Estimate of parkinsonism prevalence through drug prescription histories in the Province of Rome, Italy

Global prevalence and incidence of Young Onset Parkinson's disease: A systematic review and meta-analysis

BACKGROUND

There is a lack of enough evidence regarding the epidemiology of Young-onset Parkinson's disease (YOPD) which is needed by clinicians and healthcare policymakers.

AIM

Herein, in this systematic review and meta-analysis, we aimed to estimate the global prevalence and incidence rates of YOPD.

METHODS

We searched the literature in PubMed, Scopus, and Web of Science in May 2022. We included retrospective, prospective, cross-sectional observational population-based studies that reported the prevalence or incidence of PD in individuals younger than 40 years with known diagnostic criteria.

RESULTS

After two-step screening, 50 studies were eligible to be included in our study. The age-standardized prevalence of YOPD was 10.2 per 100,000 persons globally while it was 14.7 per 100,000 population in European countries. Age-standardized prevalence estimates for 5-year age bands showed that the YOPD prevalence estimates varied from 6.1 per 100,000 population in the group aged 20-24 to 16.1 per 100,000 population in the group aged 35-39. Also, the age-standardized incidence of YOPD was 1.3 per 100,000 person-years population worldwide and 1.2 per 100,000 person-years in the European population.

CONCLUSION

Based on this systematic review and meta-analysis, the overall prevalence of YOPD is 10.2 per 100,000 population, although estimates of the prevalence and incidence in low-income countries remain scarce. To improve monitoring and certain diagnoses of YOPD, healthcare providers and policymakers should be aware that much more effective tools are required.

Estimating the prevalence and incidence of treated type 2 diabetes using prescription data as a proxy: A stepwise approach on Iranian data

AIMS

Type 2 diabetes is a serious health challenge, and large-scale studies on its prevalence in Iran are lacking. In pharmacoepidemiology, case-finding can be done by reviewing the prescription databases for specific drug(s) prescribed for a disease. We aimed to determine the prevalence and incidence of type 2 diabetes in Fars province, Iran, using prescription data and a stepwise approach to ascertain the results.

METHODS

A dataset of 3,113 insured individuals aged ≥35 years were selected. Their Prescription Data Centre records were reviewed for all drugs frequently used in controlling type 2 diabetes available in the Iranian pharmacopeia. Then we used a stepwise method for case-finding. In step one, each individual with a positive drug history for type 2 diabetes was labeled as an individual with diabetes. The next two steps were implemented for ascertainment of step one estimations.

RESULTS

Prevalence of type 2 diabetes based on prescription, internist opinion, and phone call verification in 2015 and 2016 was 9.3% and 10.3%, 8.5% and 9.8%, and 7.2% and 8.7%, respectively. An incidence of 1.9% was determined for 2016.

CONCLUSIONS

We obtained a realistic estimation of prevalence and incidence of treated type 2 diabetes, using prescription data which are large-scale, low cost, and real-time.

Patterns and Determinants of Prescribing for Parkinson's Disease: A Systematic Literature Review

Since the discovery of levodopa (L-dopa) in 1967, the range of medications available to treat Parkinson's disease has increased significantly and guidance on the use, efficacy, and safety of these medications has evolved. To assess levels of adherence to national prescribing guidelines and awareness of changes in the efficacy and safety data published in the profiles of medications for the treatment of PD, we have reviewed studies on patterns and determinants of prescribing PD medications conducted in the last 50 years (since the discovery of L-dopa). A systematic literature review was conducted using EMBASE (1967 to March, 2018), Ovid MEDLINE(R) ALL (1967 to March 16, 2018), PsycINFO (1967 to the 2^nd week of March, 2018), and PubMed to identify all studies measuring prescribing patterns of PD medication between 1967 and 2017. Study design, source of data, country, year of study, number of patients and/or prescriptions, unit of analysis, prescribing determinants, and percentage utilisation of PD medications were extracted where possible. 44 studies examining prescribing patterns and/or prescribing determinants across 17 countries were identified. Unsurprisingly, L-dopa was the most commonly prescribed medication in all studies, accounting for 46.50% to 100% of all prescriptions for PD. In several studies, the prescribing rate of ergot-derived dopamine agonists (DAs) decreased over time in concordance with guidance. In contrast, the prescribing rates of non-ergot DAs increased over the last ten years in most of the included studies. In examining prescribing factors, two major categories were exemplified, patients' factors and prescribers' factors, with patients' age being the most common factor that affected the prescription in most studies. In conclusion, L-dopa is now the most commonly prescribed medication for cases of PD but there is large variation in the prescribing rates of catechol-O-methyltransferase (COMT) inhibitors, monoamine oxidase B (MAO-B) inhibitors, amantadine, and anticholinergics between countries. New studies examining the effects of recent clinical trials and measuring the prescribing rates of newly approved medications are warranted.

