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Vol. 36, No. 3, 2011
Issue release date: June 2011
Section title: Original Paper
Free Access
Neuroepidemiology 2011;36:150–154
(DOI:10.1159/000324935)

Delayed Parkinson’s Disease Diagnosis among African-Americans: The Role of Reporting of Disability

Dahodwala N.a–c · Karlawish J.b, d · Siderowf A.a–c · Duda J.E.a, c · Mandell D.S.b, e
aParkinson’s Disease Research, Education and Clinical Center, Philadelphia VA Medical Center, and bLeonard Davis Institute of Health Economics and Departments of cNeurology, dMedicine and ePsychiatry, University of Pennsylvania, Philadelphia, Pa., USA
email Corresponding Author

Abstract

Background/Aims: Racial differences in the observed prevalence of Parkinson’s disease (PD) may be due to delayed diagnosis among African-Americans. We sought to compare the stage at which African-American and white PD patients present for healthcare, and determine whether perception of disability accounts for racial differences. Methods: Using records of veterans with newly diagnosed PD at the Philadelphia Veterans Affairs Medical Center, we calculated differences in reporting of symptoms as the difference in z-scores on the Unified Parkinson Disease Rating Scale part 2 (disability) and part 3 (motor impairment). Ordinal logistic regression was used to determine predictors of stage at diagnosis. Results: African-American (n = 16) and white (n = 58) veterans with a mean age of 70.1 years were identified. African-Americans presented at a later PD stage than whites (median Hoehn + Yahr stage 2.5 vs. 2.0, p = 0.02) and were more likely to under-report disability relative to motor impairment (81 vs. 40%, p < 0.01). Multivariate analysis showed that under-reporting of disability accounted for much of the effect of race on stage of diagnosis. Conclusions: Under-reporting of disability among African-Americans may account for later stages of PD diagnosis than whites. This study begins to explain the mechanisms underlying observed racial disparities in PD.

© 2011 S. Karger AG, Basel


  

Key Words

  • African-American
  • Delay
  • Diagnosis
  • Health services
  • Parkinsonism
  • Race

References

  1. de Rijk MC, Breteler MM, Graveland GA, Ott A, Grobbee DE, van der Meché FG, Hofman A: Prevalence of Parkinson’s disease in the elderly: the Rotterdam Study. Neurology 1995;45:2143–2146.
  2. Kis B, Schrag A, Ben-Shlomo Y, Klein C, Gasperi A, Spoegler F, Schoenhuber R, Pramstaller PP: Novel three-stage ascertainment method: prevalence of PD and parkinsonism in South Tyrol, Italy. Neurology 2002;58:1820–1825.
  3. Tison F, Dartigues JF, Dubes L, Zuber M, Alperovitch A, Henry P: Prevalence of Parkinson’s disease in the elderly: a population study in Gironde, France. Acta Neurol Scand 1994;90:111–115.
  4. Melcon MO, Anderson DW, Vergara RH, Rocca WA: Prevalence of Parkinson’s disease in Junin, Buenos Aires province, Argentina. Mov Disord 1997;12:197–205.
  5. Dotchin C, Msuya O, Kissima J, Massawe J, Mhina A, Moshy A, Aris E, Jusabani A, Whiting D, Masuki G, Walker R: The prevalence of Parkinson’s disease in rural Tanzania. Mov Disord 2008;23:1567–1572.
  6. Schoenberg BS, Anderson DW, Haerer AF: Prevalence of Parkinson’s disease in the biracial population of Copiah county, Mississippi. Neurology 1985;35:841–845.
  7. Shulman LM, Pretzer-Aboff I, Anderson KE, Stevenson R, Vaughan CG, Gruber-Baldini AL, Reich SG, Weiner WJ: Subjective report versus objective measurement of activities of daily living in Parkinson’s disease. Mov Disord 2006;21:794–799.
  8. Leritz E, Loftis C, Crucian G, Friedman W, Bowers D: Self-awareness of deficits in Parkinson disease. Clin Neuropsychol 2004;18:352–361.
  9. Seltzer B, Vasterling JJ, Mathias CW, Brennan A: Clinical and neuropsychological correlates of impaired awareness of deficits in Alzheimer disease and Parkinson disease: a comparative study. Neuropsychiatry Neuropsychol Behav Neurol 2001;14:122–129.
  10. Brown RG, MacCarthy B, Jahanshahi M, Marsden CD: Accuracy of self-reported disability in patients with parkinsonism. Arch Neurol 1989;46:955–959.
  11. McInerney-Leo A, Gwinn-Hardy K, Nussbaum RL: Prevalence of Parkinson’s disease in populations of African ancestry: a review. J Nat Med Assoc 2004;96:974–979.
  12. Dahodwala N, Siderowf A, Xie M, Noll E, Stern MB, Mandell DS: Racial differences in the diagnosis of Parkinson’s disease. Mov Disord 2009;24:1200–1205.
  13. Wright Willis A, Evanoff BA, Lian M, Criswell SR, Racette BA: Geographic and ethnic variation in parkinson disease: a population-based study of US medicare beneficiaries. Neuroepidemiology 2010;34:143–151.
  14. Saha S, Freeman M, Toure J, Tippens KM, Weeks C, Ibrahim S: Racial and ethnic disparities in the VA health care system: a systematic review. J Gen Intern Med 2008;23:654–671.
  15. Gelb DJ, Oliver E, Gilman S: Diagnostic criteria for Parkinson disease. Arch Neurol 1999;56:33–39.
  16. Louis ED, Lynch T, Marder K, Fahn S: Reliability of patient completion of the historial section of the unified Parkinson’s disease rating scale. Mov Disord 1996;11:185–192.
  17. Martinez-Martin P, Benito-Leon J, Alonso F, Catalan MJ, Pondal M, Tobias A, Zamarbide I: Patients’, doctors’, and caregivers’ assessment of disability using the UPDRS-ADL section: are these ratings interchangeable? Mov Disord 2003;18:985–992.
  18. Sarkisian CA, Shunkwiler SM, Aguilar I, Moore AA: Ethnic differences in expectations for aging among older adults. J Am Geriatr Soc 2006;54:1277–1282.
  19. Sarkisian CA, Lee-Henderson MH, Mangione CM: Do depressed older adults who attribute depression to ‘old age’ believe it is important to seek care? J Gen Intern Med 2003;18:1001–1005.
  20. Dahodwala N, Xie M, Noll E, Siderowf A, Mandell DS: Treatment disparities in Parkinson’s disease. Ann Neurol 2009;66:142–145.
  21. Rybicki BA, Johnson CC, Gorell JM: Demographic differences in referral rates to neurologists of patients with suspected Parkinson’s disease: implications for case-control study design. Neuroepidemiology 1995;14:72–81.

