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Grotewold N, Albin RL. Update: Descriptive epidemiology of Parkinson disease. Parkinsonism Relat Disord 2024; 120:106000. [PMID: 38233324 PMCID: PMC10922566 DOI: 10.1016/j.parkreldis.2024.106000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/19/2024]
Abstract
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.
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Affiliation(s)
- Nikolas Grotewold
- Dept. of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Roger L Albin
- Dept. of Neurology, University of Michigan, Ann Arbor, MI, 48109, USA; GRECC, VAAAHS, Ann Arbor, MI, 48105, USA; University of Michigan Morris K. Udall Center of Excellence for Parkinson's Disease Research, Ann Arbor, MI, 48109, USA; University of Michigan Parkinson's Foundation Research Center of Excellence, USA.
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Barde F, Ascione S, Pacoureau L, Macdonald C, Salliot C, Boutron-Ruault MC, Seror R, Nguyen Y. Accuracy of self-reported diagnoses of polymyalgia rheumatica and giant cell arteritis in the French prospective E3N- EPIC cohort: A validation study. Semin Arthritis Rheum 2024; 64:152298. [PMID: 38000317 DOI: 10.1016/j.semarthrit.2023.152298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/26/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVES To assess the accuracy of self-reported giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) diagnoses in a large French population-based prospective cohort, and to devise algorithms to improve their accuracy. METHODS The E3N-EPIC cohort study (Etude Epidémiologique auprès des femmes de la Mutuelle Générale de l'Education Nationale) includes 98,995 French women born between 1925 and 1950, recruited in 1990 to study risk factors of cancer and chronic diseases. They completed biennially mailed questionnaires to update their health-related information and lifestyle characteristics. In three questionnaires, women could self-report a diagnosis of GCA/PMR. Those women were additionally sent a specific questionnaire, designed to ascertain self-reported diagnoses of GCA/PMR. Four algorithms were then devised to improve their identification. Accuracies of self-reported diagnoses and of each algorithm were calculated by comparing the diagnoses with a blinded medical chart review. RESULTS Among 98,995 participants, 1,392 women self-reported GCA/PMR. 830 women sent back the specific questionnaire, and 202 women provided medical charts. After independent review of the 202 medical charts, 87.6 % of the self-reported diagnoses of GCA/PMR were accurate. Using additional data from a specific questionnaire (diagnosis confirmation by a physician, and self-report of >3-month of glucocorticoids), and from a reimbursement database (at least two deliveries of glucocorticoids in less than 3 consecutive months) improved their accuracy (91.8 % to 92.8 %). CONCLUSION The accuracy of self-reported diagnosis of GCA/PMR was high in the E3N-cohort but using additional data as a specific GCA/PMR questionnaire and/or corticosteroid reimbursement database further improved this accuracy. With nearly 600 detected cases of GCA/PMR, we will be able to investigate risk factors for GCA/PMR in women.
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Affiliation(s)
- François Barde
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Sophia Ascione
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Lucas Pacoureau
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Conor Macdonald
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Carine Salliot
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France; Department of Rheumatology, Centre Hospitalier Régional d'Orléans, Orléans, France
| | | | - Raphaèle Seror
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France; Department of Rheumatology and National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, Hôpital Bicêtre, Université Paris-Saclay, INSERM UMR1184, Le Kremlin Bicêtre, France.
