Black and Hispanic patients less likely to see neurologists

Black and Hispanic patients with neurologic disorders are less likely to see brain specialists than white people with these conditions, a recent U.S. study suggests.

Researchers examined data on more than 279,000 patients, including nearly 17,000 who reported having neurological disorders, like epilepsy, Parkinson disease, multiple sclerosis or other conditions like headaches or cerebrovascular disease.

They found that black patients were 28 percent less likely to see neurologists for outpatient care than white patients. Hispanic patients were 39 percent less likely to see neurologists, the study also found.

“Previous studies have focused on specific neurologic diseases such as stroke or Parkinson’s disease,” said lead study author Dr. Altaf Saadi, a neurology chief resident at Massachusetts General Hospital in Boston.

“This is the first study to look beyond individual neurologic diseases and show racial disparities among a broad range of neurologic illnesses, regardless of insurance, socioeconomic or health status,” Saadi said by email.

“This is a much larger issue than previously documented,” she added.

Neurologic illness is common, affecting about 14 percent of American households, researchers note in the journal Neurology. Stroke, for example, is a leading cause of disability and the third most common cause of death in the U.S., and rates of other neurologic disorders like Alzheimer disease and Parkinson disease are projected to soar as the population ages.

Saadi’s team examined data collected from 2006 to 2013 from a nationally representative survey of medical expenditures.

Across the entire study population, just 6 percent reported having a neurological disorder. About 2 percent, or 5,890 patients, received a total of 13,685 outpatient neurology visits.

People who had at least one outpatient visit with a neurologist were more likely to be female, older, white, nonimmigrant, more educated and affluent and to have health benefits through Medicare or private insurance, the study found.

Patients with certain neurologic diagnoses such as multiple sclerosis, epilepsy and Parkinson disease were more likely to see specialists than people with other types of neurologic conditions, the study also found.

Among participants with known neurologic conditions, blacks were more likely to be cared for in the emergency department, to have more hospital stays, and to have higher per capita inpatient expenditures than their white counterparts.

For every 100 patients with neurological disorders, 12.55 black patients went to the emergency room for care rather than seeing a neurologist in an outpatient clinic, compared with 7.66 Hispanic patients and 7.70 white patients.

Geography may explain some of these disparities, because outpatient neurological services are more widely available in regions like the Northeast, while there are fewer specialists in parts of the Southeastern U.S. where far more people have neurologic disorders requiring specialty care, the authors note.

One limitation of the study is that excludes people living in nursing homes and other institutional settings where many patients with seizures and dementia may reside, the authors point out. Researchers also lacked data on individual patient or physician choices or preferences about care, which might have influenced whether some people received outpatient neurology services.

Even so, the findings suggest that insufficient outpatient care may be disproportionately driving certain racial groups to the emergency room, said Dr. Jorge Burneo, a neurology researcher at Western University in London, Ontario, who wasn’t involved in the study.

These emergency department visits may also become more costly for people who didn’t get outpatient care or waited until symptoms got severe to seek help, Burneo said by email.

“If a patient visited his or her neurologist on a regular basis, there would be better control of the neurological problem, which would avoid an emergency room visit and admission to a hospital,” Burneo added.