  

Author Contacts

Nabila Dahodwala, MD, MS
Parkinson’s Disease and Movement Disorders Center
330 S. 9th St., 2nd floor
Philadelphia, PA 19107 (USA)
Tel. +1 215 829 6708, E-Mail dahodwan@mail.med.upenn.edu

  

Article Information

Received: December 13, 2010
Accepted: January 29, 2011
Published online: April 20, 2011
Number of Print Pages : 5
Number of Figures : 1, Number of Tables : 1, Number of References : 21

  

Publication Details

Neuroepidemiology

Vol. 36, No. 3, Year 2011 (Cover Date: June 2011)

Journal Editor: Feigin V.L. (Auckland)
ISSN: 0251-5350 (Print), eISSN: 1423-0208 (Online)

For additional information: http://www.karger.com/NED


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Background/Aims: Racial differences in the observed prevalence of Parkinson’s disease (PD) may be due to delayed diagnosis among African-Americans. We sought to compare the stage at which African-American and white PD patients present for healthcare, and determine whether perception of disability accounts for racial differences. Methods: Using records of veterans with newly diagnosed PD at the Philadelphia Veterans Affairs Medical Center, we calculated differences in reporting of symptoms as the difference in z-scores on the Unified Parkinson Disease Rating Scale part 2 (disability) and part 3 (motor impairment). Ordinal logistic regression was used to determine predictors of stage at diagnosis. Results: African-American (n = 16) and white (n = 58) veterans with a mean age of 70.1 years were identified. African-Americans presented at a later PD stage than whites (median Hoehn + Yahr stage 2.5 vs. 2.0, p = 0.02) and were more likely to under-report disability relative to motor impairment (81 vs. 40%, p < 0.01). Multivariate analysis showed that under-reporting of disability accounted for much of the effect of race on stage of diagnosis. Conclusions: Under-reporting of disability among African-Americans may account for later stages of PD diagnosis than whites. This study begins to explain the mechanisms underlying observed racial disparities in PD.

© 2011 S. Karger AG, Basel


  

Author Contacts

Nabila Dahodwala, MD, MS
Parkinson’s Disease and Movement Disorders Center
330 S. 9th St., 2nd floor
Philadelphia, PA 19107 (USA)
Tel. +1 215 829 6708, E-Mail dahodwan@mail.med.upenn.edu

  

Article Information

Received: December 13, 2010
Accepted: January 29, 2011
Published online: April 20, 2011
Number of Print Pages : 5
Number of Figures : 1, Number of Tables : 1, Number of References : 21

  

Publication Details

Neuroepidemiology

Vol. 36, No. 3, Year 2011 (Cover Date: June 2011)

Journal Editor: Feigin V.L. (Auckland)
ISSN: 0251-5350 (Print), eISSN: 1423-0208 (Online)

For additional information: http://www.karger.com/NED


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 12/13/2010
Accepted: 1/29/2011
Published online: 4/20/2011
Issue release date: June 2011

