Evidence of health disparities in PD is growing. Dahodwala et al20 abstracted data from the Pennsylvania Medicaid claims bank and reported that African Americans were half as likely to be diagnosed as having PD as whites. Americans (3). Data were obtained from patients evaluated by movement disorder specialists (P.S.F., S.G.R., W.J.W., and L.M.S.)  GKissela  et al. The use of carbidopa-levodopa without newer adjunctive agents was more common in the lower-income population (67.3% in the <$30 000 group and 56.7% in the >$70 000 group, P = .03). and Shulman, L.M.  MChaudhuri  KR Parkinson's disease in populations of African origin: a review. The administration of antipsychotic medications was higher in African Americans (12.7% vs 6.1%; P = .04). For overall differences, P < .001 for each outcome. 60,000 Americans are newly diagnosed with the disease, though likely treating Parkinson’s disease, and they often work with a group of other Lleras-Muney32 demonstrated that life expectancy was lengthened by as much as 1.7 years for each extra year of schooling. African Americans and those with lower socioeconomic status have greater disease severity and disability than whites. Acquisition of data: Hemming, Anderson, Fishman, Reich, Weiner, and Shulman.  S Parkinsonian syndromes. Studies in different patient populations and geographic locations are necessary to confirm these findings. programs for Parkinson’s disease patients and their loved ones (www.nwpf.org). Differences related to educational level also remained significant (all P < .01). Disparities by income and educational level have been reported in other populations. (2010) Geographic and Ethnic Variation in Parkinson  MEEggers Access to specialty care can vary across recording of Parkinson’s disease on death certificates.  AMandell  NSiderowf Parkinson disease (PD) is a progressive neurodegenerative disease affecting more than 2 million Americans. Because parkinsonism may be characterized by fluctuation of symptoms, patients were instructed to provide 2 responses describing their best and worst level of functioning. "There are widespread disparities among Parkinson's patients that are restricting equal utilization of evidence-based care, limiting patients' quality of life, and increasing societal and health care costs," said lead study author Allison Willis, MD, Assistant Professor of Neurology and …  JRShaw  PMFreedman Pressley JCTang M-XMarder KCote LJMayeux R Disparities in the  DS Racial differences in the diagnosis of Parkinson's disease. Future studies should investigate patient attitudes, their beliefs about PD symptoms and therapies, and physician attitudes regarding referral and PD management.  MNoll Among people over Van Den Eeden The COVID-19 pandemic has exacerbated America's health disparities, widening the divide between the haves and have nots. © 2020 American Medical Association. Background: Parkinson’s disease (PD) is among the most prevalent neurodegenerative disorders and poses a high economic burden on the healthcare system. Annals of After controlling for age, CIRS-G score, percentage with PD, and time since diagnosis, significant but less pronounced differences persisted (6.7-point difference in UPDRS, P < .001; 5.3-point difference in OARS, P < .001). of Parkinson’s disease patients. P.S., Reich, S.G., Weiner, W.J.  RC Differences between African Americans and whites in their perceptions of Alzheimer disease. The Mini-Mental State Examination score was not included in adjusted models (it was associated with educational level) because of concerns that the test itself may be 1 potential cause for the observed outcome differences (on the causal pathway). Patients with lower educational level were more likely to be prescribed antipsychotics (8.4% with less than a college education vs 4.7% with a college education, P = .01). United States Department of Health and Human Services; Agency for Healthcare Research and Quality.  K The strengths of the study include the size and scope of items contained in the Quality of Life & Function Study database. US Census Bureau, State and County QuickFacts—Baltimore City, Maryland. Not all data were collected from the initial visit at our Movement Disorders Center. Financial Disclosure: Dr Shulman has received compensation from Teva Pharmaceutical Industries Ltd and Boehringer Ingelheim GmbH; Dr Fishman, from Pfizer Incorporated, Forest Pharmaceuticals Inc, Ortho-McNeil-Janssen Pharmaceuticals Inc, GlaxoSmithKlein plc, Boehringer Ingelheim GmbH, Novartis AG, and Allergan Inc; Dr Reich, from Teva Pharmaceutical Industries Ltd, Cephalon Inc, Guilford Pharmaceuticals Inc, and General Electric Company; and Dr Weiner, from EMD Pharmaceuticals Inc, Teva Pharmaceutical Industries Ltd, Boehringer Ingelheim GmbH, Santhera Pharmaceuticals, and GlaxoSmithKline plc. Chan, A.K., McGovern, R.A., Brown, L.T., Sheehy, J.P., Zacharia, unclear whether the incidence and prevalence of Parkinson’s disease is The American Parkinson Disease Association (APDA) is the largest grassroots network dedicated to fighting Parkinson’s disease (PD) and works tirelessly to help the approximately one million with PD in the United States live life to the fullest in the face of this chronic, neurological disorder. A more detailed description of the modified OARS is available.16 If patients were unable to complete the questionnaire, a family member or caregiver completed it. Parkinson's disease affects more than 1 million people in the United States annually, with at least 60,000 new cases diagnosed each year. There was no disparity in the use of antiparkinsonian medications by income or educational level, although lower SES groups were also less likely to receive newer agents. Arch Neurol. 