Prevalence of parkinsonism estimated using the drug prescription archive: a possible method to estimate the prevalence of a chronic neurological disease?

Many surveys estimated prevalence of parkinsonism, with results varying largely. We used prescription records of medications for parkinsonism to estimate the prevalence of this condition. Retrospective survey based on Lazio (Italy) regional drugs' prescriptions registry. Cases of parkinsonism were defined as those who received a medication for parkinsonism (Dopa and dopa derivatives or Monoamine oxidase B-inhibitors) for at least 6 months in a 5-year period (2005-2009). Crude and standardized prevalence rates at June 2009 were calculated. Crude and standardized prevalence rates of parkinsonism in Lazio were, respectively, 283 per 100,000 (95 % CI 278-287), and 294 per 100,000 (95 % CI 289-298), higher in men than in women (292 per 100,000 vs. 274 per 100,000). The highest overall prevalence rate was observed among people aged 85-89 years (246 per 100,000), while the lowest in subjects aged <65 (38 per 100,000). Prevalence rates in people older than 65 and older 75 were, respectively, 1275 per 100,000 and 1912 per 100,000. Using a regional drug registry, based on currently available health information systems, may be a suitable method to estimate prevalence of parkinsonism, which is essential for public health programming, the more in presence of a demographic shift as the current one.

Initiatives to improve prescribing efficiency for drugs to treat Parkinson's disease in Croatia: influence and future directions

Parkinson's disease (PD) is the second most common neurological disease affecting older adults. Consequently, this disease should be a focus among payers, with increasing utilization of newer premium-priced patent-protected add-on therapies to stabilize or even improve motor function over time. However, expenditure can be moderated by reforms. Consequently, there is a need to assess the influence of these reforms on the prescribing efficiency for drugs to treat PD in Croatia before proposing additional measures. Prescribing efficiency is defined as increasing the use of add-on therapies for similar expenditure. An observational retrospective study of the Croatian Institute for Health Insurance database of drugs to treat patients with PD in Croatia from 2000 to 2010 was carried out, with utilization measured in defined daily doses (defined as the average maintenance dose of a drug when used in its major indication in adults). The study years were chosen to reflect recent reforms. Only reimbursed expenditure is measured from a health insurance perspective. Utilization of drugs to treat PD increased by 218% between 2000 and 2010. Reimbursed expenditure increased by 360%, principally driven by increasing utilization of premium-priced patent-protected add-on therapies, including ropinirole and pramipexole. However, following recent reforms, reducing expenditure/defined daily dose for the different drugs, as well as overall expenditure, stabilized reimbursed expenditure between 2005 and 2010. Treatment of PD is complex, and add-on therapies are needed to improve care. Reimbursed expenditure should now fall following stabilization, despite increasing volumes, as successive add-on therapies lose their patents, further increasing prescribing efficiency.

Prediction model of Parkinson's disease based on antiparkinsonian drug claims

Drug claims databases are increasingly available and provide opportunities to investigate epidemiologic questions. The authors used computerized drug claims databases from a social security system in 5 French districts to predict the probability that a person had Parkinson's disease (PD) based on patterns of antiparkinsonian drug (APD) use. Clinical information for a population-based sample of persons using APDs in 2007 was collected. The authors built a prediction model using demographic variables and APDs as predictors and investigated the additional predictive benefit of including information on dose and regularity of use. Among 1,114 APD users, 320 (29%) had PD and 794 (71%) had another diagnosis as determined by study neurologists. A logistic model including information on cumulative APD dose and regularity of use showed good performance (c statistic = 0.953, sensitivity = 92.5%, specificity = 86.4%). Predicted PD prevalence (among persons aged ≥18 years) was 6.66/1,000; correcting this estimate using sensitivity/specificity led to a similar figure (6.04/1,000). These data demonstrate that drug claims databases can be used to estimate the probability that a person is being treated for PD and that information on APD dose and regularity of use improves models' performances. Similar approaches could be developed for other conditions.

