Utilization, surgical populations, centers, coverages, regional balance, and their influential factors of deep brain stimulation for Parkinson’s disease: A large-scale multicenter cross-sectional study from 1997-2021

Abstract

Background: Deep brain stimulation (DBS) is an emerging effective therapy for Parkinson’s disease (PD). However, little is known about its utilization, surgical populations, centers, coverages, regional balance, and their influential factors. Materials and methods: This large-scale multicenter cross-sectional study was conducted using a national census involving 74 Chinese centers. National DBS populations and centers for PD were investigated in 1997-2021, and regional sociodemographic features, surgical populations, related resources, and insurance policies in 2020 were explored. Results: From the first DBS surgery in 1997, a total of 38,122 PD patients from 349 centers underwent DBS by 2021, which covered 1.118% (1.108-1.129) of patients and 0.954% (0.933-0.976) of centers. Significant upward trends in the annual surgical population and coverages were observed with rapid climbing rates, while the annual surgical center and their coverage showed two growth peaks in 2002-2006 and 2010-2018, correlating with clinical approvals and new technologies. A total of 103,070 (51,165-154,975) PD patients [2.088% (1.351-2.825) coverage] and 603 (72-1,134) centers [1.356% (1.126-1.586) coverage] are predicted to conduct DBS by 2030. The new remotely programmed DBS technology was recoded as the first application in 2015 and rapidly increased to 2,771 (47.39%, 46.11-48.67) patients with 10,507 remote programming sessions annually in 2021. Provinces in the eastern and central regions had better economic status, more surgical patients, higher insurance affordability, and more related resources than those in the western and northeastern regions. Higher gross domestic product per capita (β=5.041, 3.324-6.758 and β=0.008, 0.004-0.012; all P<0.001) and more functional neurosurgery doctors (β=3.596, 0.353-6.839; P=0.031 and β=0.010, 0.002-0.017; P=0.013) positively influenced surgical populations and coverages, while higher insurance levels (β=128.888, 64.702-193.075; P<0.001) positively influenced surgical coverages. Conclusions: Although surgical populations, centers, and coverages of DBS for PD have rapidly improved and are predicted to show future increases, this is still insufficient to cover potential eligible patients. Regionally imbalanced health coverage should be given attention to promote coordinated development.