Is practitioner appraisal of facial expressivity and emotional engagement in simulated Parkinson’s disease affected by race?

Abstract

Background

Black people are diagnosed with Parkinson’s disease (PD) at half the rate as White people. One unexplored possibility to explain this disparity is that practitioners have a racial bias, specifically when appraising motor signs of PD in Black versus White people.

Objective

The current study explores whether practitioners have a racial bias when appraising/evaluating Black versus White people with or without hypomimia (a motor sign of PD that results in reduced facial expressivity, which was simulated in this current study). Such bias may cause delays in the diagnosis of PD, which could explain the large racial disparity of the disease in Black versus White people.

Methods

A multi-level modeling approach was used to compare practitioners’ (N = 175) (1) appraisal of facial expressivity (2) perception of pathology and (3) impression of emotional engagement, in Black versus White people (paid actors) with or without simulated hypomimia. Additional analyses explored the association between these variables and practitioners’ demographics.

Results

Results show that practitioners rated facial expressivity higher in Black versus White individuals with no hypomimia, t(500.170) = 8.916, p < 0.001, estimate = -13.352. Additionally, more years of patient experience was associated with higher pathology ratings by practitioners, for Black and White people with hypomimia.

Conclusion

Although this study did not find a racial bias in practitioners’ appraisal of Black versus White people with hypomimia, the results highlight that quantity (i.e., years of experience), and possibly, quality of training could lead to a more accurate evaluation of Black patients with signs of Parkinson’s disease, which is a feasible point of intervention.