| | - Yann Nguyen
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France; Department of Rheumatology and National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, Hôpital Bicêtre, Université Paris-Saclay, INSERM UMR1184, Le Kremlin Bicêtre, France; Department of Internal Medicine, AP-HP. Nord, Hôpital Beaujon, Université de Paris, Clichy, France
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Ben-Shlomo Y, Darweesh S, Llibre-Guerra J, Marras C, San Luciano M, Tanner C. The epidemiology of Parkinson's disease. Lancet 2024; 403:283-292. [PMID: 38245248 PMCID: PMC11123577 DOI: 10.1016/s0140-6736(23)01419-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 04/26/2023] [Accepted: 07/05/2023] [Indexed: 01/22/2024]
Abstract
The epidemiology of Parkinson's disease shows marked variations in time, geography, ethnicity, age, and sex. Internationally, prevalence has increased over and above demographic changes. There are several potential reasons for this increase, including the decline in other competing causes of death. Whether incidence is increasing, especially in women or in many low-income and middle-income countries where there is a shortage of high-quality data, is less certain. Parkinson's disease is more common in older people and men, and a variety of environmental factors have been suggested to explain why, including exposure to neurotoxic agents. Within countries, there appear to be ethnic differences in disease risk, although these differences might reflect differential access to health care. The cause of Parkinson's disease is multifactorial, and involves genetic and environmental factors. Both risk factors (eg, pesticides) and protective factors (eg, physical activity and tendency to smoke) have been postulated to have a role in Parkinson's disease, although elucidating causality is complicated by the long prodromal period. Following the establishment of public health strategies to prevent cardiovascular diseases and some cancers, chronic neurodegenerative diseases such as Parkinson's disease and dementia are gaining a deserved higher priority. Multipronged prevention strategies are required that tackle population-based primary prevention, high-risk targeted secondary prevention, and Parkinson's disease-modifying therapies for tertiary prevention. Future international collaborations will be required to triangulate evidence from basic, applied, and epidemiological research, thereby enhancing the understanding and prevention of Parkinson's disease at a global level.
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Affiliation(s)
- Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Sirwan Darweesh
- Centre of Expertise for Parkinson and Movement Disorders, Department of Neurology, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, Netherlands
| | | | - Connie Marras
- The Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Marta San Luciano
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Caroline Tanner
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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Albin RL, Grotewold N. What is the Parkinson Pandemic? Mov Disord 2023; 38:2141-2144. [PMID: 37859586 PMCID: PMC10843050 DOI: 10.1002/mds.29637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/25/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Affiliation(s)
- Roger L. Albin
- Dept. of Neurology, University of Michigan, Ann Arbor, MI, USA
- Neurology Service & GRECC, VAAAHS, Ann Arbor, MI, USA
- University of Michigan Morris K. Udall Center of Excellence for Parkinson;s Disease Reseach
- Parkinson’s Foundation Research Center of Excellence
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Dammertz L, Schrag A, Bohlken J, Heuer J, Kohring C, Schorlemmer J, Akmatov MK, Bätzing J, Holstiege J. Falling incidence of Parkinson's disease in Germany. Eur J Neurol 2023; 30:3124-3131. [PMID: 37498553 DOI: 10.1111/ene.16000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/22/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND AND PURPOSE Idiopathic Parkinson's disease (IPD) is a progressive neurodegenerative disorder that is strongly associated with age. The aim of the present study was to describe current sex- and age-specific trends and regional differences in the incidence of IPD diagnosed in older people in Germany. METHODS This study was based on nationwide outpatient claims and drug prescription data from the German Statutory Health Insurance, covering approximately 87% of the general population. We conducted a cohort study in patients aged 50 years or older with observation time of at least 4 years. To assess the robustness of nationwide annual IPD incidence trends from 2013 to 2019, three case definitions with varying levels of stringency regarding coded outpatient diagnoses and drug prescriptions were applied. RESULTS In 2019, the population at risk comprised 30,575,726 persons. Using the primary and most specific case definition, annual age- and sex-standardized cumulative IPD incidence decreased stepwise from 137 (2013) to 106 (2019) new cases per 100,000 persons. The decline in incidence was seen in both sexes, in all age groups and in the majority of German regions. The relative decrease (2013-2019) in the annual age- and sex-standardized IPD incidence varied from 23% to 28% among case definitions. CONCLUSION Our findings indicate a nationwide decline in the age- and sex-standardized incidence of IPD from 2013 to 2019 in Germany. This trend was consistent using different case definitions. Further research is needed to elucidate the factors underlying this trend.
