title: Racial disparities in the diagnosis and management of trigeminal neuralgia.
abstract: OBJECTIVE A number of studies have documented inequalities in care and outcomes for a variety of clinical conditions. The authors sought to identify racial and socioeconomic disparities in the diagnosis and treatment of trigeminal neuralgia (TN), as well as the potential underlying reasons for those disparities, which could serve as areas of focus for future quality improvement initiatives. METHODS The medical records of patients with an ICD-9 code of 350.1, signifying a diagnosis of TN, at the Henry Ford Medical Group (HFMG) in the period from 2006 to 2012 were searched, and clinical and socioeconomic data were retrospectively reviewed. Analyses were conducted to assess potential racial differences in subspecialty referral patterns and the specific type of treatment modality undertaken for patients with TN. RESULTS The authors identified 652 patients eligible for analysis. Compared with white patients, black patients were less likely to undergo percutaneous ablative procedures, stereotactic radiosurgery, or microvascular decompression (p < 0.001). However, there was no difference in the likelihood of blacks and whites undergoing a procedure once they had seen a neurosurgeon (67% vs 70%, respectively; p = 0.712). Blacks and whites were equally likely to be seen by a neurologist or neurosurgeon if they were initially seen in either the emergency room (38% vs 37%, p = 0.879) or internal medicine (48% vs 50%, p = 0.806). Among patients diagnosed (268 patients) after the 2008 publication of the European Federation of Neurological Societies and the American Academy of Neurology guidelines for medical therapy for TN, fewer than 50% were on medications sanctioned by the guidelines, and there were no statistically significant racial disparities between white and black patients (p = 0.060). CONCLUSIONS According to data from a large database from one of the nation's largest comprehensive health care systems, there were significant racial disparities in the likelihood of a patient undergoing a procedure for TN. This appeared to stem from outside HFMG from a difference in referral patterns to the neurologists and neurosurgeons.
authors.affiliation: Department of Neurosurgery, Henry Ford Medical Group, and.
authors.forename: Kevin
authors.initials: K
authors.lastname: Reinard
authors.affiliation: Department of Neurosurgery, Henry Ford Medical Group, and.
authors.forename: David R
authors.initials: DR
authors.lastname: Nerenz
authors.affiliation: Department of Neurosurgery, Henry Ford Medical Group, and.
authors.forename: Azam
authors.initials: A
authors.lastname: Basheer
authors.affiliation: Department of Neurosurgery, Henry Ford Medical Group, and.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Tahir
authors.affiliation: Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Timothy
authors.initials: T
authors.lastname: Jelsema
authors.affiliation: Department of Neurosurgery, Henry Ford Medical Group, and.
authors.forename: Lonni
authors.initials: L
authors.lastname: Schultz
authors.affiliation: Department of Neurosurgery, Henry Ford Medical Group, and.
authors.forename: Ghaus
authors.initials: G
authors.lastname: Malik
authors.affiliation: Department of Neurosurgery, Henry Ford Medical Group, and.
authors.forename: Ellen L
authors.initials: EL
authors.lastname: Air
authors.affiliation: Department of Neurosurgery, Henry Ford Medical Group, and.|Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Schwalb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014277:Trigeminal Neuralgia / Q000175:diagnosis* / Q000208:ethnology / Q000628:therapy*; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: AAN = American Academy of Neurology; EFNS = European Federation of Neurological Societies; ER = emergency room; HFMG = Henry Ford Medical Group; MS = multiple sclerosis; MVD = microvascular decompression; PCTR = percutaneous rhizotomy; SRS = stereotactic radiosurgery; TN = trigeminal neuralgia; chronic pain management; functional neurosurgery; pain; racial disparity; socioeconomic status; trigeminal neuralgia