Allison W.Willis, Assistant Professor, University of Pennsylvania School of MedicineAllison.Willis@uphs.upenn.edu
Submitted August 06, 2014
We agree with Barrett et al. that coding inaccuracy, physical function, physician bias/prejudice, or patient preferences cannot be accounted for using Medicare data. Medicare data undoubtedly contains poor DBS candidates--due to PD or other illness--who may be unevenly distributed across physician specialties, gender, race, and socioeconomic groups. We reported the data on the entire PD population because we did not want to continue the practice of excluding individuals diagnosed with PD who do not or cannot receive neurologist care (the majority of which are white women and those living in rural areas). When we repeated our primary analyses on the portion of beneficiaries receiving neurologist care, the gender, race, and socioeconomic disparities in DBS were even more striking.
We considered using prescription data, but thought additional bias would occur. Medicare Part D prescription enrollment varies widely across sociodemographic groups and states. [1] Dopamine may initially/partially benefit individuals with other 'parkinsonisms'. [2,3] Prescription data would not capture the magnitude of benefit or diagnostic implications thereof.
Our overall finding of DBS underutilization highlights a potential access to care or treatment dissemination issue that needs to be addressed given the substantial public investment in novel therapies for PD.
1. Centers for Medicare and Medicaid Services. Variation of Part D Enrollment by Race, Age, Gender and State. 14 A.D.
2. Zijlmans JC, Katzenschlager R, Daniel SE, Lees AJ. The L-dopa response in vascular parkinsonism. J Neurol Neurosurg Psychiatry 2004;75:545-547.
3. Constantinescu R, Richard I, Kurlan R. Levodopa responsiveness in disorders with parkinsonism: a review of the literature. Mov Disord 2007;22:2141-2148.
4. Hemming JP, Gruber-Baldini AL, Anderson KE, et al. Racial and socioeconomic disparities in parkinsonism. Arch Neurol 2011;68:498-503.
5. Yacoubian TA, Howard G, Kissela B, Sands CD, Standaert DG. Racial differences in Parkinson's disease medication use in the reasons for geographic and racial differences in stroke cohort: a cross-sectional study. Neuroepidemiology 2009;33:329-334.
For disclosures, contact the editorial office at journal@neurology.org.
We agree with Barrett et al. that coding inaccuracy, physical function, physician bias/prejudice, or patient preferences cannot be accounted for using Medicare data. Medicare data undoubtedly contains poor DBS candidates--due to PD or other illness--who may be unevenly distributed across physician specialties, gender, race, and socioeconomic groups. We reported the data on the entire PD population because we did not want to continue the practice of excluding individuals diagnosed with PD who do not or cannot receive neurologist care (the majority of which are white women and those living in rural areas). When we repeated our primary analyses on the portion of beneficiaries receiving neurologist care, the gender, race, and socioeconomic disparities in DBS were even more striking.
We considered using prescription data, but thought additional bias would occur. Medicare Part D prescription enrollment varies widely across sociodemographic groups and states. [1] Dopamine may initially/partially benefit individuals with other 'parkinsonisms'. [2,3] Prescription data would not capture the magnitude of benefit or diagnostic implications thereof.
Our overall finding of DBS underutilization highlights a potential access to care or treatment dissemination issue that needs to be addressed given the substantial public investment in novel therapies for PD.
1. Centers for Medicare and Medicaid Services. Variation of Part D Enrollment by Race, Age, Gender and State. 14 A.D.
2. Zijlmans JC, Katzenschlager R, Daniel SE, Lees AJ. The L-dopa response in vascular parkinsonism. J Neurol Neurosurg Psychiatry 2004;75:545-547.
3. Constantinescu R, Richard I, Kurlan R. Levodopa responsiveness in disorders with parkinsonism: a review of the literature. Mov Disord 2007;22:2141-2148.
4. Hemming JP, Gruber-Baldini AL, Anderson KE, et al. Racial and socioeconomic disparities in parkinsonism. Arch Neurol 2011;68:498-503.
5. Yacoubian TA, Howard G, Kissela B, Sands CD, Standaert DG. Racial differences in Parkinson's disease medication use in the reasons for geographic and racial differences in stroke cohort: a cross-sectional study. Neuroepidemiology 2009;33:329-334.
For disclosures, contact the editorial office at journal@neurology.org.