Mortality of People with Parkinson's Disease in a Large UK-Based Cohort Study: Time Trends and Relationship to Disease Duration

Update: Protective and risk factors for Parkinson disease

We review the epidemiologic literature on potential protective and risk factors in Parkinson's Disease (PD). Prior research identified numerous possible protective and risk factors. Potential protective factors include tobacco abuse, physical activity, urate levels, NSAID use, calcium channel blocker use, statin use, and use of some α1-adrenergic antagonists. Some potential protective factors could be products of reverse causation, including increased serum urate, tobacco abuse, and coffee-tea-caffeine consumption. Potential risk factors include traumatic brain injury, pesticide exposure, organic solvent exposure, lead exposure, air pollution, Type 2 Diabetes, some dairy products, cardiovascular disease, and some infections including Hepatitis C, H. pylori, and COVID-19. Potential non-environmental risk factors include bipolar disorder, essential tremor, bullous pemphigoid, and inflammatory bowel disease. There is an inverse relationship with PD and risk of most cancers. Though many potential protective and risk factors for PD were identified, research has not yet led to unique, rigorous prevention trials or successful disease-modifying interventions. While efforts to reduce exposure to some industrial toxicants are well justified, PD incidence might be most effectively reduced by mitigation of risks, such as Type 2 Diabetes, air pollution, traumatic brain injury, or physical inactivity, that are general public health intervention targets.

Trends in parkinson's disease mortality in China from 2004 to 2021: a joinpoint analysis

BACKGROUND

This study aimed to analyze the trends of Parkinson's disease (PD) mortality rates among Chinese residents from 2004 to 2021, provide evidence for the formulation of PD prevention and control strategies to improve the quality of life among PD residents.

METHODS

Demographic and sociological data such as gender, urban or rural residency and age were obtained from the National Cause of Death Surveillance Dataset from 2004 to 2021. We then analyzed the trends of PD mortality rates by Joinpoint regression.

RESULTS

The PD mortality and standardized mortality rates in China showed an overall increasing trend during 2004-2021 (average annual percentage change [AAPC] = 7.14%, AAPCASMR=3.21%, P < 0.001). The mortality and standardized mortality rate in male (AAPC = 7.65%, AAPCASMR=3.18%, P < 0.001) were higher than that of female (AAPC = 7.03%, AAPCASMR=3.09%, P < 0.001). The PD standardized mortality rates of urban (AAPC = 5.13%, AAPCASMR=1.76%, P < 0.001) and rural (AAPC = 8.40%, AAPCASMR=4.29%, P < 0.001) residents both increased gradually. In the age analysis, the mortality rate increased with age. And the mortality rates of those aged > 85 years was the highest. Considering gender, female aged > 85 years had the fastest mortality trend (annual percentage change [APC] = 5.69%, P < 0.001). Considering urban/rural, rural aged 80-84 years had the fastest mortality trend (APC = 6.68%, P < 0.001).

CONCLUSIONS

The mortality rate of PD among Chinese residents increased from 2004 to 2021. Male sex, urban residence and age > 85 years were risk factors for PD-related death and should be the primary focus for PD prevention.

Update: Descriptive epidemiology of Parkinson disease

We review the descriptive epidemiology of Parkinson disease (PD). PD is a prevalent neurologic disorder in high Socio-Demographic Index (SDI) nations with rising prevalence in low and middle SDI nations. PD became a prevalent disorder in high SDI nations during the 20th century. Population growth, population aging, and increased disease duration are major drivers of rising PD prevalence. Exposure to industrial toxicants may also be a contributor to rising PD prevalence. PD is an age-related disorder with incidence likely peaking in the 8th decade of life and prevalence in the 9th decade of life. PD is notable for significant sex difference in PD risk with greater risk in men. There may be ancestral differences in PD prevalence and risk. PD is associated with moderately increased mortality though this may be underestimated. Despite significant research, there is considerable uncertainty about basic features of PD epidemiology.

Case-Fatality Rate in Parkinson's Disease: A Nationwide Registry Study

BACKGROUND

Patients with Parkinson's disease (PD) may have an increased risk of mortality, but robust estimates are lacking.

OBJECTIVE

To compare mortality rates nationally between patients with PD and controls.

