When someone with Parkinson's disease or essential tremor needs advanced care, who actually gets it? A look at over 3,200 patients at a major movement disorders center found that only about 12% underwent deep brain stimulation (DBS) surgery—a procedure that can significantly improve symptoms. The patterns of who received the surgery were surprising. Patients with Medi-Cal (California's public insurance for low-income residents) and those living in neighborhoods with lower socioeconomic status had higher odds of getting the surgery. Meanwhile, younger patients, those who were single, and patients of Asian race had lower odds. This is a single-center study looking back at past records, so we can't say these factors cause the differences—they're just associated. The findings might reflect a specific referral pattern at this hospital, where patients with fewer resources are being connected to this advanced surgical option more readily than to routine care. It doesn't tell us about access across the country or whether these patterns are fair or ideal. It simply shows that at this one place, your insurance and where you live were linked to your chances of getting this specific treatment.
Retrospective study finds 12.1% of PD/ET patients underwent DBS surgery at a tertiary centerWho gets brain surgery for Parkinson's? Insurance and neighborhood matter
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Key Takeaway
Interpret single-center DBS utilization patterns cautiously as observational associations, not causation.
This retrospective cohort study analyzed patterns of deep brain stimulation (DBS) surgery utilization among 3286 patients with Parkinson's disease or essential tremor at a single tertiary movement disorders center between 2012 and 2022. The study compared patients who underwent DBS implantation with those who did not, aiming to characterize surgery patterns and identify associations with clinical and sociodemographic factors.
Overall, 12.1% of patients in the cohort underwent DBS surgery. The surgical group was characterized as younger, with fewer medical comorbidities, and had higher proportions of Hispanic ethnicity, non-English language preference, Medicare or Medi-Cal insurance, and residence in neighborhoods with lower socioeconomic status. Multivariable logistic regression found that having Medi-Cal insurance and living in a low-SES neighborhood were associated with higher odds of undergoing DBS surgery. Conversely, younger age at the initial clinic visit, single marital status, and Asian race were associated with lower odds of surgery. Specific effect sizes, absolute numbers, and p-values or confidence intervals for these associations were not reported.
Safety and tolerability data for DBS were not reported in this analysis. The primary limitation is the retrospective, single-center design using chart review data, which limits generalizability. The authors note the findings suggest possible referral bias, with better access to DBS surgery than routine care for low-SES and Medi-Cal patients at this specific center. These are observational associations and do not imply causation. The practice relevance is restrained, as the patterns may be unique to this center's referral population and practices.
What this means for you:
At one hospital, public insurance and lower neighborhood income linked to higher odds of getting Parkinson's brain surgery. More on Parkinson's Disease
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View Original Abstract ↓
BackgroundBarriers in access to Movement Disorders specialty care may explain sociodemographic differences in the utilization of deep brain stimulation (DBS) surgery for medically refractory Parkinson’s disease (PD) and essential tremor (ET).MethodsThis retrospective chart review used electronic medical records between 2012 and 2022 from a single tertiary movement disorders center to characterize DBS surgery patterns among a diverse group of movement disorders patients. Patients were diagnosed with PD, ET, or unspecified tremor aged 18 or older. Patient characteristics were summarized and compared between those who did and did not undergo DBS implantation using chi-square tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. Multivariable regression model was used to identify associations between clinical and sociodemographic covariates and DBS surgery.ResultsOf 3,286 PD/ET patients between 2012 and 2022, 12.1% underwent DBS surgery. Those who underwent surgery were younger and had fewer medical comorbidities. Within the surgical group, there were higher proportions of Hispanic ethnicity, non-English language preference, Medicare or Medi-Cal insurance, and residence in neighborhoods with lower socioeconomic status (SES). On multivariable logistic regression analysis, MediCal insurance and low neighborhood SES were associated with higher odds of surgery. Conversely, younger age at initial visit, single marital status, and Asian race were associated with lower odds of surgery.ConclusionSociodemographic variables associated with higher odds of receiving DBS surgery included low SES and Medi-Cal insurance. This may reflect a referral bias suggestive of better access to our center for DBS surgery than for routine movement disorders care for those from low SES and Medi-Cal. Future studies within our center will focus on quantitative and qualitative evaluation of referral processes for the treatment of advanced movement disorders in order to better understand and improve accessibility of these therapies to all patients in our health system and nationally.
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