Objective: Compare rural and urban patients living with Parkinson’s Disease (PD)

Background: Rural populations face unique health challenges including but not limited to access to specialty care, limited use of telehealth, and higher ED utilization [1, 2]. To our knowledge, there is little known about the use of telehealth and advanced therapies (deep brain stimulation, focused ultrasound, intestinal or subcutaneous pump therapies) in rural populations compared to urban populations with PD.

Method: In this retrospective chart review, we included people with idiopathic PD (PwP) seen at our Movement Disorders Center between 1/1/2020 and 1/9/2026 and reviewed their geographic location as classified by Rural-Urban Commuting Area codes, which included North Carolina, Virginia, West Virginia, and Tennessee. We identified 103 rural dwelling PwP, who we compared to 103 randomly selected urban dwelling PwP. Clinical and epidemiologic data collected as part of routine clinical care (disease severity, time from disease onset to diagnosis, falls, use of online patient portal, emergency department (ED) utilization, and use of advanced therapies) were analyzed. Chi-square test, Fisher’s exact test, and Mann-Whitney U were used as indicated.

Results: We included 206 PwP (rural, n=103; urban, n=103). Both groups had similar demographics and disease severity [table1]. There were fewer ED visits in rural PwP (Mdn 0, IQR 0-2) than in urban PwP (Mdn 2, IQR 0-5) (U=3694, p<.0005). Median time (in months) from first symptom to diagnosis in rural PwP was 24 [IQR 12-24] and urban PwP was 12 [IQR 12-24] (U=1699, p=.080). Use of online patient portal in rural PwP was 11% less than urban PwP (X2(1)=3.074, p=.08) [table2]. There were no differences in use of advanced therapies or fall frequency between rural and urban dwelling PwP [table2].

Conclusion: Within our single center population, there was higher ED use in urban dwelling PwP than rural dwelling. There are potential trends of longer time to diagnosis from symptom onset and less often online patient portal use in rural dwelling patients. There were no major differences in advanced therapy use between the two groups, but sample sizes were small. Further case-controlled, larger scale studies, accounting for co-variates are warranted to better understand these preliminary findings.

Table 1. Demographic data

Table 2. Data analyzed using Chi-square/Fisher’s

References: 1. Maclagan, L. C., Marras, C., Sewell, I. J., Wu, C. F., Butt, D. A., Tu, K., & Bronskill, S. E. (2023). Trends in health service use among persons with Parkinson’s disease by rurality: A population-based repeated cross-sectional study. PloS one, 18(5), e0285585. https://doi.org/10.1371/journal.pone.0285585

2. Kyle MA, Blendon RJ, Findling MG, Benson JM. Telehealth use and Satisfaction among U.S. Households: Results of a National Survey. J Patient Exp. 2021 Oct 29;8:23743735211052737. doi: 10.1177/23743735211052737. PMID: 34734114; PMCID: PMC8559175.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/clinical-and-sociodemographic-characteristics-of-rural-and-urban-individuals-living-with-parkinsons-disease/