METHODS

The case-fatality rates of Finnish PD patients diagnosed in 2004-2018 (n = 23,688; 57% male, mean age at diagnosis = 71 years) and randomly selected sex- and age-matched control subjects (n = 94,752) were compared using data from national registries. The median follow-up duration was 5.8 years (max 17 years).

RESULTS

The case-fatality rate in patients with PD was higher than that in matched controls (HR 2.29; 95% CI 2.24-2.33; P < 0.0001). Excess fatality among PD patients was already present at 1 year from diagnosis and then plateaued at 29% at 12 years after diagnosis. The long-term relative hazard of death in PD patients vs. matched controls did not differ based on sex. Patients with early-onset PD (age at diagnosis <50 years old) had the highest relative hazard of death (HR 3.36) compared to matched control subjects, and the relative hazard decreased with higher age at diagnosis. The seven-year excess risk of death decreased during the study period, especially in men. In patients with PD, male sex, increasing age, and increasing comorbidity burden were associated with an increased risk of death.

CONCLUSIONS

An increased risk of death among PD patients was evident from early on. The increase in risk was greatest among young-onset patients. The excess risk in early PD declined during the study period, particularly in men. The reasons for this are unknown.

Mortality rates for Parkinson's disease are increasing in Spain. An Age-Period-Cohort and Joinpoint Analysis in Mortality Rates from 1981 to 2020

BACKGROUND

Mortality in Parkinson's disease is increasing worldwide, but Spanish data need further study.

OBJECTIVE

To analyse the mortality trends of Parkinson's disease in Spain between 1981 and 2020.

METHODS

This observational retrospective study assessed the Parkinson's disease mortality data from 1981 to 2020 were collected from the National Statistics Institute of Spain. Age-standardized mortality rates were analysed by age and sex groups, detecting significant mortality trends through a joinpoint analysis. Age-period-cohort effect and potential years of life lost analyses were conducted. The European standard population of 2013 was considered for the analyses.

RESULTS

A total of 88,034 deaths were assessed. The overall age-standardized mortality rate rose throughout the period from 3.67 to 8.57 per 100,000 inhabitants. Mortality rates in men were higher than in women, 11.63 versus 6.57 deaths per 100,000 inhabitants. The sex ratio showed an increase in premature mortality in men during 2020. The overall joinpoint analysis recorded a rise in mortality, primarily since the twentieth century, mainly in male and older groups, that matched with a period effect. The age effect was detected, confirming higher mortality at an older age. The analysis of potential years of life lost detected a growth in this rate, changing from 0.66 in 1981 to 1.06 in 2020.

CONCLUSIONS

Mortality data for Parkinson's disease in Spain rose significantly in forty years. Mortality rate was higher in the male and age group above 75 years of age. The sex ratio showed premature mortality in men in 2020, which will need further study.

[Trends in Prevalence of Parkinson's Disease in German General and Neurological Practices from 2010 to 2019]

Hintergrund Bis 2040 wird mit einer erheblichen Prävalenzzunahme der Parkinson-Erkrankung und damit einhergehend mit einer erheblichen Belastung der Versorgungssysteme gerechnet. Ziel der Studie war es deshalb, eine Veränderung der Anzahl an Parkinson-Patienten bereits im Zeitraum 2010 bis 2019 in deutschen Haus- und neurologischen Facharztpraxen zu untersuchen.

Methode Die vorliegende Querschnittstudie basiert auf den Daten von 411 Hausarzt- (HA) und 56 neurologischen Facharzt-Praxen (FA) aus der IQVIA Disease Analyzer Datenbank. Die Anzahl der etablierten und neu diagnostizierten Patienten mit Parkinson-Erkrankung wurde in den Jahren 2010 und 2019 mit Alters- und Geschlechtsstruktur und der Anteil therapierten Patienten untersucht.Ergebnisse Die Zahl der Parkinson-Patienten veränderte sich geringfügig zwischen 2010 bis 2019 von 3352 (0,36% aller Patienten) auf 3541 (0,33%) in den HA-Praxen und von 4976 (3,48%) auf 4826 (3,34%) in den FA-Praxen. Die Anzahl der neu diagnostizierten Fälle fiel bei den HA-Praxen leicht von 862 (0,09% aller Patienten) auf 836 (0,08%) und bei den FA-Praxen von 1818 (1,27%) auf 1372 (0,95% aller Patienten). Der Anteil an Frauen unter allen Parkinson-Erkrankten sank sowohl in HA- und FA- Praxen von 52,0% bzw. 50,2% auf 47,3% bzw. 46,0%. Das Durchschnittsalter stieg bei den HA-Praxen von 77,1 (SD 10,4) im Jahr 2010 auf 77,7 (SD 9,3) Jahre im Jahr 2019 und in FA-Praxen von 74,6 (SD 9,9) auf 75,8 (SD 9,9) Jahre.