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Affiliation(s)
- Lotte Dammertz
- Department of Epidemiology and Healthcare Atlas, Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Jens Bohlken
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP) der Medizinischen Fakultät der Universität Leipzig, Leipzig, Germany
| | - Joachim Heuer
- Department of Epidemiology and Healthcare Atlas, Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Claudia Kohring
- Department of Epidemiology and Healthcare Atlas, Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | | | - Manas K Akmatov
- Department of Epidemiology and Healthcare Atlas, Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Jörg Bätzing
- Department of Epidemiology and Healthcare Atlas, Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Jakob Holstiege
- Department of Epidemiology and Healthcare Atlas, Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
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Portugal B, Artaud F, Degaey I, Roze E, Fournier A, Severi G, Canonico M, Proust-Lima C, Elbaz A. Association of Physical Activity and Parkinson Disease in Women: Long-term Follow-up of the E3N Cohort Study. Neurology 2023; 101:e386-e398. [PMID: 37197993 PMCID: PMC10435054 DOI: 10.1212/wnl.0000000000207424] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 04/03/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Previous cohort studies reported that a single measure of physical activity (PA) assessed at baseline was associated with lower Parkinson disease (PD) incidence, but a meta-analysis suggested that this association was restricted to men. Because of the long prodromal phase of the disease, reverse causation could not be excluded as a potential explanation. Our objective was to study the association between time-varying PA and PD in women using lagged analyses to address the potential for reverse causation and to compare PA trajectories in patients before diagnosis and matched controls. METHODS We used data from the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale (1990-2018), a cohort study of women affiliated with a national health insurance plan for persons working in education. PA was self-reported in 6 questionnaires over the follow-up. As questions changed across questionnaires, we created a time-varying latent PA (LPA) variable using latent process mixed models. PD was ascertained using a multistep validation process based on medical records or a validated algorithm based on drug claims. We set up a nested case-control study to examine differences in LPA trajectories using multivariable linear mixed models with a retrospective timescale. Cox proportional hazards models with age as the timescale and adjusted for confounders were used to estimate the association between time-varying LPA and PD incidence. Our main analysis used a 10-year lag to account for reverse causation; sensitivity analyses used 5-, 15-, and 20-year lags. RESULTS Analyses of trajectories (1,196 cases and 23,879 controls) showed that LPA was significantly lower in cases than in controls throughout the follow-up, including 29 years before diagnosis; the difference between cases and controls started to increase ∼10 years before diagnosis (p interaction = 0.003). In our main survival analysis, of 95,354 women free of PD in 2000, 1,074 women developed PD over a mean follow-up of 17.2 years. PD incidence decreased with increasing LPA (p trend = 0.001), with 25% lower incidence in those in the highest quartile compared with the lowest (adjusted hazard ratio 0.75, 95% CI 0.63-0.89). Using longer lags yielded similar conclusions. DISCUSSION Higher PA level is associated with lower PD incidence in women, not explained by reverse causation. These results are important for planning interventions for PD prevention.
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Affiliation(s)
- Berta Portugal
- From the Université Paris-Saclay (B.P., F.A., I.D., A.F., G.S., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, U1018, Team "Exposome, Heredity, Cancer, and Health," CESP, Villejuif; Neurology Department (E.R.), Hôpital Pitié-Salpêtrière, AP-HP; Sorbonne Université (E.R.); INSERM U1127 (E.R.), CNRS 7225, Brain Institute, Paris, France; Department of Statistics (G.S.), Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy; and Université Bordeaux (C.P.-L.), Inserm, Bordeaux Population Health Research Center, UMR1219, France
| | - Fanny Artaud
