Objective: To examine the disparities in utilization of botulinum toxin (BoNT) injections for patients with cervical dystonia (CD) within the United States Medicare population.

Background: BoNT injections have been established as an effective first-line treatment for CD. Disparities in utilization among different groups have not been assessed for BoNT treatment of CD.

Method: Medicare data from the Centers for Medicare & Medicaid Services were utilized. A retrospective cohort study design was employed, using data from 2024. Sex, region, and race/ethnicity were examined. Chi-square tests were conducted to determine any statistical differences between these demographic factors and the likelihood of receiving BoNT injections.

Results: The study included 65,480 patients diagnosed with CD within the 65.9 million Medicare population for the calendar year analyzed (99 patients per 100,000). A majority were female (72.6%), White (87.5%), and received BoNT treatment (51.2%). Black (35.4%; 1385/3917) and Hispanic (43.1%; 549/1274) patients were found to be significantly less likely (both p<0.001) to receive BoNT injections compared with White patients (52.5%; 30,075/57,268), respectively. Additionally, men (48.1%; 8626/17,938) were significantly less likely (p<0.001) to receive BoNT compared with female patients (52.4%; 24,932/47,542). Among the top 10 largest Medicare beneficiary states, all showed lower rates of BoNT use for Black vs White patients with CD. Georgia, Florida, Michigan, and Texas had the largest absolute differences in BoNT utilization rates for Black vs White beneficiaries (25.0%, 24.5%, 21.6%, and 20.7% less, respectively), whereas Pennsylvania, New York, California, and Ohio had the smallest differences (7.3%, 7.9%, 8.5%, and 8.5% less, respectively).

Conclusion: This analysis reveals disparities in BoNT utilization for certain CD populations within the United States Medicare population. Black and Hispanic patients were significantly less likely to receive BoNT injections compared with their White counterparts, while males were also less likely than females. These disparities may arise due to various factors, including systemic barriers, socioeconomic factors, regional influences, and implicit biases. Strategies should be developed and employed to mitigate these disparities.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/disparities-in-botulinum-toxin-utilization-for-cervical-dystonia-in-a-united-states-medicare-population/