| Description |
- Background
Differences in the rates of deep brain stimulation (DBS) based on socioeconomic and demographic variables have been investigated for indications such as Parkinson’s disease, essential tremor, and epilepsy. Descriptive studies analyzing the rates of DBS for dystonia based on these factors however has yet to be investigated.
Methods
We queried the National Inpatient Sample (NIS) from January 1st 2012 to December 31st 2019 for all discharges with a diagnosis code of dystonia as well as those who underwent DBS for dystonia. The national estimates of frequencies and percentages of dystonia and receiving DBS for dystonia from the years 2012-2019 were estimated using discharge weights and estimated within levels of patient factors and hospital region. Multivariable logistic regression was fit to examine patient and hospital factors associated with receiving DBS for dystonia. Factors of interest included sex, race, hospital region, median household income based on zip, and primary insurance carrier.
Results
Of 199,400 weighted discharges with dystonia, the estimated mean age was 60.3 (standard error 0.1) years, 60.9% were female, 68.5% were white, 15.6% were black, and 6.7% were Hispanic. An estimated 63.2% indicated Medicare as the primary insurance, 16.1% were Private, and 15.8% were Medicaid. Based on the patient zip code, 31.1% were in the first quartile (lowest quartile) of median household income, but only 19.4% were in the fourth quartile.
Among discharges with dystonia, the weighted percentage of DBS for dystonia was 0.74% in 2012, increased to a peak of 0.95% in 2016, and decreased to 0.52% in 2019. The weighted percentages of DBS for dystonia were 0.81%, 0.13%, and 0.56% for white, black, and Hispanic patients, respectively. The weighted percentages of DBS for dystonia were 1.76%, 0.52%, and 0.46% for private insurance, Medicare, and Medicaid patients, respectively. Tthere were significantly lower odds of having DBS for dystonia for black patients (odds ratio [95% confidence interval], OR= 0.14 [0.07-0.29], p<0.001) compared to white patients, patients with Medicare or Medicaid (OR=0.57 [0.40-0.79], p=0.001 and OR=0.29 [0.19-0.45], p<0.001 respectively) compared to private insurance, and patients discharged from hospitals that were located in the Northeast (OR=0.43 [0.27-0.68], p<0.001) compared to the West. Patients with a zip code in the second Median household income quartile had higher odds of receiving DBS compared to the first income quartile (OR=1.43 [1.02-1.99], p=0.036).
Conclusion
Within the current cohort, DBS for dystonia has been decreasing since 2017. Black patients, discharges from hospitals in the Northeast, discharges with Medicare and Medicaid, and those in the lowest income quartile have lower odds of receiving DBS for their dystonia compared to white patients, patients discharged from hospitals in western states, patients with private insurance, and patients in the second income quartile.
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