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Time Trends of the Incidence, Prevalence, and Mortality of Parkinsonism

  • Jessica J. Wong (a1) (a2) (a3) (a4), Jeffrey C. Kwong (a1) (a2) (a5) (a6) (a7), Karen Tu (a6) (a7) (a8), Debra A. Butt (a6) (a9), Ray Copes (a1) (a2) (a6), Andrew S. Wilton (a5), Brian J. Murray (a10), Alexander Kopp (a5) and Hong Chen (a1) (a2) (a5)...

Abstract:

Objectives: We assessed trends in the incidence, prevalence, and post-diagnosis mortality of parkinsonism in Ontario, Canada over 18 years. We also explored the influence of a range of risk factors for brain health on the trend of incident parkinsonism. Methods: We established an open cohort by linking population-based health administrative databases from 1996 to 2014 in Ontario. The study population comprised residents aged 20–100 years with an incident diagnosis of parkinsonism ascertained using a validated algorithm. We calculated age- and sex-standardized incidence, prevalence, and mortality of parkinsonism, stratified by young onset (20–39 years) and mid/late onset (≥40 years). We assessed trends in incidence using Poisson regression, mortality using negative binomial regression, and prevalence of parkinsonism and pre-existing conditions (e.g., head injury) using the Cochran–Armitage trend test. To better understand trends in the incidence of mid/late-onset parkinsonism, we adjusted for various pre-existing conditions in the Poisson regression model. Results: From 1996 to 2014, we identified 73,129 incident cases of parkinsonism (source population of ∼10.5 million), of whom 56% were male, mean age at diagnosis was 72.6 years, and 99% had mid/late-onset parkinsonism. Over 18 years, the age- and sex-standardized incidence decreased by 13.0% for mid/late-onset parkinsonism but remained unchanged for young-onset parkinsonism. The age- and sex-standardized prevalence increased by 22.8%, while post-diagnosis mortality decreased by 5.5%. Adjustment for pre-existing conditions did not appreciably explain the declining incidence of mid/late-onset parkinsonism. Conclusion: Young-onset and mid/late-onset parkinsonism exhibited differing trends in incidence over 18 years in Ontario. Further research to identify other factors that may appreciably explain trends in incident parkinsonism is warranted.

Tendances temporelles de l'incidence, de la prévalence et du taux de mortalité du parkinsonisme. Objectifs: Au cours d'une période de 18 ans, nous avons tenté d'évaluer en Ontario (Canada) diverses tendances du parkinsonisme, qu'il s'agisse de l'incidence et de la prévalence de cette maladie mais également du taux de mortalité suivant un diagnostic. Nous avons aussi exploré le rôle d'un éventail de facteurs de risque liés à la santé du cerveau en relation avec la tendance à voir de nouveaux cas de parkinsonisme apparaître. Méthodes: Aux fins de cette étude, nous avons établi une cohorte ouverte en liant entre elles des bases de données administratives du domaine de la santé, et ce, pour les années 1996 à 2014. La population à l'étude comprenait des résidents de l'Ontario âgés de 20 à 100 ans chez qui l'on avait diagnostiqué, au moyen d'un algorithme préalablement validé, les premiers signes de parkinsonisme. Une fois les variables du sexe et de l'âge standardisées, nous avons par la suite calculé l'incidence, la prévalence et le taux de mortalité du parkinsonisme en stratifiant nos cas en fonction d'un âge précoce (20 à 39 ans) ou d'un âge intermédiaire/avancé (≥ de 40 ans). Au moyen de la régression de Poisson, nous avons évalué les tendances en matière d'incidence; dans le cas du taux de mortalité, nous nous sommes basés sur une régression binomiale négative; enfin, tant la prévalence du parkinsonisme que des conditions préexistantes (par exemple des blessures à la tête) ont été évaluées à l'aide du test de tendance Cochran-Armitage. Afin de mieux comprendre les tendances liées à l'incidence du parkinsonisme apparaissant à un âge intermédiaire/avancé, nous avons effectué des ajustements dans le modèle de régression de Poisson en tenant compte de nombreuses conditions préexistantes. Résultats: De 1996 à 2014, nous avons identifié 73 129 nouveaux cas de parkinsonisme au sein d'une population d'environ 10,5 millions d'individus. 56 % des sujets atteints de cette maladie étaient de sexe masculin. Ajoutons aussi que leur âge moyen au moment d'un diagnostic était de 72,6 ans et que 99 % d'entre eux étaient atteints de parkinsonisme s'étant développé à un âge intermédiaire/avancé. Au cours de cette période de 18 ans, l'incidence standardisée en fonction de l'âge et du sexe a diminué de 13,0 % en ce qui concerne le parkinsonisme apparu à un âge intermédiaire/avancé. Elle est néanmoins demeurée inchangée pour ce qui est du parkinsonisme apparu à un âge précoce. La prévalence standardisée en fonction de l'âge et du sexe a quant à elle augmenté de 22,8 % alors que le taux de mortalité suivant un diagnostic a baissé de 5,5 %. Nos ajustements tenant compte de conditions préexistantes n'ont pas permis d'expliquer de façon satisfaisante l'incidence en baisse du parkinsonisme apparu à un âge intermédiaire/avancé. Conclusions: Qu'il s'agisse de parkinsonisme apparaissant à un âge précoce ou à un âge intermédiaire/avancé, on a pu observer différentes tendances en matière d'incidence au cours de cette période de 18 ans. Des recherches plus poussées permettant d'identifier d'autres facteurs pouvant expliquer de façon plus sensible ces tendances sont ainsi justifiées.

Copyright

Corresponding author

Correspondence to: Hong Chen, Public Health Ontario, 480 University Avenue, Toronto, Ontario M5G 1V2, Canada. Email: hong.chen@oahpp.ca

References

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