Browsing by Author "Beck, James"

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    Racial and Ethnic Differences in Health-Related Quality of Life for Individuals with Parkinson Disease Across Centers of Excellence.
    (Neurology, 2023-04) Di Luca, Daniel Garbin; Luo, Sheng; Liu, Hongliang; Cohn, Melanie; Davis, Thomas L; Ramirez-Zamora, Adoldo; Rafferty, Miriam; Dahodwala, Nabila; Naito, Anna; Neault, Marilyn; Beck, James; Marras, Connie

    Background and objectives

    Racial and ethnic minorities have been underrepresented in Parkinson's disease (PD) research, limiting our understanding of treatments and outcomes across all non-White groups. The goal of this research is to investigate variability in health-related quality of life (HRQoL), and other outcomes in patients with PD across different races and ethnicities.

    Methods

    This was a retrospective, cross-sectional and longitudinal, cohort study of individuals evaluated at PD Centers of Excellence. A multivariable regression analysis adjusted for sex, age, disease duration, Hoehn and Yahr (H&Y) Stage, comorbidities and cognitive score was used to investigate differences between racial and ethnic groups. A multivariable regression with skewed-t errors was performed to assess the individual contribution of each variable to the association of PDQ-39 with race and ethnicity.

    Results

    A total of 8,514 participants had at least one recorded visit. The majority (90.2%) self-identified as White (n=7,687), followed by 5.81% Hispanic (n=495), 2% Asians (n=170), and 1.9% African American (162). After adjustment, total PDQ-39 scores were significantly higher (worse) in African Americans (28.56), Hispanics (26.62) and Asians (25.43) when compared to White patients (22.73, p<0.001). This difference was also significant in most PDQ-39 subscales. In the longitudinal analysis, the inclusion of cognitive scores significantly decreased the strength of association of PDQ-39, race/ethnicity for minority groups. A mediation analysis demonstrated that cognition partially mediated the association between race/ethnicity and PDQ-39 scores (proportion mediated 0.251, p <0.001).

    Discussion

    There were differences in PD outcomes across racial and ethnic groups, even after adjustment for sex, disease duration, HY stage, age and some comorbid conditions. Most notably, there was worse HRQoL among non-Whites when compared to White patients, which was partially explained by cognitive scores. The underlying reason for these differences needs to be a focus of future research.
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    State-level prevalence, health service use, and spending vary widely among Medicare beneficiaries with Parkinson disease.
    (NPJ Parkinson's disease, 2019-01-24) Mantri, Sneha; Fullard, Michelle E; Beck, James; Willis, Allison W
    State-level variations in disease, healthcare utilization, and spending influence healthcare planning at federal and state levels and should be examined to understand national disparities in health outcomes. This descriptive study examined state-level variations in Parkinson disease (PD) prevalence, patient characteristics, Medicare spending, out-of-pocket costs, and health service utilization using data on 27.5 million Medicare beneficiaries in the US in 2014. We found that 45.8% (n = 179,496) of Medicare beneficiaries diagnosed with PD were women; 26.1% (n = 102,205) were aged 85+. The District of Columbia, New York, Illinois, Connecticut, and Florida had the highest age-, race-, and sex-adjusted prevalence of Parkinson disease among Medicare beneficiaries in the US. Women comprised over 48.5% of PD patient populations in West Virginia, Kentucky, Mississippi, Louisiana, and Arkansas. More than 31% of the PD populations in Connecticut, Pennsylvania, Hawaii, and Rhode Island were aged 85+. PD patients who were "dual-eligible"-receiving both Medicare and Medicaid benefits-also varied by state, from <10% to >25%. Hospitalizations varied from 304 to 653 stays per 1000 PD patients and accounted for 26.5% of the 7.9 billion United States Dollars (USD) paid by the Medicare program for healthcare services delivered to our sample. A diagnosis of PD was associated with greater healthcare use and spending. This study provides initial evidence of substantial geographic variation in PD patient characteristics, health service use, and spending. Further study is necessary to inform the development of state- and federal-level health policies that are cost-efficient and support desired outcomes for PD patients.