 8.07, P=0.04).

Conclusion: GT placement in PD does not decrease the risk of aspiration pneumonia, nor prolong survival in the advanced stage of the disease. Clear guidelines for GT placement specifically in PD are lacking. Even though the trend of GT placement in PD is decreasing, many patients are still are getting GT placement, more commonly among Whites and Asians, and in the Northeast and West.  Further research is needed to understand the racial and geographic disparities and physician practice patterns.

References: 1. Saadi A, Himmelstein DU, Woolhandler S, Mejia NI. Racial disparities in neurologic health care access and utilization in the United States. Neurology. 2017;88(24):2268-2275. doi:10.1212/WNL.0000000000004025 2. Hemming JP, Gruber-Baldini AL, Anderson KE, et al. Racial and socioeconomic disparities in parkinsonism. Arch Neurol. 2011;68(4):498-503. doi:10.1001/archneurol.2010.326 3. Willis AW, Schootman M, Kung N, Wang X-Y, Perlmutter JS, Racette BA. Disparities in deep brain stimulation surgery among insured elders with Parkinson disease. Neurology. 2014;82(2):163-171. doi:10.1212/WNL.0000000000000017 4. Mantri S, Fullard ME, Beck J, Willis AW. State-level prevalence, health service use, and spending vary widely among Medicare beneficiaries with Parkinson disease. NPJ Park Dis. 2019;5:1. doi:10.1038/s41531-019-0074-8

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MDS Abstracts - https://www.mdsabstracts.org/abstract/racial-and-geographic-disparities-in-parkinsons-disease-patients-with-gastrostomy-feeding-tube-placement/