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Addressing Health Inequalities in Access to Device-Assisted Therapies for Parkinson’s Disease in East London

Code: BC-DTP_2026_30

Title: Addressing Health Inequalities in Access to Device-Assisted Therapies for Parkinson’s Disease in East London

Primary Supervisor: Laura Smith

Email: L.J.Smith@qmul.ac.uk

Institute: Wolfson Institute of Population Health

Secondary Supervisor: Alastair Noyce

Email: A.Noyce@qmul.ac.uk

Institute: Wolfson Institute of Population Health

Lay Summary:

Parkinson’s disease is a condition that affects the brain and gradually gets worse over time. Around 166,000 people live with Parkinson’s in the UK, and this number is increasing. Although there is no cure, treatments can help manage symptoms. Parkinson’s occurs when the brain loses cells that produce dopamine, a chemical needed for movement. Medicines that boost dopamine are important, but over time they become less effective. When this happens, device-assisted therapies (DAT) including surgery, and/or infusions, and injections that provide a steady supply of dopamine, may be offered.

DAT can improve movement and quality of life, but not everyone who could benefit is able to access them. Research shows that older adults, women, people from Black communities, and people with lower incomes face more barriers. East London is an area with high diversity in ethnicity, culture, and income, and several local hospitals provide DAT. This makes it an ideal place to study why access may be unequal and how to improve it.

Our project has three parts. First, we will look at anonymous health records across East London hospitals to understand who is being referred for or starting DAT, and whether characteristics such as age, gender, or ethnicity play a role. Second, we will speak to people with Parkinson’s, family members, community organisations, and clinicians to understand their experiences, challenges, and what matters to them. Finally, we will work with the public to co-develop practical recommendations to ensure that advanced Parkinson’s treatments are offered to everyone who may benefit.

Aims and Objectives:

1.) Calculate the proportion of patients on DBS, CSI, or CLIG pathways in East London and describe them in terms of sociodemographic and clinical characteristics. Examine the contribution and intersection of sociodemographic characteristics using regression models. 

2.) Capture multi-stakeholder perceptions, decision-making processes, and barriers/ facilitators around DAT in PD. Discuss strategies to promote equitable provision, including what these could look like, how they could be implemented, mechanisms of change, and outcomes. 

3.) Use these findings to co-develop tools for healthcare professionals and people with PD to facilitate equitable access to DAT in East London.

References:

  • Ben-Joseph, A., Acharya, A., Budu, C., Simonet, C., Noyce, A., & Gallagher, D. (2021). Audit of Non-Oral (Advanced) Therapies for Treatment of  Parkinson’s disease. Unpublished Clinical Audit.
  • Bishay, A. E., Hughes, N. C., Zargari, M., Paulo, D. L., Bishay, S., Lyons, A. T., ... & Bick, S. K. (2024). Disparities in access to deep brain stimulation for Parkinson’s disease and proposed interventions: a literature review. Stereotactic and Functional Neurosurgery, 102(3), 179-194.
  • Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 77-101.
  • Cavaleri, J., Stefanescu, K., Lee, D., & Mason, X. (2025). Deep brain stimulation access in 2025: geographic, gender, racial, and socioeconomic disparities re-examined. Current Opinion in Neurology, 38(4), 330-336.
  • Jost, S. T., Strobel, L., Rizos, A., Loehrer, P. A., Ashkan, K., Evans, J., ... & EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson’s Disease Study Group. (2022). Gender gap in deep brain stimulation for Parkinson’s disease. NPJ Parkinson's disease, 8(1), 47.
  • Marsili, L., Bologna, M., Miyasaki, J. M., & Colosimo, C. (2021). Parkinson's disease advanced therapies-a systematic review: more unanswered questions than guidance. Parkinsonism & related disorders, 83, 132-139.
  • Memon, A. A., Gelman, K., Melott, J., Billings, R., Fullard, M., Catiul, C., ... & Amara, A. W. (2023). A systematic review of health disparities research in deep brain stimulation surgery for Parkinson’s disease. Frontiers in Human Neuroscience, 17, 1269401.
  • Zirra, A., Dey, K. C., Camboe, E., Waters, S., Haque, T., Huxford, B., ... & Noyce, A. J. (2025). The East London Parkinson’s disease project–a case-control study of Parkinson’s Disease in a diverse population. npj Parkinson's Disease, 11(1), 172.
  • Parkinson’s UK. (2025). Prevalence and incidence of Parkinson's in the UK dashboard. Retrieved from: https://www.parkinsons.org.uk/professionals/resources/prevalence-and-incidence-parkinsons-uk-dashboard
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