Objective: To investigate healthcare disparities in provision of care to Parkinson’s disease (PD) and PD-plus patients in an ethnically diverse population in an inner-city hospital.

Background: Epidemiologic studies in Parkinson’s disease and PD-plus syndromes are typically conducted on a predominantly white population creating a lack of data in minority populations. Several studies have shown that there are racial and socioeconomic disparities in the care of patients with Parkinson’s disease. For example: patients treated in minority serving clinics are less likely to receive DBS, regardless of race, and blacks are less likely to receive DBS compared to whites; African Americans and those with lower socioeconomic status and/or lower education have greater disease severity and disability than whites. A Parkinson’s specific clinic targeting these at-risk populations may help to address these disparities.

Methods: Retrospective analysis of patients evaluated at the Movement Disorders Clinic at Bellevue Hospital Center seen between January 2012 and August 2017. Data was collected via chart review.

Results: We enrolled 100 patients, of whom 55% were women, with a mean age of 67.1 years at the last clinic visit. The patients racially identified as Hispanic (56%), Asian (18%), White (14%) and African American (12%). 65% had Medicaid and 34% Medicare, with no difference between races. PD was the most common diagnosis (66%), followed by PSP (9%), vascular PD (4%), DLB and drug-induced PD (3% each), CBGD (2%), MSA (1%) and atypical parkinsonism (12%). There were no clinically significant differences in HY scores or LEDD between races; men had higher LEDD compared to women (999mg vs 553mg, p <0.016). There were also no clinically significant differences in healthcare utilization between races, genders, or insurance status. Uninsured patients were on a higher number of dopaminergic medications compared to the insured (1.6 vs 1.1, p <0.032). We identified only 1 patient with DBS implanted and 10 candidates for DBS, 7 of which did not qualify due to lack of insurance.

Conclusions: Among PD and PD-plus seen in a public health institution, there are no clinically significant disparities in the care provided to patients regardless of race, gender or insurance status. This study also suggests that lack of insurance is an important barrier to access to DBS in minority PD populations with lower socioeconomic status.

References: 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;82(2):163-71. Hemming JP, Gruber-Baldini AL, Anderson KE, Fishman PS, Reich SG, Weiner WJ, Shulman LM. Racial and socioeconomic disparities in parkinsonism. Arch Neurol 2011;68(4):498-503.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-characteristics-of-patients-with-movement-disorders-in-a-diverse-inner-city-hospital/