- From the Université Paris-Saclay (B.P., F.A., I.D., A.F., G.S., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, U1018, Team "Exposome, Heredity, Cancer, and Health," CESP, Villejuif; Neurology Department (E.R.), Hôpital Pitié-Salpêtrière, AP-HP; Sorbonne Université (E.R.); INSERM U1127 (E.R.), CNRS 7225, Brain Institute, Paris, France; Department of Statistics (G.S.), Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy; and Université Bordeaux (C.P.-L.), Inserm, Bordeaux Population Health Research Center, UMR1219, France
| | - Isabelle Degaey
- From the Université Paris-Saclay (B.P., F.A., I.D., A.F., G.S., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, U1018, Team "Exposome, Heredity, Cancer, and Health," CESP, Villejuif; Neurology Department (E.R.), Hôpital Pitié-Salpêtrière, AP-HP; Sorbonne Université (E.R.); INSERM U1127 (E.R.), CNRS 7225, Brain Institute, Paris, France; Department of Statistics (G.S.), Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy; and Université Bordeaux (C.P.-L.), Inserm, Bordeaux Population Health Research Center, UMR1219, France
| | - Emmanuel Roze
- From the Université Paris-Saclay (B.P., F.A., I.D., A.F., G.S., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, U1018, Team "Exposome, Heredity, Cancer, and Health," CESP, Villejuif; Neurology Department (E.R.), Hôpital Pitié-Salpêtrière, AP-HP; Sorbonne Université (E.R.); INSERM U1127 (E.R.), CNRS 7225, Brain Institute, Paris, France; Department of Statistics (G.S.), Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy; and Université Bordeaux (C.P.-L.), Inserm, Bordeaux Population Health Research Center, UMR1219, France
| | - Agnès Fournier
- From the Université Paris-Saclay (B.P., F.A., I.D., A.F., G.S., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, U1018, Team "Exposome, Heredity, Cancer, and Health," CESP, Villejuif; Neurology Department (E.R.), Hôpital Pitié-Salpêtrière, AP-HP; Sorbonne Université (E.R.); INSERM U1127 (E.R.), CNRS 7225, Brain Institute, Paris, France; Department of Statistics (G.S.), Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy; and Université Bordeaux (C.P.-L.), Inserm, Bordeaux Population Health Research Center, UMR1219, France
| | - Gianluca Severi
- From the Université Paris-Saclay (B.P., F.A., I.D., A.F., G.S., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, U1018, Team "Exposome, Heredity, Cancer, and Health," CESP, Villejuif; Neurology Department (E.R.), Hôpital Pitié-Salpêtrière, AP-HP; Sorbonne Université (E.R.); INSERM U1127 (E.R.), CNRS 7225, Brain Institute, Paris, France; Department of Statistics (G.S.), Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy; and Université Bordeaux (C.P.-L.), Inserm, Bordeaux Population Health Research Center, UMR1219, France
| | - Marianne Canonico
- From the Université Paris-Saclay (B.P., F.A., I.D., A.F., G.S., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, U1018, Team "Exposome, Heredity, Cancer, and Health," CESP, Villejuif; Neurology Department (E.R.), Hôpital Pitié-Salpêtrière, AP-HP; Sorbonne Université (E.R.); INSERM U1127 (E.R.), CNRS 7225, Brain Institute, Paris, France; Department of Statistics (G.S.), Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy; and Université Bordeaux (C.P.-L.), Inserm, Bordeaux Population Health Research Center, UMR1219, France
| | - Cécile Proust-Lima
- From the Université Paris-Saclay (B.P., F.A., I.D., A.F., G.S., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, U1018, Team "Exposome, Heredity, Cancer, and Health," CESP, Villejuif; Neurology Department (E.R.), Hôpital Pitié-Salpêtrière, AP-HP; Sorbonne Université (E.R.); INSERM U1127 (E.R.), CNRS 7225, Brain Institute, Paris, France; Department of Statistics (G.S.), Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy; and Université Bordeaux (C.P.-L.), Inserm, Bordeaux Population Health Research Center, UMR1219, France
| | - Alexis Elbaz
- From the Université Paris-Saclay (B.P., F.A., I.D., A.F., G.S., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, U1018, Team "Exposome, Heredity, Cancer, and Health," CESP, Villejuif; Neurology Department (E.R.), Hôpital Pitié-Salpêtrière, AP-HP; Sorbonne Université (E.R.); INSERM U1127 (E.R.), CNRS 7225, Brain Institute, Paris, France; Department of Statistics (G.S.), Computer Science, Applications "G. Parenti" (DISIA), University of Florence, Italy; and Université Bordeaux (C.P.-L.), Inserm, Bordeaux Population Health Research Center, UMR1219, France.