Large differences in levodopa dose requirement in Parkinson's disease: men use higher doses than women

BACKGROUND AND PURPOSE

The characteristics of levodopa dosing are not well described in the literature. The aims were to investigate the use of levodopa in a nationwide Swedish survey and to study the characteristics of low-dose and high-dose patients with Parkinson's disease (PD) in a university hospital.

METHODS

Patients with >or= 1 and >or= 2 purchases of levodopa during 2007 were selected from the prescribed drug register. Daily levodopa doses were estimated. Records of 504 patients with PD who visited the neurology clinic at Uppsala University Hospital during 2006-2007 were examined to select a low-dose group (< or = 400 mg levodopa daily, n = 21) and a high-dose group (>or= 1200 mg daily, n = 26) with at least 5 years of PD duration.

RESULTS

In total, 33 534 levodopa users with > or = 1 levodopa purchase were found. Daily levodopa dose range was large; median daily dose was 465 mg for men and 395 mg for women (P < 0.0001). Almost half (46%) of the patients used < 400 mg levodopa daily. Significantly, more men were treated with doses >or= 1200 mg daily. Dose and age correlated negatively (P < 0.0001). Patients with high dose at 5 years PD duration continuously increased their dosage the following years, whereas low-dose patients did not. The occurrence of dyskinesias was about the same in both groups despite the large difference in levodopa dose.

CONCLUSIONS

We conclude that the levodopa requirement in PD ranges considerably, and that men use higher levodopa dose than women. Levodopa requirement is constant during the progression of the disease in low-dose patients but increases in high-dose patients.

Geographical difference in Parkinson's disease prevalence within West Scotland

The wide range in reported prevalence of Parkinson's disease (PD) in the United Kingdom (between 108 and 164 per 100,000) is usually attributed to differences in study methodology. We report prevalence of PD in four geographic areas within West Scotland, which was calculated using the same methodology, from prescription database searches within primary care, combined with full case record review. Crude prevalence was 119.2 per 100,000 (95% CI 109.7-128.6) and age-adjusted prevalence was 129.5 (95% CI 119.6-139.4) in 92 General Practices covering a population of 511,927. Prevalence was significantly lower in South Glasgow (men 98.3, CI 78.7-117.9; women 83.9, CI 65.6-102.2) than South Lanarkshire (men 202.7, CI 175.0-230.4; women 151.1, CI 127.7-174.5), age-adjusted rates, both P < 0.001. Factors associated with higher prevalence of PD, such as lower cigarette smoking rates, higher education level, and rural living, were higher in South Lanarkshire than South Glasgow, but the magnitude of the difference was greater than expected considering studies describing relative risk for these factors. Access to services, and specialist clinic attendance were both higher for South Glasgow, which may influence diagnostic accuracy, time to diagnosis, and time to initiating antiparkinson therapy. Exploration of these factors is justified to explain further such wide variation in PD prevalence.

High prevalence of Parkinsonian disorders associated to manganese exposure in the vicinities of ferroalloy industries

OBJECTIVE

To assess the prevalence of Parkinsonian disturbances in relationship to environmental exposure to manganese due to ferroalloy industries in the province of Brescia, Northern Italy.

METHODS

Manganese concentrations were measured in settled dust collected in each of the 206 municipalities. Parkinsonian patients were identified using two sources: (1) clinical registers from local hospitals, specialized neurologists, and exemption from prescription payment; (2) L-Dopa prescriptions. Standardized prevalence rates and raw and full Bayesian-smoothed standardized morbidity ratios (SMRs) were calculated for the entire province and for each municipality.

RESULTS

Manganese concentrations in settled dust were significantly higher in the surroundings and downwind from the industrial plants. A total number of 2,677 Parkinsonian cases were identified among 903,997 residents (crude prevalence, 296/100,000; 95% CI: 284.80-307.20; standardized prevalence, 407/100,000; 95% CI: 393.87-420.12). Significantly higher SMRs (Kruskal-Wallis chi(2) 1 df = 17.55, P < 0.001) were observed in 37 municipalities in the vicinities of ferromanganese plants (324 cases among 77,708 residents; standardized prevalence 492/100,000; 95% CI: 442.80-541.20), compared to the other 169 municipalities of the province (2,353 cases among 826,289 residents, standardized prevalence 321/100,000; 95% CI 308.80-333.20). Row and Bayesian SMRs were associated with the concentrations of manganese in settled dust.

CONCLUSION

Study results suggest that environmental exposure to manganese is associated with an increased prevalence of Parkinsonian disturbances. Since the highest prevalence rates were observed in a closed community of the pre-Alps where the industries are located, further research should address a possible interactive role of genetic factors.