Number of Print Pages: 5
Number of Figures: 1
Number of Tables: 1

ISSN: 0251-5350 (Print)
eISSN: 1423-0208 (Online)

For additional information: http://www.karger.com/NED


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. de Rijk MC, Breteler MM, Graveland GA, Ott A, Grobbee DE, van der Meché FG, Hofman A: Prevalence of Parkinson’s disease in the elderly: the Rotterdam Study. Neurology 1995;45:2143–2146.
  2. Kis B, Schrag A, Ben-Shlomo Y, Klein C, Gasperi A, Spoegler F, Schoenhuber R, Pramstaller PP: Novel three-stage ascertainment method: prevalence of PD and parkinsonism in South Tyrol, Italy. Neurology 2002;58:1820–1825.
  3. Tison F, Dartigues JF, Dubes L, Zuber M, Alperovitch A, Henry P: Prevalence of Parkinson’s disease in the elderly: a population study in Gironde, France. Acta Neurol Scand 1994;90:111–115.
  4. Melcon MO, Anderson DW, Vergara RH, Rocca WA: Prevalence of Parkinson’s disease in Junin, Buenos Aires province, Argentina. Mov Disord 1997;12:197–205.
  5. Dotchin C, Msuya O, Kissima J, Massawe J, Mhina A, Moshy A, Aris E, Jusabani A, Whiting D, Masuki G, Walker R: The prevalence of Parkinson’s disease in rural Tanzania. Mov Disord 2008;23:1567–1572.
  6. Schoenberg BS, Anderson DW, Haerer AF: Prevalence of Parkinson’s disease in the biracial population of Copiah county, Mississippi. Neurology 1985;35:841–845.
  7. Shulman LM, Pretzer-Aboff I, Anderson KE, Stevenson R, Vaughan CG, Gruber-Baldini AL, Reich SG, Weiner WJ: Subjective report versus objective measurement of activities of daily living in Parkinson’s disease. Mov Disord 2006;21:794–799.
  8. Leritz E, Loftis C, Crucian G, Friedman W, Bowers D: Self-awareness of deficits in Parkinson disease. Clin Neuropsychol 2004;18:352–361.
  9. Seltzer B, Vasterling JJ, Mathias CW, Brennan A: Clinical and neuropsychological correlates of impaired awareness of deficits in Alzheimer disease and Parkinson disease: a comparative study. Neuropsychiatry Neuropsychol Behav Neurol 2001;14:122–129.
  10. Brown RG, MacCarthy B, Jahanshahi M, Marsden CD: Accuracy of self-reported disability in patients with parkinsonism. Arch Neurol 1989;46:955–959.
  11. McInerney-Leo A, Gwinn-Hardy K, Nussbaum RL: Prevalence of Parkinson’s disease in populations of African ancestry: a review. J Nat Med Assoc 2004;96:974–979.
  12. Dahodwala N, Siderowf A, Xie M, Noll E, Stern MB, Mandell DS: Racial differences in the diagnosis of Parkinson’s disease. Mov Disord 2009;24:1200–1205.
  13. Wright Willis A, Evanoff BA, Lian M, Criswell SR, Racette BA: Geographic and ethnic variation in parkinson disease: a population-based study of US medicare beneficiaries. Neuroepidemiology 2010;34:143–151.
  14. Saha S, Freeman M, Toure J, Tippens KM, Weeks C, Ibrahim S: Racial and ethnic disparities in the VA health care system: a systematic review. J Gen Intern Med 2008;23:654–671.
  15. Gelb DJ, Oliver E, Gilman S: Diagnostic criteria for Parkinson disease. Arch Neurol 1999;56:33–39.
  16. Louis ED, Lynch T, Marder K, Fahn S: Reliability of patient completion of the historial section of the unified Parkinson’s disease rating scale. Mov Disord 1996;11:185–192.
  17. Martinez-Martin P, Benito-Leon J, Alonso F, Catalan MJ, Pondal M, Tobias A, Zamarbide I: Patients’, doctors’, and caregivers’ assessment of disability using the UPDRS-ADL section: are these ratings interchangeable? Mov Disord 2003;18:985–992.
  18. Sarkisian CA, Shunkwiler SM, Aguilar I, Moore AA: Ethnic differences in expectations for aging among older adults. J Am Geriatr Soc 2006;54:1277–1282.
  19. Sarkisian CA, Lee-Henderson MH, Mangione CM: Do depressed older adults who attribute depression to ‘old age’ believe it is important to seek care? J Gen Intern Med 2003;18:1001–1005.
  20. Dahodwala N, Xie M, Noll E, Siderowf A, Mandell DS: Treatment disparities in Parkinson’s disease. Ann Neurol 2009;66:142–145.
  21. Rybicki BA, Johnson CC, Gorell JM: Demographic differences in referral rates to neurologists of patients with suspected Parkinson’s disease: implications for case-control study design. Neuroepidemiology 1995;14:72–81.