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Pesce G, Artaud F, Roze E, Degaey I, Portugal B, Nguyen TTH, Fournier A, Boutron-Ruault MC, Severi G, Elbaz A, Canonico M. Reproductive characteristics, use of exogenous hormones and Parkinson disease in women from the E3N study. Brain 2023; 146:2535-2546. [PMID: 36415953 PMCID: PMC10232244 DOI: 10.1093/brain/awac440] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/26/2022] [Accepted: 11/08/2022] [Indexed: 09/19/2023] Open
Abstract
Despite experimental studies suggesting a disease-modifying role of oestrogens, results from epidemiological studies on the relation of reproductive characteristics and hormonal exposures with Parkinson disease in women are conflicting. We used the data from the E3N cohort study including 98 068 women aged 40-65 years in 1990 followed until 2018. Parkinson disease was ascertained using a validation process based on drug claim databases and medical records. Reproductive characteristics and hormonal exposures were self-reported (11 questionnaires). Associations of exposures with Parkinson disease incidence were investigated using time-varying Cox proportional hazards regression with a 5-year exposure lag and age as the timescale adjusted for confounders. We identified 1165 incident Parkinson disease cases during a mean follow-up of 22.0 years (incidence rate = 54.7 per 100 000 person-years). Parkinson disease incidence was higher in women with early (<12 years, HR = 1.21, 95% CI = 1.04-1.40) or late age at menarche (≥14 years, HR = 1.18, 95% CI = 1.03-1.35) than in women with menarche at 12-13 years. Nulliparity was not associated with Parkinson disease, but Parkinson disease incidence increased with the number of children in parous women (P-trend = 0.009). Women with artificial (surgical, iatrogenic) menopause were at greater risk than women with natural menopause (HR = 1.28, 95% CI = 1.09-1.47), especially when artificial menopause occurred at an early age (≤45.0 years). Postmenopausal hormone therapy tended to mitigate greater risk associated with artificial or early menopause (≤45.0 years). While fertility treatments were not associated with Parkinson disease overall, ever users of clomiphene were at greater Parkinson disease risk than never users (HR = 1.81, 95% CI = 1.14-2.88). Other exposures (breastfeeding, oral contraceptives) were not associated with Parkinson disease. Our findings suggest that early and late age at menarche, higher parity, and artificial menopause, in particular at an early age, are associated with increased Parkinson disease incidence in women. In addition, there was some evidence that use of exogenous hormones may increase (fertility treatments) or decrease (postmenopausal hormone therapy) Parkinson disease incidence. These findings support the hypothesis that hormonal exposures play a role in the susceptibility to neurodegenerative diseases. If confirmed, they could help to identify subgroups at high risk for Parkinson disease.
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Affiliation(s)
- Giancarlo Pesce
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, Équipe « Exposome, hérédité, cancer et santé », CESP UMR 1018, Villejuif, F-94807, France
| | - Fanny Artaud
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, Équipe « Exposome, hérédité, cancer et santé », CESP UMR 1018, Villejuif, F-94807, France
| | - Emmanuel Roze
- AP-HP, Hôpital Pitié-Salpêtrière, Département de Neurologie, Paris, F-75013, France
- Sorbonne Université, France; INSERM U1127, CNRS 7225, Institut du Cerveau, Paris, F-75013, France
| | - Isabelle Degaey
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, Équipe « Exposome, hérédité, cancer et santé », CESP UMR 1018, Villejuif, F-94807, France
| | - Berta Portugal
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, Équipe « Exposome, hérédité, cancer et santé », CESP UMR 1018, Villejuif, F-94807, France
| | - Thi Thu Ha Nguyen
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, Équipe « Exposome, hérédité, cancer et santé », CESP UMR 1018, Villejuif, F-94807, France
| | - Agnès Fournier
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, Équipe « Exposome, hérédité, cancer et santé », CESP UMR 1018, Villejuif, F-94807, France
| | - Marie-Christine Boutron-Ruault
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, Équipe « Exposome, hérédité, cancer et santé », CESP UMR 1018, Villejuif, F-94807, France
| | - Gianluca Severi
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, Équipe « Exposome, hérédité, cancer et santé », CESP UMR 1018, Villejuif, F-94807, France
- Department of Statistics, Computer Science, Applications "G.Parenti" (DISIA), University of Florence, 50134, Italy
| | - Alexis Elbaz
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, Équipe « Exposome, hérédité, cancer et santé », CESP UMR 1018, Villejuif, F-94807, France
| | - Marianne Canonico
- Université Paris-Saclay, UVSQ, Gustave Roussy, Inserm, Équipe « Exposome, hérédité, cancer et santé », CESP UMR 1018, Villejuif, F-94807, France
