title: Delayed Parkinson's disease diagnosis among African-Americans: the role of reporting of disability.
abstract: OBJECTIVE
  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.
authors.affiliation: Parkinson's Disease Research, Education and Clinical Center, Philadelphia VA Medical Center, Philadelphia, PA, USA. dahodwan@mail.med.upenn.edu
authors.forename: Nabila
authors.initials: N
authors.lastname: Dahodwala
authors.forename: Jason
authors.initials: J
authors.lastname: Karlawish
authors.forename: Andrew
authors.initials: A
authors.lastname: Siderowf
authors.forename: John E
authors.initials: JE
authors.lastname: Duda
authors.forename: David S
authors.initials: DS
authors.lastname: Mandell
mesh_terms: D001741:Black or African American / Q000208:ethnology*; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis* / Q000208:ethnology*; D014481:United States / Q000208:ethnology; D044465:White People / Q000208:ethnology*