Abstract Details

Title Gender, Race, and Socioeconomic Disparities on Surgical Device-aided Therapies (DATs) Among Medicare Beneficiaries with Advanced Parkinson’s Disease (aPD)

Topic Movement Disorders

Presentation(s) S2 - Movement Disorders: Epidemiology and Clinical Aspects (2:12 PM-2:24 PM)

Poster/Presentation
Number 007

Background

Carbidopa-levodopa enteral suspension (CLES) and deep brain stimulation (DBS) are treatment options for PwaPD. While an individuals’ preference plays a significant role in choice of treatment, initiation of these surgical DATs may be potentially impacted by health disparities.

Objective To determine the impact of demographic and clinical characteristics, geographic factors, and social determinants of health on initiation of a surgical device-aided therapy (DAT) among people with advanced Parkinson’s Disease (PwaPD).

Design/Methods Adults diagnosed with PD and meeting aPD indicators were identified in 100% Medicare Fee-for-Service claims between 2018-2020. Multivariate logistic regression models were used to determine factors associated with DAT initiation vs non-DAT initiation. Subgroup analysis was conducted for DBS or CLES initiators. Observations were reweighted by sample size in sensitivity analyses.

Results

Of 112,773 PwaPD, 2.2% received a DAT (DBS, n=1,861; CLES, n=589). Individuals who had rescue medication use, levodopa equivalent daily dose (LEDD) ≥1000 mg, or ≥1 neurologist visit were 3.0x, 1.9x, and 1.3x more likely to receive a DAT, respectively. Younger individuals (<75 vs 75-84 years) were 2-3x more likely to receive a DAT. Factors associated with a lower likelihood of DAT initiation were female gender, black race, moderate to severe comorbidity, and having lower income status (0.9x, 0.4x, 0.4-0.7x, 0.4x, respectively). In subgroup analyses, individuals who were married (4.1x) or living in a state with higher number of DAT facilities (1.3x to 1.5x) were more likely to initiate CLES, while completing up to high school education had lower likelihood (0.5x) of CLES initiation versus non-DAT initiation.

Conclusions Few PwaPD initiated a surgical DAT. Younger PwaPD or those with greater neurologist access were more likely to initiate a DAT. Increased attention should focus on women, racial minorities, or lower socioeconomic populations to minimize access disparities around efficacious DATs.

Authors/Disclosures
Joohi Jimenez Shahed, MD (Icahn School of Medicine at Mount Sinai) PRESENTER	Dr. Jimenez Shahed has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bracket Global LLC. Dr. Jimenez Shahed has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Teva. Dr. Jimenez Shahed has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medtronic. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alpha Omega. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for RegenXBio. Dr. Jimenez Shahed has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Praxis. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Kyowa Kirin. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BlueRock Therapeutics. Dr. Jimenez Shahed has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for PhotoPharmics. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Emalex. The institution of Dr. Jimenez Shahed has received research support from Michael J Fox Foundation. The institution of Dr. Jimenez Shahed has received research support from Amneal. The institution of Dr. Jimenez Shahed has received research support from Annovis. The institution of Dr. Jimenez Shahed has received research support from SAGE. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Faculty with Movement Disorders Society. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Faculty with American Academy of Neurology. Dr. Jimenez Shahed has received personal compensation in the range of $500-$4,999 for serving as a Grant Reviewer with Parkinson Foundation. Dr. Jimenez Shahed has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant on Research Grant with Florida Atlantic University. Dr. Jimenez Shahed has received personal compensation in the range of $0-$499 for serving as a Speaker with Tourette Association of America. Dr. Jimenez Shahed has received personal compensation in the range of $5,000-$9,999 for serving as a Speaker with NACCME.
Irene Malaty, MD, FAAN (University of Florida)	Dr. Malaty has received personal compensation in the range of $0-$499 for serving as a Consultant for Abbvie. The institution of Dr. Malaty has received research support from Abbvie. The institution of Dr. Malaty has received research support from Revance. The institution of Dr. Malaty has received research support from Neuroderm. The institution of Dr. Malaty has received research support from Parkinson Foundation. The institution of Dr. Malaty has received research support from SAGE. The institution of Dr. Malaty has received research support from Emalex. Dr. Malaty has received publishing royalties from a publication relating to health care. Dr. Malaty has received personal compensation in the range of $500-$4,999 for serving as a CME Speaker with Cleveland Clinic. Dr. Malaty has received personal compensation in the range of $500-$4,999 for serving as a Speaker & Center of Excellence Director with Parkinson Foundation. Dr. Malaty has a non-compensated relationship as a MAB member & Center of Excellence Directory with Tourette Association of America that is relevant to AAN interests or activities.
Michael Soileau, MD, FAAN (Texas Movement Disorder Specialists, PLLC)	The institution of Dr. Soileau has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Abbott. The institution of Dr. Soileau has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. The institution of Dr. Soileau has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbvie. The institution of Dr. Soileau has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Supernus. The institution of Dr. Soileau has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Neurocrine PHarmaceuticals. The institution of Dr. Soileau has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal Pharmaceuticals. Dr. Soileau has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Abbvie. Dr. Soileau has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Amneal. Dr. Soileau has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Kyowa Kiran. The institution of Dr. Soileau has received research support from Abbvie. The institution of Dr. Soileau has received research support from Cerevel. The institution of Dr. Soileau has received research support from Praxis. The institution of Dr. Soileau has received research support from CND Life Sciences. The institution of Dr. Soileau has received research support from Teva. The institution of Dr. Soileau has received research support from Abbott. The institution of Dr. Soileau has received research support from Jazz Pharmaceuticals. The institution of Dr. Soileau has received research support from Scion. Dr. Soileau has received publishing royalties from a publication relating to health care.
Zach Baldwin (AbbVie)	No disclosure on file
Connie H. Yan, PhD, PharmD (AbbVie Inc)	Dr. Yan has received personal compensation for serving as an employee of AbbVie Inc. Dr. Yan has stock in AbbVie Inc.
Prasanna L. Kandukuri	Mrs. Kandukuri has nothing to disclose.
Jill Schinkel	No disclosure on file
Christie Teigland (Inovalon)	No disclosure on file
Zulkarnain Pulungan (Inovalon)	No disclosure on file
Megha Shah	Megha Shah has received personal compensation for serving as an employee of AbbVie. Megha Shah has stock in AbbVIe .
Pavnit Kukreja, PharmD (AbbVie)	Dr. Kukreja has received personal compensation for serving as an employee of AbbVie. Dr. Kukreja has stock in AbbVie.
Aaron Hambrick	Aaron Hambrick has received personal compensation for serving as an employee of AbbVie. Aaron Hambrick has stock in AbbVie.
Anand R. Shewale (AbbVie)	Anand R. Shewale has received personal compensation for serving as an employee of AbbVie. Anand R. Shewale has stock in AbbVie.
Hubert H. Fernandez, MD, FAAN (Center for Neurological Restoration, Cleveland Clinic)	Dr. Fernandez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie. Dr. Fernandez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerevel. Dr. Fernandez has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amneal. Dr. Fernandez has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. The institution of Dr. Fernandez has received research support from Biogen. The institution of Dr. Fernandez has received research support from Michael J Fox Founda. The institution of Dr. Fernandez has received research support from Roche. The institution of Dr. Fernandez has received research support from Parkinson Foundation. The institution of Dr. Fernandez has received research support from UCB. Dr. Fernandez has received publishing royalties from a publication relating to health care. Dr. Fernandez has received personal compensation in the range of $10,000-$49,999 for serving as a Steering Committee/Advisory Committee Member with Parkinson Study Group.