Authored by: Surabhi Shastry
Parkinson’s disease (PD), a rapidly growing neurodegenerative disorder, affects over 10 million people worldwide [1]. However, significant racial and ethnic disparities persist in PD diagnosis, treatment, and clinical research representation. These disparities impact disease manifestation, progression, and patient outcomes across racial groups, primarily due to the healthcare system’s focus on predominantly White populations. This systemic gap affects diagnostic accuracy and treatment accessibility for minorities, worsening health inequities.
A major concern in PD is the delayed or missed diagnoses in minority populations. Black, Asian, and Latino patients are often underdiagnosed or misdiagnosed compared to White counterparts. For example, Aamodt et al. (2023) report that Black patients are diagnosed with PD less frequently, even with hallmark symptoms like tremors and bradykinesia [2]. Factors contributing to this underdiagnosis include limited provider awareness about PD’s varied manifestations across racial groups. For instance, Black patients more often experience non-motor symptoms, such as cognitive decline and depression, which may delay diagnosis and limit the effectiveness of early intervention.
Racial and ethnic disparities also appear in PD treatment access. Minority populations receive less access to advanced PD therapies, such as deep brain stimulation (DBS) and levodopa, standard PD medications. According to Ben-Joseph et al. (2020), Black and Latino patients are significantly less likely to receive DBS compared to White patients, partly due to socioeconomic barriers, limited healthcare access, and potential provider biases [3].
To address these issues, interventions targeting diagnosis, treatment, and research participation are crucial. First, healthcare systems should prioritize recruiting more diverse participants for PD research. Studies with equitable representation help ensure that treatments are effective across populations. For example, organizations like the Michael J. Fox Foundation have begun launching diversity initiatives to increase minority participation in PD research, with positive early outcomes in participant trust and engagement. Governments and health organizations in countries like the U.S. have similarly provided grant incentives to diversify clinical trial recruitment, which has increased minority representation in some disease studies by over 20%.
Additionally, healthcare providers need targeted training to enhance cultural competency and recognize PD symptoms across diverse populations [4]. Hospitals such as the Mayo Clinic and Mount Sinai have implemented cultural competency training, leading to improved patient satisfaction and diagnostic accuracy in minority groups. Adopting similar practices across other medical centers can address implicit bias and equip providers to recommend advanced therapies, regardless of patients’ racial or ethnic backgrounds.
Underrepresentation of minority populations in PD research further limits the effectiveness of treatment guidelines. For example, the pharmacokinetics of levodopa, a primary PD drug, may differ due to genetic factors, yet most efficacy studies have focused on White patients. Increasing minority participation in PD trials will allow researchers to determine if drug efficacy varies across populations, ultimately leading to more inclusive and effective treatment options.
Finally, public health initiatives should emphasize PD awareness in minority communities. The New York City Department of Health and Mental Hygiene, for instance, has successfully increased awareness of diabetes and hypertension in Black and Latino populations through community outreach, using multilingual resources and collaborating with local leaders [5]. A similar model could work for PD, improving early diagnosis rates in these communities.
These interventions underscore the need for systemic change to ensure equitable PD care. Building trust through culturally sensitive research practices, enhancing provider training, and increasing minority community awareness are all essential to bridging PD disparities. Addressing these issues will not only improve patient outcomes but also contribute to a healthcare system that provides high-quality, inclusive care for all.
References
Subramaniam S.R., Chesselet M.F. Mitochondrial dysfunction and oxidative stress in Parkinson’s disease. Prog. Neurobiol. 2013;106–107:17–32. doi: 10.1016/j.pneurobio.2013.04.004.
Aamodt, W. W., Willis, A. W., & Dahodwala, N. (2023). Racial and Ethnic Disparities in Parkinson Disease: A Call to Action. Neurology. Clinical Practice, 13(2), e200138. https://doi.org/10.1212/CPJ.0000000000200138
Ben-Joseph, A., Marshall, C. R., Lees, A. J., & Noyce, A. J. (2020). Ethnic Variation in the Manifestation of Parkinson's Disease: A Narrative Review. Journal of Parkinson's Disease, 10(1), 31–45. https://doi.org/10.3233/JPD-191763
Brach, C., & Fraser, I. (2000). Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model. Medical care research and review : MCRR, 57 Suppl 1(Suppl 1), 181–217. https://doi.org/10.1177/1077558700057001S09
Joo, J. Y., & Liu, M. F. (2021). Culturally tailored interventions for ethnic minorities: A scoping review. Nursing open, 8(5), 2078–2090. https://doi.org/10.1002/nop2.733
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