498-503. https://doi.org/10.1001/archneurol.2010.326, 5. This finding may be accounted for by the small number of African American patients. UW and Northwest Parkinson’s Foundation (NWPF), a local resource based  BSands  SM Assessing the impact of ease of administration and tolerability on treatment choices in Parkinson's disease. African American patients and those with lower socioeconomic status have more advanced disease and greater disability when they seek … Disparities in Access to Deep Brain Stimulation Surgery for Parkinson  EStern African-Americans and Chinese-Americans are more likely to perceive Sixty-six patients with parkinsonism self-identified their race as African American. the patient may also influence a physician’s diagnosis or decision to  MHSchiffer 2009. African Americans had greater disability and disease severity (Table 2). different communities, and for some, limited access to services can lead Disparities in natural history, clinical care, and outcomes in diverse Parkinson’s disease populations within the United States There are documented discrepancies in the natural history, clinical care, and outcomes received by patients of varying ethnicities within the United States. Marwick the same between white and African American populations, but evidence Mandell. Most patients (57.4%) completed self-report forms independently and 40.7% of the total required help. After controlling for age, sex, and geography, African Americans were 4 times less likely to receive any treatment for PD.21 Yacoubian et al22 found that among the cohort of patients in the Reasons for Geographic and Racial Differences in Stroke study, whites were nearly twice as likely to be prescribed medication for PD. One study found that African-Americans were eight © 2020 American Medical Association.  BSLinn Accessibility Statement, Patient Characteristics by Race, Income, and Educational Level, Disability and Disease Severity of Patients Grouped by Race, Income, and Educational Level, Adjusted Means by Race, Income, and Educational Level After Controlling for the Other 2 Variables, Medications by Race, Educational Level, and Income. The level of medical comorbidity was assessed with the Cumulative Illness Rating Scale–Geriatrics (CIRS-G), with the score based on the number and severity of medical disorders by organ system.17 Medications were categorized by class, including dopaminergic medications and antipsychotics. Parkinson’s disease compared to whites (8). Racette, B.A. The Unified Parkinson’s Disease Rating Scale (UPDRS)18 was used to assess the severity of parkinsonian signs in all patients. Table 4 presents the comparative use of medications.  et al. Harborview Medical Center and UW Medicine will not be liable for any complication, injuries or other medical accidents arising from or in connection with the use of or reliance upon information on this website. The evolution of disability in Parkinson disease.  V Facility and county effects on racial differences in nursing home quality indicators. 2007 Jan 30;68(5):326-37; Neurology. To improve health care in this patient population, it is important to recognize and study the potential factors limiting access to care.  DS Treatment disparities in Parkinson's disease. This presentation focused on health disparities that afflict some minority populations and laid out a blueprint of how to overcome these challenges.  AGwinn-Hardy The primary outcome measures were presence of a caregiver at the baseline visit, caregiver … 2005;20 (3) 315- 321N Dahodwala, MD, M Xie, E Noll, A Siderowf, DS Dopaminergics were subcategorized into carbidopa-levodopa only vs newer medications such as carbidopa-levodopa-entacapone or the dopamine receptor agonists. The chronic and progressive neurological condition is the second most common neurodegenerative aging disorder, after Alzheimer's disease. Analysis and interpretation of data: Hemming, Gruber-Baldini, Anderson, Weiner, and Shulman. This is the first study, to our knowledge, to show health disparities in disease severity and disability in parkinsonism.  KNussbaum More men than women are diagnosed with Parkinson's Disease by almost a 2 to 1 margin. All Rights Reserved. (2014) Knowledge and Attitudes About Parkinson’s Disease Among a For more information contact: This finding suggests that the racial disparity in PD management is not fully explained by income or educational level. Among people over the age of 65, about 1% have Parkinson’s disease.  LJMayeux  DA Progression of gait disorder and rigidity and risk of death in older persons. Other factors may include physician decision-making, patient acceptance of medications, and access to care. sign up for alerts, and more, to access your subscriptions, sign up for alerts, and more, to download free article PDFs, sign up for alerts, customize your interests, and more, to make a comment, download free article PDFs, sign up for alerts and more, Archives of Neurology & Psychiatry (1919-1959), http://www.ahrq.gov/qual/nhdr05/nhdr05.pdf, http://quickfacts.census.gov/qfd/states/24/24510.html, FDA Approval and Regulation of Pharmaceuticals, 1983-2018, Global Burden of Skin Diseases, 1990-2017, Health Care Spending in the US and Other High-Income Countries, Life Expectancy and Mortality Rates in the United States, 1959-2017, Medical Marketing in the United States, 1997-2016, Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter, US Burden of Cardiovascular Disease, 1990-2016, US Burden of Neurological Disease, 1990-2017, Waste in the US Health Care System: Estimated Costs and Potential for Savings, Register for email alerts with links to free full-text articles. Race, educational level, and SES may be factors in physician decision-making regarding referral to a specialist for consultation.29 Bach et al30 reported that differences also exist between the primary care physicians whom African Americans visit and those whom whites visit. One study found that and Dahodwala, N. Results remained significant across all variables by income (P ≤ .001).  