Exploring Rates of Functional Neurosurgery Procedures in the Hispanic Population: A Single-Institution Analysis From 2017 to 2024.

Abstract

Introduction: Racial and ethnic disparities in utilization of functional neurosurgical procedures have been extensively documented. However, few studies have focused on the differences between Hispanic and non-Hispanic White populations in regions with high representation of both groups. Given the large Hispanic population within our hospital's catchment area, we aimed to compare the utilization of functional neurosurgery between the Hispanic and White populations in our practice.

Materials and methods: We conducted a retrospective review of patients undergoing functional neurosurgery procedures from 2017 to 2024 at the University of Arizona in Tucson. Rates of epilepsy, pain, and movement disorder procedures were compared by ethnicity, focusing on Hispanic vs non-Hispanic White populations. Correlations with age, American Society of Anesthesiologists class, income, insurance status, distance from the treatment center, and complications were examined.

Results: A total of 750 procedures were performed among 702 patients. Deep brain stimulation accounted for 27.73% of procedures, spinal cord stimulation for 35.87%, epilepsy surgery for 22.53%, and intrathecal pump placement for 13.7%. Among the included patients, 43.3% were treated for chronic pain, 22.5% for epilepsy, 18.1% for Parkinson's disease, 4.8% for essential tremor, 2.3% for spasticity, 0.9% for dystonia, and 8.0% for other/unknown diagnoses. Regarding ethnicity, 74.3% of our cohort identified as non-Hispanic White, 18.1% as Hispanic, and 7.6% as other or unknown ethnicity. Hispanic patients were significantly underrepresented relative to Southern Arizona demographics (χ² [1, n = 693] = 280.38, p < 0.0001, ϕ=0.64). This disparity was consistent and significant across all procedure types. Significant differences in five-year median inflation-adjusted household income were observed between Hispanic and White non-Hispanic groups (Welch t-test [n = 693] = 5.79, p < 0.0001, Cohen d = 0.53). Cluster analysis revealed four distinct clusters based on multiple predictors, and multinomial regression identified several significant predictors of undergoing each procedure type.

Discussion: Functional procedures are underutilized among Hispanic patients in Southern Arizona, with disparities associated with age, income, and distance from the treatment center.