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Portugal B, Artaud F, Domenighetti C, Roze E, Degaey I, Canonico M, Elbaz A. Body Mass Index, Abdominal Adiposity, and Incidence of Parkinson Disease in French Women From the E3N Cohort Study. Neurology 2023; 100:e324-e335. [PMID: 36192171 DOI: 10.1212/wnl.0000000000201468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/09/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Previous studies on the relationship between body mass index (BMI) and Parkinson disease (PD) provided inconsistent results, likely due to reverse causation explained by weight loss during the prodromal phase. We examined the association of BMI and abdominal adiposity with PD incidence using lagged analyses to address the potential for reverse causation and compared BMI trajectories in patients before diagnosis and matched controls. METHODS We used data from the E3N cohort study of French women with a 29-year follow-up (1990-2018). BMI (kg/m2) was computed based on self-reported weight and height up to 11 times; up to 6 waist circumference (WC) and hip circumference measures were available. PD diagnoses were validated based on medical records and drug claim databases. Multivariable time-varying Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs according to BMI categories (underweight <18.5 kg/m2; normal = [18.5-25.0[ kg/m2; overweight = [25.0-30.0[ kg/m2; obese ≥30.0 kg/m2). Exposures were lagged by 5 years in main analyses; we used longer lags (10 and 20 years) in sensitivity analyses. We examined trajectories of BMI categories within a nested case-control study using multivariable generalized estimating equations multinomial logistic models. RESULTS Of 96,702 women (baseline age = 40-65 years), 1,164 developed PD. PD incidence was lower (HR = 0.76, 95% CI = 0.59-0.98, p = 0.032) among women with obesity compared with those with normal BMI. There was a similar association in analyses using longer lag times (20 years, 598 cases, HR = 0.52, 95% CI = 0.30-0.88, p = 0.016). A similar pattern was seen for WC and waist-height ratio but not waist-hip ratio. Trajectories of BMI categories (1,196 patients and 23,876 controls) showed that obesity was less frequent in patients with PD before diagnosis than in controls, with a statistically significant difference 29 years before. In addition, the frequency of obesity decreased 5-10 years before diagnosis in patients. DISCUSSION In this large cohort of women with a long follow-up, obesity was associated with a lower hazard of PD, even when measured 20 years before diagnosis, in agreement with Mendelian randomization studies. Our analyses underscore the importance of lagged analyses to account for reverse causation. These findings warrant further investigations to understand the mechanisms underlying this inverse association.
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Affiliation(s)
- Berta Portugal
- Université Paris-Saclay (B.P., F.A., C.D., I.D., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, Villejuif; and AP-HP, Hôpital Pitié-Salpêtrière (E.R.), Département de Neurologie, Paris; Sorbonne Université, France and INSERM U1127, Institut du Cerveau, Paris, France
| | - Fanny Artaud
- Université Paris-Saclay (B.P., F.A., C.D., I.D., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, Villejuif; and AP-HP, Hôpital Pitié-Salpêtrière (E.R.), Département de Neurologie, Paris; Sorbonne Université, France and INSERM U1127, Institut du Cerveau, Paris, France
| | - Cloé Domenighetti
- Université Paris-Saclay (B.P., F.A., C.D., I.D., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, Villejuif; and AP-HP, Hôpital Pitié-Salpêtrière (E.R.), Département de Neurologie, Paris; Sorbonne Université, France and INSERM U1127, Institut du Cerveau, Paris, France
| | - Emmanuel Roze
- Université Paris-Saclay (B.P., F.A., C.D., I.D., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, Villejuif; and AP-HP, Hôpital Pitié-Salpêtrière (E.R.), Département de Neurologie, Paris; Sorbonne Université, France and INSERM U1127, Institut du Cerveau, Paris, France
| | - Isabelle Degaey
- Université Paris-Saclay (B.P., F.A., C.D., I.D., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, Villejuif; and AP-HP, Hôpital Pitié-Salpêtrière (E.R.), Département de Neurologie, Paris; Sorbonne Université, France and INSERM U1127, Institut du Cerveau, Paris, France
| | - Marianne Canonico
- Université Paris-Saclay (B.P., F.A., C.D., I.D., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, Villejuif; and AP-HP, Hôpital Pitié-Salpêtrière (E.R.), Département de Neurologie, Paris; Sorbonne Université, France and INSERM U1127, Institut du Cerveau, Paris, France
| | - Alexis Elbaz
- Université Paris-Saclay (B.P., F.A., C.D., I.D., M.C., A.E.), UVSQ, Univ. Paris-Sud, Gustave Roussy, Inserm, Villejuif; and AP-HP, Hôpital Pitié-Salpêtrière (E.R.), Département de Neurologie, Paris; Sorbonne Université, France and INSERM U1127, Institut du Cerveau, Paris, France
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Towards a European "Cohort Moonshot": revisiting the long-term strategy to support health research of tomorrow. Eur J Epidemiol 2023; 38:121-122. [PMID: 36598706 PMCID: PMC9867653 DOI: 10.1007/s10654-022-00939-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/26/2022] [Indexed: 01/05/2023]
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