title: Socioeconomic Status May Impact Functional Outcome of Deep Brain Stimulation Surgery in Parkinson's Disease.
abstract: OBJECTIVE
  To investigate the association between socioeconomic status and deep brain stimulation (DBS) outcomes in Parkinson's disease (PD).
  
  
  METHODS
  We analyzed a cohort of PD patients who underwent DBS from 2007 to 2011, who had Clinical Global Impression Scale-Improvement subscale (CGI-I) scores at approximately one year postsurgery. We also analyzed a subgroup of patients who had pre and postoperative Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part II (functional subscale) and European Quality of Life Scale (EQ5D) scores. We performed regression analyses to determine the association between their median household income and their improvement in the MDS-UPDRS Part II, EQ-5D, and CGI-I post-DBS surgery.
  
  
  RESULTS
  We analyzed 125 PD patients with CGI-I at one year post-DBS, including a subset of 43 patients who had pre- and post-DBS MDS-UPDRS Part II and EQ5D scores at 6 and 12 months. Median income was not significantly associated with the one-year CGI-I, the six-month MDS-UPDRS II, and the six-month and one-year EQ5D score. However, after adjusting for preoperative MDS-UPDRS II score, for every $10,000 increase in household median income, there was a 2.15-point improvement on the MDS-UPDRS II score after one year (95% confidence interval = -3.63 to -0.66, p = 0.0060).
  
  
  CONCLUSIONS
  PD patients with higher household incomes had better functional improvement at one year. However, this did not necessarily translate to better quality of life or overall clinical improvement when compared with PD patients with lower household incomes. The influence of household income on DBS and other advanced therapies for PD will need further investigation.
authors.affiliation: Cleveland Clinic, Neurological Institute, Center for Neurological Restoration, Cleveland, OH, USA.|Department of Neurology, Gumussuyu Military Hospital, Istanbul, Turkey.
authors.forename: Gencer
authors.initials: G
authors.lastname: Genc
authors.affiliation: Cleveland Clinic, Neurological Institute, Center for Neurological Restoration, Cleveland, OH, USA.
authors.forename: Hesham
authors.initials: H
authors.lastname: Abboud
authors.affiliation: Cleveland Clinic, Neurological Institute, Center for Neurological Restoration, Cleveland, OH, USA.
authors.forename: Srivadee
authors.initials: S
authors.lastname: Oravivattanakul
authors.affiliation: Cleveland Clinic, Neurological Institute, Center for Neurological Restoration, Cleveland, OH, USA.
authors.forename: Faisal
authors.initials: F
authors.lastname: Alsallom
authors.affiliation: Cleveland Clinic, Neurological Institute, Center for Outcomes Research and Evaluation, Cleveland, OH, USA.
authors.forename: Nicolas R
authors.initials: NR
authors.lastname: Thompson
authors.affiliation: Cleveland Clinic, Neurological Institute, Center for Neurological Restoration, Cleveland, OH, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Cooper
authors.affiliation: Cleveland Clinic, Neurological Institute, Center for Neurological Restoration, Cleveland, OH, USA.
authors.forename: Michal
authors.initials: M
authors.lastname: Gostkowski
authors.affiliation: Cleveland Clinic, Neurological Institute, Center for Neurological Restoration, Cleveland, OH, USA.
authors.forename: Andre
authors.initials: A
authors.lastname: Machado
authors.affiliation: Cleveland Clinic, Neurological Institute, Center for Neurological Restoration, Cleveland, OH, USA.
authors.forename: Hubert H
authors.initials: HH
authors.lastname: Fernandez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000523:psychology* / Q000628:therapy*; D012720:Severity of Illness Index; D012923:Social Class; D020531:Subthalamic Nucleus / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Deep brain stimulation; Parkinson's disease; household income; socioeconomic status