A pharmacoepidemiological study of the consumption of antiparkinson drugs in the Basque Autonomous Community (Spain) (1992-2004)

PURPOSE

To monitor the rise in consumption of antiparkinson drugs as well as the prevalence of this illness in the Basque Autonomous Community (Spain) over a period of 13 years (1992-2004).

METHODS

A retrospective population-based study where consumption of antiparkinson drugs was conducted using data obtained from the ECOM (Especialidades Consumo de Medicamentos) database of the Spanish Ministry of Health, which contains the number of prescriptions filled in community pharmacies and charged to the National Health System. The results are expressed as DID, Defined daily doses per 1000 inhabitants per day.

CONCLUSIONS

Consumption of antiparkinson drugs has increased in the Basque Autonomous Community.

The Prevalence of Parkinson’s Disease in an Area of North Tyneside in the North-East of England

OBJECTIVES

UK prevalence studies have demonstrated prevalence rates for Parkinson's disease (PD) of 108 to 164 cases per 100,000. we aimed to calculate the prevalence of PD in an area of the North-East of England.

MATERIAL AND METHODS

A case finding methodology was used to identify cases in North Tyneside with a population of 108,597 at the 2001 UK census.

RESULTS

161 cases were identified giving crude and age-adjusted prevalence estimates of 148 cases (95% CI 124-174) and 139 cases (95% CI 116-162) per 100,000, respectively. The mean age was 74.1 years (range 44-96 years) with mean disease duration of 5.6 years.

CONCLUSIONS

The prevalence of PD in North Tyneside is comparable with that of the rest of the UK. The prevalence of PD in the UK appears not to have changed greatly over the last 30 years.

Use of antiparkinsonian drugs in Denmark: Results from a nationwide pharmacoepidemiological study

The objective of the present study was to record the use of antiparkinsonian drugs (APD) in Denmark and discuss estimates of the incidence and prevalence rates of Parkinson's disease (PD). The main indication for treatment with APD is idiopathic PD. The use of APD is, therefore, an indicator of the epidemiology of PD and Parkinsonism. We used a drug tracer design, which previously has been found applicable in estimating the frequency of PD. From a national prescription database, all persons who purchased APD from 1995 to 2002 could be identified on an individual level. Results show an age-standardized prevalence rate for APD purchase of 164.0 persons per 100,000, and an incidence rate of 55.9 persons per 100,000. The total number of persons purchasing APD was 11,656 per year on average. Our results showed higher figures of persons purchasing APD than the estimated prevalence of idiopathic PD in Denmark, which is approximately 100 persons per 100,000, corresponding to 5,000 to 6,000 persons. The differences might in part be explained by other indications for APD prescription in addition to PD and in part by misdiagnosis. However, the possibility of somewhat higher incidence and prevalence rates of PD than hitherto estimated should be considered.

The prevalence of Parkinson's disease in British Columbia, Canada, estimated by using drug tracer methodology

OBJECTIVE

To estimate the prevalence of Parkinson's disease (PD) in British Columbia utilizing the prescription database of the College of Pharmacists.

METHODS

Patients receiving anti-parkinsonian drug (anti-PD) prescriptions between 1996 and 1998 were stratified by year, age, gender, drug use category, and geographic location. The numbers of patients on levodopa alone, or levodopa and/or other anti-PD drugs were adjusted using published data which gave estimates of the proportion of undiagnosed patients with PD, the proportion of those treated for parkinsonism with definite PD, the proportion of patients with PD not being treated with anti-PD medications, and the proportion of patients treated with anti-PD medications who have PD. Use of the anti-PD drug bromocriptine for other purposes in women under 50 years of age was also considered.

RESULTS

The estimated prevalences of PD based on all anti-PD medications used were 109, 121, and 125 per 100,000 population in 1996, 1997, and 1998, respectively. Estimated prevalences of PD based on levodopa use were 126, 134, and 144, respectively. The prevalence in both prescription groups increased with age. The male to female ratio of prevalence ranged from 1.16 to 1.21.

CONCLUSIONS

Using a large, accurate database, it is possible to estimate the prevalence of PD in a large population, though the assumptions built into the estimate remain to be validated in the subject population.

