{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T05:52:26Z","timestamp":1774936346667,"version":"3.50.1"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Barriers in access to Movement Disorders specialty care may explain sociodemographic differences in the utilization of deep brain stimulation (DBS) surgery for medically refractory Parkinson\u2019s disease (PD) and essential tremor (ET).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective chart review used electronic medical records between 2012 and 2022 from a single tertiary movement disorders center to characterize DBS surgery patterns among a diverse group of movement disorders patients. Patients were diagnosed with PD, ET, or unspecified tremor aged 18 or older. Patient characteristics were summarized and compared between those who did and did not undergo DBS implantation using chi-square tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. Multivariable regression model was used to identify associations between clinical and sociodemographic covariates and DBS surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 3,286 PD\/ET patients between 2012 and 2022, 12.1% underwent DBS surgery. Those who underwent surgery were younger and had fewer medical comorbidities. Within the surgical group, there were higher proportions of Hispanic ethnicity, non-English language preference, Medicare or Medi-Cal insurance, and residence in neighborhoods with lower socioeconomic status (SES). On multivariable logistic regression analysis, MediCal insurance and low neighborhood SES were associated with higher odds of surgery. Conversely, younger age at initial visit, single marital status, and Asian race were associated with lower odds of surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Sociodemographic variables associated with higher odds of receiving DBS surgery included low SES and Medi-Cal insurance. This may reflect a referral bias suggestive of better access to our center for DBS surgery than for routine movement disorders care for those from low SES and Medi-Cal. Future studies within our center will focus on quantitative and qualitative evaluation of referral processes for the treatment of advanced movement disorders in order to better understand and improve accessibility of these therapies to all patients in our health system and nationally.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1743834","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T04:15:41Z","timestamp":1774930541000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Access to movement disorders care and advanced surgical therapies in a tertiary care center"],"prefix":"10.3389","volume":"17","author":[{"given":"Jacob A.","family":"Alderete","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of California Los Angeles","place":["Los Angeles, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashley","family":"Madera","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of California Los Angeles","place":["Los Angeles, CA, United States"]},{"name":"Department of Neurology, Barrow Neurological Institute","place":["Phoenix, AZ, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Markovic","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Health Sciences Research, University of California Los Angeles","place":["Los Angeles, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ziad","family":"Rifi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mt. Sinai Health System","place":["New York, NY, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maya","family":"Harary","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California Los Angeles","place":["Los Angeles, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine A.","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of California Los Angeles","place":["Los Angeles, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katy A.","family":"Cross","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of California Los Angeles","place":["Los Angeles, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ausaf A.","family":"Bari","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California Los Angeles","place":["Los Angeles, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adys","family":"Mendizabal","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of California Los Angeles","place":["Los Angeles, CA, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"22","DOI":"10.3389\/fneur.2011.00022","article-title":"The case for subspecialization in neurology: movement disorders","volume":"2","author":"Farbman","year":"2011","journal-title":"Front Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1269401","DOI":"10.3389\/fnhum.2023.1269401","article-title":"A systematic review of health disparities research in deep brain stimulation surgery for Parkinson's disease","volume":"17","author":"Memon","year":"2023","journal-title":"Front Hum Neurosci"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"241","DOI":"10.3171\/2023.11.JNS23882","article-title":"Disparities in the treatment of movement disorders using deep brain stimulation","volume":"141","author":"Venkatraman","year":"2024","journal-title":"J Neurosurg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1212\/WNL.0000000000000017","article-title":"Disparities in deep brain stimulation surgery among insured elders with Parkinson disease","volume":"82","author":"Willis","year":"2014","journal-title":"Neurology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1038\/s41531-022-00305-y","article-title":"Gender gap in deep brain stimulation for Parkinson's disease","volume":"8","author":"Jost","year":"2022","journal-title":"NPJ Parkinsons Dis"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1001\/jamaneurol.2013.5798","article-title":"Disparities in access to deep brain stimulation surgery for Parkinson disease: interaction between African American race and Medicaid use","volume":"71","author":"Chan","year":"2014","journal-title":"JAMA Neurol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"100599","DOI":"10.1016\/j.lana.2023.100599","article-title":"Trends and disparities in deep brain stimulation utilization in the United States: a Nationwide inpatient sample analysis from 1993 to 2017","volume":"26","author":"Sarica","year":"2023","journal-title":"Lancet Reg Health Am"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.1227\/neu.0000000000002339","article-title":"Identifying the sources of racial disparity in the treatment of Parkinson's disease with deep brain stimulation","volume":"92","author":"Skelton","year":"2023","journal-title":"Neurosurgery"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"105811","DOI":"10.1016\/j.parkreldis.2023.105811","article-title":"Black and hispanic patients with movement disorders less likely to undergo deep brain stimulation","volume":"115","author":"Dorritie","year":"2023","journal-title":"Parkinsonism Relat Disord"},{"key":"ref10","year":""},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2456","DOI":"10.1056\/NEJMp1802313","article-title":"Making Neighborhood-disadvantage metrics accessible - 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