Objective: 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 surgical work-up and surgery.

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.

Method: 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 USA 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 lead time between PD diagnosis and initial discussion of DBS surgical candidacy (F=3.20, p=0.025). When analyzed separately, insurance type (p=0.086) and gender (0.089) were significant independent predictors, while race was not (p=1.106). Mean lead time was greater for women (10.52 years) than men (8.46 years), and greater for those with public insurance (9.86 years) than commercial insurance (8.16 years). Combined with previously reported results*, commercial insurance is a significant predictor of both shorter lead time between diagnosis and initial discussion of DBS as a treatment option, and lower UPDRS-III score at the time of pre-surgical evaluation. There were no disparities in the lead time between when DBS surgery is first discussed and when patients decide to proceed with the surgery.

Conclusion: Female PD patients and those with public insurance plans are more likely to experience a longer lead time between PD diagnosis and initial discussion of DBS as a treatment option.
*This abstract includes updates to the original abstract accepted for the AAN Annual Meeting, April 26, 2020.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cultural-disparities-in-deep-brain-stimulation-dbs-decision-making-in-patients-with-parkinsons-disease-pd-updates/