Database analysis of ethnicity, sex, and insurance status of patients with Parkinson's disease
Cavanaugh, William Thomas
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Parkinson's Disease (PD) is the second most common neurodegenerative condition in humans, after Alzheimer's disease. It can be observed in all races and both genders, in the United States and worldwide. However, disparities in disease progression and manifestation exist between races and sexes. In addition, treatment options and overall health, impacted by insurance type, may affect a PD patient's disease state. The purpose of this study is to contribute to the background demographic information of PD patients, particularly as pertaining to insurance classification, which has not yet been addressed in the literature. The Hoehn and Yahr (H&Y) scores of patients both ON and OFF medication, a method of ranking and analyzing disease severity in Parkinson's patients, were analyzed in this study. The hypothesis is that the H&Y scores are impacted by race, gender, and insurance status. A univariate analysis of each variable was performed, the Student's t-test was used for gender and insurance status and a One-way ANOVA for race. A multivariate regression model analysis was then run for the primary outcomes and included all the variables and known confounders. A secondary analysis of disease complications utilizing Chi-square tests and logistic regression was also performed. Gender and insurance status did not differ significantly in H&Y scores. Black or African patients had a significantly increased PD progression as compared to Caucasian patients. Males and females differed significantly with regard to several disease complications. Subjects with public insurance also exhibited greater odds of some disease complications as compared to subjects with private insurance. In agreement with the literature, black PD patients exhibited a greater disease progression as compared to white PD patients. However, the reason for this has not yet been adequately addressed. In addition, more studies are needed to analyze other racial groups that were too small to appropriately address in this study. Despite a lack of difference in H&Y scores, PD is observed to be manifested differently between genders (disease complications), also in agreement with the literature. More studies are required to discover the reason for this disparity. Insurance classification does not impact H&Y scores. However, more studies are required to address whether this is maintained with a more sensitive outcome measure, such as the UPDRS. In addition, some complications differ between insurance categories, implying a disparity in treatment options and therapies.