GCVan Woert Among all patients with parkinsonism, PD was specifically diagnosed by a movement disorder specialist. Setter “Statistics.” Parkinson’s Foundation, https://www.parkinson.org/Understanding-Parkinsons/Statistics. reported that physicians did not consistently document whether PD patients who were … Obtained funding: Shulman. Working with a professionals with expertise in Parkinson’s disease, such as physical, it is estimated to affect around 1 million people. Hemming JP, Gruber-Baldini AL, Anderson KE, et al. Our study shows that race and SES influence disease severity and disability related to parkinsonism among patients being treated at an academic Movement Disorders Center. Study participants completed a demographics questionnaire for age, time since diagnosis of parkinsonism, and self-identified race, household income, and educational level.  JSConnell All Rights Reserved. Parkinson’s disease is a progressive disease. Dahodwala Parkinson’s disease (PD) is a chronic, progressive movement disorder that affects the lives of =between 500,000 and 1 million Americans (Neurology.  MWGurel Prevalence of parkinsonian signs and associated mortality in a community population of older people. Data analysis was based on an average of the best and worst ratings on each OARS item for each patient. Incidence of Parkinson's disease: variation by age, gender, and race/ethnicity. 2. Cheng et al.  C Healthy People 2010 initiative launched. The results of this study suggest we need to better understand the cause of parkinsonism and to find remedies for disparate outcomes among patients with parkinsonian disease who are of different backgrounds and means. Terms of Use| Richards C Marras, JC Beck, JH Bower, E Roberts, B Ritz, GW Ross, RD  R Disparities in the recording of Parkinson's disease on death certificates. Disability Exception for Citizenship (N-648), https://www.parkinson.org/Understanding-Parkinsons/Statistics, https://doi.org/10.1001/archneurol.2010.326, https://doi.org/10.1001/jamaneurol.2013.5798, https://doi.org/10.1007/s10823-014-9233-x. 2011;68(4):498–503. 2013 Mar;28(3):311-8; NPJ Parkinsons Dis. Hemming, J.P., Gruber-Baldini, A.L., Anderson, K.E., Fishman, Drafting of the manuscript: Hemming, Gruber-Baldini, Weiner, and Shulman. Some evidence suggests that PD is underdiagnosed in African Americans.14 The objective of this study is to assess the presence of differences in disease severity and disability in patients with parkinsonism treated at a tertiary Movement Disorders Center based on race, annual income, and educational level. The project is a collaboration between Diverse Group of Older Adults. Wilson et al26 related this magnitude in total UPDRS score to a more than doubling of mortality risk.  AL  W The diagnosis of Parkinson's disease. Objective To compare access to caregiving between men and women with Parkinson disease (PD). African Americans were also receiving fewer new dopaminergic agents (catechol- O-methyltransferase inhibitors, dopamine agonists, or monoamine oxidase inhibitors, 20.6% vs 41.1%; P = .001). Abbott, R Savica, SK Van Den Eeden, AW Willis, CM Tanner. Disclaimer: EthnoMed is designed for educational purposes only and is not rendering medical advice or professional services.  VA Persistent and growing socioeconomic disparities in disability among the elderly: 1982-2002. In the United States,  LAMurray at the University of Maryland Movement Disorders Center between May 20, 2003, and July 10, 2008. Disability and disease severity measures were compared by race, income, and educational level using analysis of variance for continuous variables and χ2 tests for dichotomous variables. 6, 7 Since the introduction of levodopa in 1967, numerous additional pharmacologic therapies have been introduced, 8, 9 including dopamine receptor agonists, monoamine oxidase inhibitors, and catechol- O …  KE Shulman By continuing to use our site, or clicking "Continue," you are agreeing to our, 2020 American Medical Association.  BWaubant Every year, about of diagnosis, often have greater disability and disease severity and are Information was obtained from 3 sources: patient-reported measures, documented medical history, and neurologic examination. The University of Maryland Movement Disorders Center is located in Baltimore, where 64% of the population is African American, mean household income is approximately $30 000, and high school dropout rates are high.25 In contrast, the patient population of the Movement Disorders Center is 93.4% white, 61.2% earn more than $50 000, and 62.7% have completed college. Medical Association seen in care of Parkinson 's disease on death certificates premature mortality detect differences may have hindered. Manuscript for important intellectual content: Hemming, Gruber-Baldini, Weiner, and material support: Frank Fishman... Design: Hemming, J.P., Gruber-Baldini, Anderson, Fishman, Reich, Weiner and. Include physician decision-making, patient acceptance of medications for depression and psychosis not. That the racial disparity in PD management therapies, and Shulman working with team. 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