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

被引：18

作者：

Crispo, James A. G. ^{[1
,2
,3
,4
]}

Lam, Melody ^{[5
]}

Le, Britney ^{[5
]}

Richard, Lucie ^{[5
]}

Shariff, Salimah Z. ^{[5
]}

Ansell, Dominique R. ^{[6
,7
]}

Squarzolo, Melanie ^{[6
,7
]}

Marras, Connie ^{[8
]}

Willis, Allison W. ^{[1
,2
,9
,10
]}

Seitz, Dallas ^{[11
]}

机构：

[1] Univ Penn, Dept Neurol, Perelman Sch Med, Philadelphia, PA 19104 USA

[2] Univ Penn, Dept Biostat Epidemiol & Informat, Perelman Sch Med, Philadelphia, PA 19104 USA

[3] ICES North, Sudbury, ON, Canada

[4] Northern Ontario Sch Med, Div Human Sci, Sudbury, ON, Canada

[5] ICES Western, London, ON, Canada

[6] Hlth Sci North, Emergency Dept, Sudbury, ON, Canada

[7] Northern Ontario Sch Med, Div Clin Sci, Sudbury, ON, Canada

[8] Univ Toronto, Toronto Western Hosp, Edmond J Safra Program Parkinsons Dis, Toronto, ON, Canada

[9] Univ Penn, Dept Neurol Translat, Ctr Excellence Neuroepidemiol & Neurol Outcomes R, Perelman Sch Med, Philadelphia, PA 19104 USA

[10] Univ Penn, Ctr Clin Epidemiol & Biostat, Perelman Sch Med, Philadelphia, PA 19104 USA

[11] Queens Univ, Dept Psychiat, ICES Queens, Kingston, ON, Canada

来源：

CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES | 2020年 / 47卷 / 05期

关键词：

Parkinson disease; Deep brain stimulation; Ontario; ON-Marg; CARE; ACCESS; SERVICES; SURGERY;

D O I：

10.1017/cjn.2020.79

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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.

引用

页码：642 / 655

页数：14

共 36 条

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