Journal
CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES
Volume 47, Issue 5, Pages 642-655Publisher
CAMBRIDGE UNIV PRESS
DOI: 10.1017/cjn.2020.79
Keywords
Parkinson disease; Deep brain stimulation; Ontario; ON-Marg
Categories
Funding
- ICES Western site
- Ontario Ministry of Health and Long-Term Care (MOHLTC)
- Academic Medical Organization of Southwestern Ontario (AMOSO)
- Schulich School of Medicine and Dentistry (SSMD), Western University
- Lawson Health Research Institute (LHRI)
- Northern Ontario Academic Medicine Association (NOAMA) Clinical Innovation Opportunities Fund Award [C-17-20]
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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.
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