OBJECTIVES:

Parkinson’s disease (PD) is a slowly progressive neurodegenerative disorder with treatments focused on symptom management. Despite efficacy of surgical device-aided therapies (DAT) to manage advanced PD (APD) symptoms, access may be limited due to barriers related to social determinants of health (SDOH). This study examined APD patient characteristics including near-neighborhood-level SDOH based on residence 9-digit ZIP-code to understand the impact of SDOH on DAT receipt.

METHODS:

100% Medicare Fee-for-Service claims data were utilized to identify adults with APD: ≥1 inpatient or ≥2 outpatient claims with a PD diagnosis 2018-2020 followed by occurrence of a treatment-related APD indicator. Demographic characteristics, SDOH, and distance between patient residence and facility were described for DAT recipients.

RESULTS:

Among 503,245 beneficiaries with PD, 112,773 were APD (22%), 2.17% of whom received DAT at 416 facilities. DAT recipients were younger (mean age 71 vs. 76) and more often male (65% vs. 34%) than those who did not receive DAT. Black patients were 3x less likely and Hispanic patients 1.3x more likely to receive DAT than White patients. Dual eligible for Medicaid (i.e., low income) patients were 2.1x less likely than non-duals, while those who qualified for Medicare age <65 due to disability were 1.8x more likely to receive DAT. No difference in receiving DAT by urban vs. rural location was observed. APD patients who received DAT had higher household income ($72,220 vs. $71,048; p=0.0050) and were less likely to have completed high school education or less (34.7% vs. 35.9%; p=0.0010). APD patients with no vehicle were less likely to receive DAT (6.3% vs. 7.1%; p=0.0001).

CONCLUSIONS: The proportion of APD patients who receive DAT varies by race/ethnicity, income, disability status, education level, and vehicle ownership. These factors may contribute to access issues resulting in health disparities for APD patients who may benefit from DAT.