Disparities in Deep Brain Stimulation Use for Parkinson’s Disease in Ontario, Canada

Abstract

Objective: To examine whether sociodemographic characteristics and health care utilization are associated with receiving deep brain stimulation (DBS) surgery for Parkinson’s disease (PD) in Ontario, Canada. Methods: Using health administrative data, we identified a cohort of individuals aged 40 years or older diagnosed with incident PD between 1995 and 2009. A case-control study was used to examine whether select factors were associated with DBS for PD. Patients were classified as cases if they underwent DBS surgery at any point 1-year after cohort entry until December 31, 2016. Conditional logistic regression modeling was used to estimate the adjusted odds of DBS surgery for sociodemographic and health care utilization indicators. Results: A total of 46,237 individuals with PD were identified, with 543 (1.2%) receiving DBS surgery. Individuals residing in northern Ontario were more likely than southern patients to receive DBS surgery [adjusted odds ratio (AOR) = 2.23, 95% confidence interval (CI) = 1.15–4.34]; however, regional variations were not observed after accounting for medication use among older adults (AOR = 1.04, 95% CI = 0.26–4.21). Patients living in neighborhoods with the highest concentration of visible minorities were less likely to receive DBS surgery compared to patients living in predominantly white neighborhoods (AOR = 0.27, 95% CI = 0.16–0.46). Regular neurologist care and use of multiple PD medications were positively associated with DBS surgery. Conclusions: Variations in use of DBS may reflect differences in access to care, specialist referral pathways, health-seeking behavior, or need for DBS. Future studies are needed to understand drivers of potential disparities in DBS use.

Predictors of Future Deep Brain Stimulation Surgery in de novo Parkinson's Disease

“…For example, DBS surgery has been related to living in neighborhoods with high socioeconomic status 30 or predominantly Caucasian neighborhoods. 28 Most participants in the PPMI cohort (92%) are white and this may partially explain the greater than expected proportion of DBS+ patients. In this cohort, we did not observe differences in ethnicity, but the lack of ethnic diversity in this group limits our ability to detect such differences.…”

“…As such, it is likely their awareness of DBS is higher, and they may have more access to surgical options. Indeed, having more frequent access to a neurologist 28 has been associated with an increased chance of DBS surgery. Possibly related to this, sex did not play a significant role in eventual DBS surgery (DBS+ 37% female, DBS− 35% female).…”

Multiculturalism and reported cognitive change in Parkinson’s disease

“…Unfortunately, this is not the case. Crispo and colleagues (2020) demonstrated that PD patients living in Ontario neighborhoods with the highest concentration of visible minorities were less likely to receive DBS than those living in predominantly white neighborhoods.…”

Mapping the Landscape of Equitable Access to Advanced Neurotechnologies in Canada

“…8 Crispo and colleagues reported significant regional variation in DBS implantation rates in Ontario. 9 Recently, two priority areas that have been identified for neuroethical inquiry are "issues of equity, resource allocation, and distributive justice" 10 and the cultural meanings of advanced neurotechnologies. 11 To our knowledge, no Canadian study has looked at whether access may differ across the lines of race, ethnicity or culture, or applied qualitative methods to investigate access disparities.…”

“…This gap is significant because the varying definitions of rural and remote and the size of populations can impact results and conclusions derived from quantitative models. 9,12 Case Study…”