Diskussion Die prognostizierte Zunahme von Parkinson-Patienten in der ambulanten Versorgung lässt sich für den Zeitraum 2010 bis 2019 nicht bestätigen. Es gab jedoch eine Verschiebung der Altersstruktur zu höheren Altersgruppen und eine Verringerung des Anteils an Frauen mit einer Parkinson-Erkrankung. Neben ätiologischen Erklärungen sollten Besonderheiten des Versorgungssystems und methodische Limitationen berücksichtigt werden.

Parkinson's disease clinical milestones and mortality

Identification of factors predicting and driving mortality in PD is important for patient information, disease management, and design of future clinical trials. This study included newly diagnosed PD patients and normal controls (NC) from a population-based study with repeated assessments over a 10-year period. We used the Kaplan–Meier method to estimate survival, Cox proportional hazards regression models to identify baseline risk factors of mortality, and Cox regression models with time-dependent covariates to evaluate the impact of four clinical milestones of advanced PD (visual hallucinations, recurrent falls, dementia, and nursing home placement) on mortality risk. During the 10-year study, 65 (34.2%) of 190 patients and 25 (12.3%) of 203 NC died, with an unadjusted hazard ratio (HR) of 2.85 (95% CI 1.80–4.52) and a HR of 2.48 (95% CI 1.55–3.95) when adjusted for confounders, including comorbidities. Higher age, more severe motor impairment, and postural instability-gait difficulty (PIGD) phenotype were independent baseline predictors of mortality. Each clinical milestone alone more than doubled the risk of death and had a cumulative effect on mortality, with a HR of 10.83 (95% CI 4.39–26.73) in those experiencing all four milestones. PD patients have an increased mortality risk that is disease-related and becomes evident early during the course of the disease. While motor severity and PIGD phenotype were early risk factors of mortality, clinical milestones signaled a substantially increased risk of death later during the disease course, highlighting their potential significance in clinical disease staging and prognosis.

Associations of Young Adult Intelligence, Education, Height, and Body Mass Index with Subsequent Risk of Parkinson's Disease and Survival: A Danish Cohort Study

BACKGROUND

The underlying disease mechanisms of Parkinson's disease (PD) are still unknown and knowledge about risk and prognostic factors is sparse.

OBJECTIVE

To examine the association between intelligence, education, body height, and body mass index (BMI) in young adulthood and risk of PD and subsequent survival.

METHODS

In total, 656,751 men born 1939-1959 with information from conscription examinations around age 19 years were followed for PD and mortality from 1977-2018 in Danish registries. Cox proportional hazard regression was used to conduct the analyses.

RESULTS

During follow-up, 5,264 (0.8%) men were diagnosed with PD. Higher intelligence, education, and body height conferred a higher hazard of PD, independent of age at disease onset. BMI above compared to below the mean (22.8 kg/m2) was associated with slightly higher hazard of late-onset PD (>60 years). During follow-up, 2,125 (40.5%) men with PD died, corresponding to a 2.55 (95% confidence interval:2.44-2.66) times higher mortality compared to men without PD. Intelligence was inversely associated with mortality in men with and without PD. Higher education and body height were also inversely associated with mortality in men without PD, whereas the estimates were less pronounced and imprecisely estimated for men with PD. Having an obese BMI was associated with higher mortality in men with PD.

CONCLUSION

Intelligence, education, and body height in young adulthood are positively associated with risk of PD later in life among men. BMI above the mean only confer a higher risk for late-onset PD. For men diagnosed with PD, high intelligence is the only early life indicator associated with better survival, whereas obese BMI predicts poorer survival.