Black people in the US may be five times less likely to be treated with deep brain stimulation (DBS) for Parkinson鈥檚 disease than white people.
is a surgical procedure used in people with Parkinson鈥檚 for whom medication is no longer effective. It involves stimulating parts of the brain to control abnormal brain activity, which can lessen the tremors associated with the condition.
at the University of Minnesota and his colleagues analysed a random sample of more than 50,000 DBS surgeries conducted between 2002 and 2018, found via the database. Cramer says the sample is large and diverse enough to make statistical inferences about surgeries carried out across the US.
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After taking into account the participants鈥� ages, any comorbidities, their insurance type and their income, the team found that Black people with Parkinson鈥檚 were five times less likely to have received DBS over the study鈥檚 16-year period, compared with white people.
Ethnic disparities in DBS in the US were last reported nearly 10 years ago, in a that found Black people were five to eight times less likely to undergo the procedure.
鈥淲e presumed that with awareness of the disparities, that this would have improved to some degree in subsequent years,鈥� says Cramer.
Regarding the latest research, Cramer says the variance between Black and white people with Parkinson鈥檚 receiving DBS may be due to reduced referrals by doctors for those in the former group. This is speculative, however, as the database didn鈥檛 include referral data, he says.
Nevertheless, Cramer thinks racial bias and structural racism would explain much of this difference. 鈥淭he persistent influence of structural racism in terms of factors such as socioeconomics, access to healthcare, access to time off from work and affordable transportation certainly contributes to some degree to the persistent racial disparity in DBS therapy,鈥� he says.
鈥淩emoving barriers to healthcare access would likely provide the biggest impact on this disparity,鈥� he says. 鈥淏eyond issues with adequate insurance coverage, there are the costs associated with care in terms of obtaining time off from work and traveling to the hospital.鈥�
at Boston University in Massachusetts thinks the disparity in DBS treatment is driven by 鈥渄ownstream鈥� factors, 鈥渕eaning patients aren鈥檛 referred to surgeons or a patient decides for themselves that surgery isn鈥檛 something they鈥檇 like to consider鈥�.
Previous suggests Black people in the US are less exposed to direct consumer pharmaceutical marketing than white people. They may therefore be less familiar with the surgery and consequently less willing to undergo it.
Annals of Neurology
