Using a multi-site registry of Parkinson’s Disease (PD) patients, we assess the impact of race, ethnicity, and socioeconomic status (SES) on the utilization of deep brain stimulation (DBS) and carbidopa-levodopa enteral suspension (Duopa), in the treatment of PD.

DBS and Duopa are used as options when levodopa therapy is limited by side effects. Past studies have shown that Black and Asian patients as well as Medicaid users are less likely to receive DBS. There is a lack of research into the demographics of patients using Duopa.

Using the Parkinson Foundation Quality Improvement Initiative (PF-QII) registry, we used chi-squared analysis to assess for differences in advanced therapy utilization by race and ethnicity, then used the Cox regression model to control for multiple covariates. We also assessed average household income by zip code which was used as a surrogate for SES.

A total of 11,588 patients were analyzed. At any given time post-PD diagnosis, AA and Hispanic patients were 70% and 25% less likely, respectively, to receive DBS compared to White patients (p<0.0001, p=0.05). Although the sample size was too small to assess for statistical significance, of the 104 Duopa recipients in the database, none were AA and two were Hispanic/Latino. Income was not statistically significant after controlling for covariates (p = 0.51).

African American and Hispanic/Latino PD patients are significantly less likely to receive DBS compared to White patients. While limited by sample size, none of the AA patients in the registry received Duopa therapy. Average household income was not a significant factor, although a multifactorial surrogate for SES may be necessary for future analysis. It will be important to develop strategies to increase education and outreach to the PD minority community to address the inequities in the use of advanced PD therapeutics.