Racial/Socioeconomic Disparities in Parkinson's

African American patients and those with lower socioeconomic status have more advanced disease and greater disability when they seek treatment from Parkinson’s disease specialists, according to a study from the University of Maryland School of Medicine. The researchers found that race, education and income were each significant and independent factors in determining a patient’s level of disability. The disparities in health care are associated with greater disease severity and earlier loss of independence. The study is published in the December 13, 2010, online edition of Archives of Neurology.

The cause of these racial and socioeconomic disparities is unclear, but possible explanations include problems with access to health care, reduced physician referral rate or patient reluctance to seek care from a movement disorders specialist. The study focused on a sample of more than 1,000 patients who were seen at the University of Maryland Parkinson’s Disease and Movement Disorders Center for parkinsonism (slow movements, tremor and rigidity, difficulty initiating movement, and problems with gait and balance), mostly due to Parkinson’s disease, but also caused by other conditions, including stroke, head trauma and medication side effects.

“Through our evaluation over a five-year period, we found that African Americans and people with lower socioeconomic status had greater disease severity and disability than whites when they first came to our clinic. Very large differences in Parkinson’s disease symptom severity and functional status were seen between blacks and whites, between high and low income groups and between groups with greater and lesser educational attainment,” says Lisa Shulman, M.D., lead author and professor of neurology at the University of Maryland School of Medicine.

“In the future, we will need to see if greater understanding and correction of these disparities could improve outcomes for these patients,” adds Dr. Shulman, who is also co-director of the Maryland Parkinson’s Disease and Movement Disorders Center at the University of Maryland Medical Center.

The analysis revealed that African American patients were less likely to receive medications for their parkinsonian symptoms overall and less likely to receive newer medications, which are generally more expensive. But the researchers acknowledge that the relatively small number of African Americans in the study (66) may limit their ability to detect differences and that more study is needed.

“The University of Maryland School of Medicine faculty has been at the forefront of tackling issues surrounding health disparities, which is a very complex subject. This study into parkinsonism shows how these disparities can affect all types of medical conditions and why it is important to identify them so we can make sure all patients receive the best care possible,” says E. Albert Reece, M.D., Ph.D., M.B.A., vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine.