Lancet regional health. Americas · 2023
Trends and disparities in deep brain stimulation utilization in the United States: a Nationwide Inpatient Sample analysis from 1993 to 2017.
СтатьяНазвание и аннотация: Перевод в очереди
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Sarica Can, Conner Christopher R, Yamamoto Kazuaki, Yang Andrew, Germann Jürgen, Lannon Melissa M, Samuel Nardin, Colditz Michael, Santyr Brendan, Chow Clement T, Iorio-Morin Christian, Aguirre-Padilla David H, Lang Stefan Thomas, Vetkas Artur, Cheyuo Cletus, Loh Aaron, Darmani Ghazaleh, Flouty Oliver, Milano Vanessa, Paff Michelle, Hodaie Mojgan, Kalia Suneil K, Munhoz Renato P, Fasano Alfonso, Lozano Andres M
Аннотация
BACKGROUND: Deep brain stimulation (DBS) is an approved treatment option for Parkinson's Disease (PD), essential tremor (ET), dystonia, obsessive-compulsive disorder and epilepsy in the United States. There are disparities in access to DBS, and clear understanding of the contextual factors driving them is important. Previous studies aimed at understanding these factors have been limited by single indications or small cohort sizes. The aim of this study is to provide an updated and comprehensive analysis of DBS utilization for multiple indications to better understand the factors driving disparities in access.
METHODS: The United States based National Inpatient Sample (NIS) database was utilized to analyze the surgical volume and trends of procedures based on indication, using relevant ICD codes. Predictors of DBS use were analyzed using a logistic regression model. DBS-implanted patients in each indication were compared based on the patient-, hospital-, and outcome-related variables.
FINDINGS: Our analysis of 104,356 DBS discharges from 1993 to 2017 revealed that the most frequent indications for DBS were PD (67%), ET (24%), and dystonia (4%). Although the number of DBS procedures has consistently increased over the years, radiofrequency ablation utilization has significantly decreased to only a few patients per year since 2003. Negative predictors for DBS utilization in PD and ET cohorts included age increase and female sex, while African American status was a negative predictor across all cohorts. Significant differences in patient-, hospital-, and outcome-related variables between DBS indications were also determined.
INTERPRETATION: Demographic and socioeconomic-based disparities in DBS use are evident. Although racial disparities are present across all indications, other disparities such as age, sex, wealth, and insurance status are only relevant in certain indications.
FUNDING: This work was supported by Alan & Susan Hudson Cornerstone Chair in Neurosurgery at University Health Network.
METHODS: The United States based National Inpatient Sample (NIS) database was utilized to analyze the surgical volume and trends of procedures based on indication, using relevant ICD codes. Predictors of DBS use were analyzed using a logistic regression model. DBS-implanted patients in each indication were compared based on the patient-, hospital-, and outcome-related variables.
FINDINGS: Our analysis of 104,356 DBS discharges from 1993 to 2017 revealed that the most frequent indications for DBS were PD (67%), ET (24%), and dystonia (4%). Although the number of DBS procedures has consistently increased over the years, radiofrequency ablation utilization has significantly decreased to only a few patients per year since 2003. Negative predictors for DBS utilization in PD and ET cohorts included age increase and female sex, while African American status was a negative predictor across all cohorts. Significant differences in patient-, hospital-, and outcome-related variables between DBS indications were also determined.
INTERPRETATION: Demographic and socioeconomic-based disparities in DBS use are evident. Although racial disparities are present across all indications, other disparities such as age, sex, wealth, and insurance status are only relevant in certain indications.
FUNDING: This work was supported by Alan & Susan Hudson Cornerstone Chair in Neurosurgery at University Health Network.