Abstract
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. 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. 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. 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.
Highlights
Parkinson’s disease (PD) is a progressive neurodegenerative movement disorder that affects more than 40,000 Ontarians.[1]
We found 46,237 individuals diagnosed with incident PD and eligible for inclusion in our study cohort between January 1, 1995, and December 31, 2009 (Figure 1)
More male patients were treated with deep brain stimulation (DBS) compared to female patients (68.0% vs. 32.0%) and the mean time from PD diagnosis to DBS surgery was 9.5 ± 3.7 years
Summary
Parkinson’s disease (PD) is a progressive neurodegenerative movement disorder that affects more than 40,000 Ontarians.[1] There is no known cure for PD; the disorder may effectively be managed with medications, physical therapies, and/or deep brain stimulation (DBS) surgery.[2,3,4] Since receiving Health Canada approval for DBS to treat patients with PD, randomized controlled trials have demonstrated that DBS is superior to existing pharmacotherapies for PD in select clinical settings and may enhance activities of daily living and quality of life.[3,5]. This may subsequently worsen health outcomes for patients with PD and increase their associated health care costs
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