Utilization and gender disparities of Deep Brain Stimulation surgery amongst Asian Americans, Native Hawaiians, and Other Pacific Islanders with Parkinson's disease in Hawai'i

Introduction: Despite its efficacy in Parkinson's disease (PD) management, Deep Brain Stimulation (DBS) is underutilized in sociodemographic minorities. Previous investigations of racial disparities in PD aggregated Asian American (AA) and Native Hawaiian or other Pacific Islander (NHPI) populations into a single category; however, these groups have significant health differences. We sought to characterize the PD population in Hawai`i and the use of DBS among AA subgroups and NHPI patients to elucidate potential sociodemographic and clinical disparities. Methods: Retrospective chart review of PD patients who received DBS from 2002 to 2021 was conducted at The Queen's Medical Center on Oahu, Hawai`i. Hawai`i PD admissions from 2016 to 2020 were collected from Laulima Data Alliance database. We compared the characteristics of DBS patients, total PD admissions, and Hawai`i census data. Alpha level of < 0.05 determined statistical significance. We did a subgroup analysis of white, AA and NHPI subgroups within the patients who underwent DBS. Results: Analysis included 4215 PD admissions and 74 DBS surgeries. Compared to census data, Whites (OR: 1.67; p < 0.0001) and AA (OR: 1.18; p < 0.0001) were overrepresented in total PD admissions; whereas NHPI (OR: 0.64; p < 0.0001) and Blacks (OR: 0.17; p < 0.0001) were underrepresented. Overall, males received DBS more than females. All NHPI patients who received DBS were male, despite 37.65 % of total NHPI PD admissions being female (p = 0.0049). Most DBS patients were AA (45.95 %), followed by Whites (43.24 %), and NHPI (10.81 %). Conclusions: NHPI and Black PD patients were disproportionately underrepresented in the Hawai`i PD population. All NHPI receiving DBS were male. These racial and gender disparities must be explored in future studies to achieve health equity and improved quality of care in a culturally sensitive manner.