Abstract Details

Title Racial/Ethnic Disparities in Parkinson Disease Patient Care in the United States: 1996-2009 Medical Expenditure Panel Survey

Topic Movement Disorders

Presentation(s) S03 - (-)

Poster/Presentation
Number 001

Objective

Background There are racial/ethnic PD care disparities [1-7]. We hypothesized Black and Latino PD patients were less likely than Whites to: 1) receive routine outpatient care and 2) had significantly less total PD treatment expenditures. Socioeconomic and geographic factors would partially explain these disparities.

Design/Methods We used 1996-2009 MEPS data representative of U.S. families, individuals, providers, and employers [8]. Information includes demographics, health conditions, and care measures including costs. We included PD patients (ICD-9 332 "paralysis agitans"), excluded age<40 to prevent diagnostic misclassification, and eliminated those with missing race/ethnicity data. To assess racial/ethnic PD care disparities (differences in PD treatment after adjustment for clinical appropriateness and need), we pursued regression analyses of PD care conditional on race/ethnicity, age, gender, activity limitation, and self-reported mental/physical health. To understand pathways explaining racial/ethnic disparities, we estimated staged regression models adjusting for age/gender then PD severity, socioeconomic variables, and geography.

Results 550 PD patients met inclusion/exclusion criteria. Mean age 72.7 years (SD 10.6); 41.1% female; race/ethnicity White 89.2%, Black 3.8%, 7.1% Latino. Most had Medicare (83.3%) and Southern residence (35.3%); 11.2% family income under the federal poverty line. Accounting for age, gender, and PD severity, the odds of White PD patients receiving any outpatient treatment were nearly three times the odds of Black PD patients (OR 2.74, CI 1.1-6.8; p=0.03); there were no PD drug therapy differences. Accounting for age, gender, and PD severity, overall PD care expenditures were lower for Latino compared to White patients (p=0.01). Racial/ethnic socioeconomic differences partially explained both disparities.

Conclusions 1996-2009 MEPS shows Black-White PD outpatient care but not drug use disparities, suggesting a lack of follow-up. Future work should identify whether resources spent on White versus Latino PD care represent Whites' overuse or Latinos' underuse.

Authors/Disclosures
Nicte Mejia, MD, MPH, FAAN (Massachusetts General Hospital) PRESENTER	Dr. Mejia has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Mejia has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology. The institution of Dr. Mejia has received research support from Biogen Foundation.
Fulton Velez	No disclosure on file
	No disclosure on file

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