Diferencias raciales y socioeconómicas en pacientes con Parkinson

Los afroamericanos y aquellos con un menor nivel socioeconómico parecen tener un parkinsonismo más grave y con mayores niveles de discapacidad, según un informe publicado en la revista Archives of Neurology, en el que se estudió a 1.159 pacientes con Parkinson que fueron evaluados por especialistas en trastornos del movimiento entre 2003 y 2008. Menores ingresos y menor nivel educativo se asociaron también con una mayor gravedad de la enfermedad y discapacidad.

Las disparidades también se observaron en los patrones de tratamiento. Se prescribieron menos medicamentos para tratar el Parkinson en la primera visita clínica (61,9% recibieron medicación, en comparación con 77,6% de los pacientes de raza blanca). Entre los pacientes afroamericanos, al 20,6% se les prescribió nuevos medicamentos dopaminérgicos, en comparación con el 41,1% de los pacientes de raza blanca, mientras que un 12,7% de los afroamericanos recibieron tratamiento con antipsicóticos en comparación con el 6,1% de los pacientes blancos.


Racial and Socioeconomic Disparities in Parkinsonism
 
Objective To assess potential racial and socioeconomic disparities in patients with parkinsonism treated at a tertiary Movement Disorders Center.

Methods Patients with parkinsonism were evaluated for demographics (age, race, annual income, and educational level), medical comorbidities, medication regimen, disability (Older Americans Resources and Services subcale), presence of Parkinson disease, and disease severity (Unified Parkinson Disease Rating Scale). Disability and disease severity measures were compared by race, income, and educational level using analysis of variance for continuous variables and 2 tests for dichotomous variables.
Results The sample included 1159 patients with parkinsonism (93.4% white, 6.1% African American, 61.2% who earned more than $50 000 annually, 62.7% who completed college, and 79.2% with a diagnosis of Parkinson disease). Cross-sectional analyses by race, income, and educational level showed greater disability and disease severity in African American compared with white patients (African American vs white Older Americans Resources and Services subscale total score, 29.8 vs 25.3, P = .005; Unified Parkinson’s Disease Rating Scale total score, 53.0 vs 42.8; P < .001). African Americans were less likely to be prescribed dopaminergic medications, particularly newer agents (African Americans 20.6% vs whites: 41.1%; P = .01). Lower income and lower educational level were independently associated with greater disease severity and disability (P < .003).
Conclusion Racial and socioeconomic disparities exist among patients with parkinsonism being treated at a tertiary Movement Disorders Center. African Americans and those with lower socioeconomic status have greater disease severity and disability than whites. These disparities may be because of problems in diagnosis, access to care, physician referrals, and patient attitudes regarding the appropriate threshold for seeking treatment at a specialized center. Understanding and correction of these disparities may improve outcomes.