Drug prescribing patterns in Parkinson's disease: a pharmacoepidemiological survey in a cohort of ambulatory patients

PURPOSE

Drug treatment of idiopathic Parkinson's disease (IPD) is a difficult task, and comorbidity and comedication add to its complexity. Since in IPD there is little information about drug use, this study investigated drug prescribing and indications in IPD patients.

METHODS

From June 1997 to April 1998, a cross-sectional survey of IPD outpatients was performed and demographic and clinical data and information about drug treatments was collected and analysed.

RESULTS

In the 130 IPD patients included in the study, anti-Parkinson drug (APD) prescriptions increased with disease duration and severity. Levodopa was most frequently used, followed by dopamine agonists and anticholinergic agents. Levodopa with other APDs was given to older patients with later IPD onset. Prescriptions of drugs for other indications (non-APDs) were given to 80.8% of the patients and their number increased with patient age. Non-APD prescriptions concerned mainly the circulatory system, mental disorders, the musculoskeletal system and the digestive system. Prescriptions for indications corresponding to secondary symptoms that often complicate IPD increased with patient age and also with IPD duration.

CONCLUSION

In IPD patients, disease duration and severity and patient age seem to be major determinants of drug use. Indications for drug prescription suggest that main comorbidity includes neuropsychiatric, circulatory, musculoskeletal and digestive disorders. Analysis of prescribing patterns in IPD can provide a readily accessible indirect indicator of patient health status for both health services and epidemiologic research purposes.

Prevalence of Parkinson's disease in Northwestern Italy: comparison of tracer methodology and clinical ascertainment of cases

The prevalence of idiopathic Parkinson's disease (PD) in an area of Northwestern Italy (Socio-Sanitary District of Cossato, 61,830 inhabitants) was analyzed and the reliability of "drug tracer methodology" evaluated. The patients were identified by both conventional epidemiological methodology (general practitioners, consultant neurologist, computerized archives) and drug tracer methodology (registered levodopa prescriptions). The diagnosis of PD was clinically verified by examining all patients. Of 146 patients examined, 104 were affected by PD; the remaining by other types of parkinsonism. The crude point prevalence rate (October 20, 1991) was 168 per 100,000 population (95% confidence interval [95% CI] 138-204), with a progressive increase up to the 80-89 age group. Using "tracer" methodology, the estimated crude point prevalence rate was 196 (95% CI 163-235), with an overestimation of the prevalence in older patients and women and an underestimation in younger and less seriously affected cases. The uneven distribution of PD in Italy appears to be the result of, at least in part, methodological factors. "Tracer" methodology may cause biases in the evaluation of the epidemiological characteristics of PD, especially if the clinical diagnosis of cases identified by this method is not carefully verified. Nevertheless, it appears useful as an additional source of cases for descriptive surveys.

Mortality in a population-based cohort of patients treated with antiparkinsonian drugs

OBJECTIVES

A number of studies have been focused on the mortality of parkinsonian patients, as compared with the rest of the population. In these studies, a mortality greater than expected on the basis of mortality of the general population has been shown. Nevertheless, just a few of these studies have investigated in detail the specific causes of death, probably as a consequence of both small cohort sizes and a short time period of observation. The aim of this study was to estimate cause-specific mortality in a cohort of patients treated with antiparkinsonian drugs.

METHODS

The study was performed on a wide population-based cohort of patients identified and followed-up through the computerized health databases of the Italian province of Rome (about 3,800,000 inhabitants). The follow-up lasted from January 1987 to December 1994. Standardized Mortality Ratios (SMR) were calculated for each specific cause of death, using the Rome province population as reference.

RESULTS

A cohort of 10,322 subjects, receiving antiparkinsonian drugs, were identified. There were 4328 deaths on an average follow-up of 5.7 years. This figure was 17% higher than was expected. A gradual decrease in SMR was observed in the oldest age groups. Statistically significant (95%) excesses of death were related to the nervous system (SMR = 1037; 95% CI 964-1110), mental disorders (SMR = 182; 95% CI 129-246), and endocrine and metabolic diseases (SMR = 117; 95% CI 102-133). Lower than expected mortality was found to be caused by malignant neoplasms (SMR = 56; 95% CI 51-61).

CONCLUSIONS

Apart from deaths specifically related to Parkinson's disease, the main differences between our cohort of patients and the general population were related to mortality due to malignant neoplasms and mental disorders. The gradual decrease in SMR for the oldest age groups, seems to indicate a greater reduction of life expectancy for patients with early onset of symptoms. This age-related trend could explain the relatively small excess of mortality, as in our cohort the median age of patients at entry was 74 years.