社会剥夺指数与深部脑刺激：一项队列研究

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-03-23 DOI:10.1016/j.clineuro.2025.108860

Susanna D. Howard , Vishnu S. Potluri , Claudia Hejazi-Garcia , Pierce Davis , Gregory G. Heuer , Maria A. Punchak , Neil R. Malhotra , Jesse Y. Hsu , Iahn Cajigas

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引用次数: 0

摘要

背景与目的脑深部电刺激（DBS）是运动障碍患者的重要治疗选择；然而，先前的研究表明，获得这种重要治疗的机会不公平。我们使用社会剥夺指数（SDI），一个社区富裕指数，来检查DBS病例的分布，并确定SDI与结果之间的关系。方法本研究是一项回顾性队列研究，纳入2013年1月1日至2024年4月1日在宾夕法尼亚大学卫生系统（UPHS）接受DBS植入的所有患者。与每个邮政编码相关的SDI值范围从0（无困境/繁荣）到100（最严重的困境），并被分为低（<50）和高（50 - 100）两类。结果在低SDI邮政编码的UPHS中，DBS病例的患病率为每10万人4.8例（95 % CI（置信区间）4.4 - 5.2），而在高SDI邮政编码中，DBS病例的患病率为每10万人2.4例（95 % CI 2.1 - 2.7），相当于2.0的比率（95 % CI 1.7 - 2.3, p <； 0.001）。调整年龄、性别、保险类型、合并症和DBS适应症后，生活在更贫困地区的人再入院的几率更高，但这没有统计学意义（OR 2.22, 95 % CI 0.91 - 5.45， p值0.08）。结论：在我们的单中心研究中，大多数在我们机构接受DBS的患者居住在更富裕的社区。未来，SDI可用于有效地将外联工作定向到获得星展计划机会较少的地理区域。

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The social deprivation index and deep brain stimulation: A cohort study

Background and objectives

Deep brain stimulation (DBS) is an important treatment option for patients with movement disorders; however, prior studies have demonstrated inequitable access to this important treatment. We used the Social Deprivation Index (SDI), an index of neighborhood affluence, to examine the distribution of DBS cases and to determine the association between the SDI and outcomes.

Methods

This was a retrospective cohort study of all patients who have undergone DBS implantation within the University of Pennsylvania Health System (UPHS) from January 1st, 2013, to April 1st, 2024. SDI values associated with each ZIP code range from zero (no distress/prosperous) to 100 (highest distress) and were dichotomized into low (<50) and high (50−100) categories.

Results

The prevalence of DBS cases performed at UPHS across low SDI ZIP codes was 4.8 per 100,000 (95 % CI (confidence interval) 4.4 – 5.2), compared to 2.4 per 100,000 people (95 % CI 2.1 – 2.7) across high SDI ZIP codes, equivalent to a rate ratio of 2.0 (95 % CI 1.7 – 2.3, p < 0.001). Adjusting for age, sex, insurance type, comorbidities, and indication for DBS, people living in more deprived regions had higher odds of readmission, but this was not statistically significant (OR 2.22, 95 % CI 0.91 – 5.45, p-value 0.08).

Conclusion

In our single-center study, most people who received DBS at our institution resided in more affluent neighborhoods. In the future, the SDI could be used to effectively target outreach efforts to geographic areas with decreased access to DBS.

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.