Trends in Parkinson's disease related mortality in England and Wales, 1993–2006

Background:  This paper describes changes in Parkinson's disease (PD) mortality in England and Wales between 1993 and 2006 using all information on death certificates.
Methods:  Information on deaths was obtained from the Office for National Statistics. Mortality rates for any mention of PD on death certificates were directly age-standardized using the European standard population. Average yearly changes in mortality rates were estimated using linear regression. The underlying cause of death on death certificates where PD was mentioned was examined by sex and calendar period.
Results:  Male PD age-standardized mortality rates for any mention of PD decreased from 15.0 to 11.7 per 100 000 between 1993 and 2006. Female PD mortality rates fell from 6.3 to 4.9 per 100 000. Decreases were greater for older age-groups. The proportion of deaths with PD recorded as the underlying cause increased by 50% in 2001 following implementation of the 10th revision of the International Classification of Diseases (ICD).
Conclusion:  Parkinson's disease mortality rates in England and Wales are decreasing, especially for men and for older age-groups. Because of data limitations we are unable to ascertain whether the decrease of PD recorded on death certificates is because of a reduction in PD incidence, or to improved survival for PD patients resulting from advancements in PD treatments or to improvements in general medical care. The dramatic increase in PD as the underlying cause of death following ICD revision in 2001 demonstrates the dangers of using underlying cause of death to investigate mortality trends without being aware of the potential for artifacts.     

Survival time, mortality, and cause of death in elderly patients with Parkinson's disease: a 9-year follow-up.

This community-based study of Parkinson's disease (PD) investigated age at death and cause of death in a cohort of 170 previously studied patients. The current study is a 9-year follow-up, and the results are compared to 510 sex- and age-matched controls from the same area. A total of 170 patients were diagnosed with PD on August 31, 1989, within a defined area of Sweden. A control group of 510 persons from the same area and with the same age and sex distribution was also examined regarding age at death and cause of death. After 9.4 years, 121 cases (71.1%) and 229 controls (44.9%) were no longer alive. Thus, the mortality rate ratio was 1.6 (95% confidence interval [CI], 1.3-1.8) when comparing PD patients with controls. The all-cause hazard ratio for cases compared to controls was 2.4 (95% CI, 1.9-3.0). The mean age at death for the cases was 81.9 (95% CI, 80.3-83.0) years and for the controls 82.9 (95% CI, 82.0-83.7) years. Survival analysis also showed a shorter survival time (P < 0.001) for PD patients. Only 53% of the death certificates for the deceased patients recorded PD as an underlying or contributory cause of death. Many PD patients reached a high age but had a shorter survival than the controls. There was a significant increase in deaths from pneumonia.     

Trends in death certification for multiple sclerosis, motor neuron disease, Parkinson’s disease and epilepsy in English populations 1979–2006

The objective of this study is to report trends in mortality, as certified on death certificates, from multiple sclerosis (MS), motor neuron disease (MND), primary Parkinson’s disease (PD), and epilepsy, analysing not only the underlying cause of death but also all certified causes for each disease. Death records in the Oxford region, 1979–2006, and England, 1996–2006, were analysed for ascertaining the trends in mortality. The percentage of deaths coded as the underlying cause changed over time, coinciding with changes to the rules for selecting the underlying cause of death. Changes over time to coding rules had a large impact on apparent trends in death rates for PD when studied by underlying cause alone. They also had significant, though smaller, effects on trends in death rates for MS, MND and epilepsy. Nationally, in the last period of the study, underlying cause mortality identified 64% of deaths with a mention of MS, 88% of MND, 56% of PD, and 48% of epilepsy. In the longstanding Oxford data from 1979 to 2006, death rates based on all certified causes of death showed no significant change for MS; an upward trend for MND (notably in women over 75), though only in the last few years of the study; a significant but small decline for PD; and no significant change for epilepsy. When mortality statistics are analysed by underlying cause only, their value is reduced. A substantial percentage of neurological deaths are missed. Time trends may be misleading. All certified causes for each disease, as well as the underlying cause, should be analysed.     

CVD mortality, 1968-1978: observations and implications

U.S. multiple cause of death data were examined for the period 1968-1978. Specifically, the role of cerebrovascular disease mortality as an underlying and associated cause of death was studied. The number of deaths where cerebrovascular disease was cited as the underlying cause of death declined much faster than the number of deaths where cerebrovascular disease was cited as the associated cause of death. This trend is indicative of a possible change in the role of cerebrovascular disease as an associated cause of death. Cause elimination life tables were constructed for cerebrovascular disease as the underlying cause of death and as any cause of death. In the general population, eliminating stroke as a cause of death is projected to have less impact in 1978 than in 1968, for men than for women, and for whites than for nonwhites. Tables were also constructed to examine the life expectancy gains for the group of individuals who died of cerebrovascular disease. For these individuals, the gain in life expectancy at birth ranges from 9 years for white males to 18 years for nonwhite females.     

Short-Term Mortality After a First Epileptic Seizure: A Population-Based Study

PURPOSE: To determine the short-term mortality in a prospective incidence cohort of patients included after any kind of first afebrile epileptic seizure (i.e., provoked and unprovoked). METHODS: Information on death occurring within the first year of follow-up was collected in a cohort of 804 patients with a first seizure between March 1, 1984, and February 28, 1985, in southwest France. The variables analyzed were the etiology of seizure, cause of death, interval between seizure and death, and age of patients. RESULTS: By the end of the 1-year follow-up, there were 149 deaths among these patients as compared with 16 expected deaths [standardized mortality ratio (SMR), 9.3; 95% confidence interval (CI), 7.9-10.9]. There were no deaths in patients with idiopathic seizures. Patients with cryptogenic seizures had slightly increased mortality (SMR, 1.6; 95% CI, 0.4-4.1). Mortality was increased for patients with remote symptomatic seizures (SMR, 6.5; 95% CI, 3.8-10.5), provoked seizures (SMR, 10.1; 95% CI, 8.1-12.4), and seizures due to a progressive neurologic condition (SMR, 19.8; 95% CI, 14.0-27.3). Causes of death were underlying pathology (64%), unrelated condition (20%), unknown cause (9%), seizure-related death (6%), and one suicide. CONCLUSIONS: Early mortality clearly differed according to the etiology of the first seizure. The highest mortality was associated with provoked seizures and with seizures caused by progressive central nervous system disorders. Patients died far more often from underlying or unrelated conditions than from seizures.     

Natural history and predictors of outcome for non-cardiac chest pain: a prospective 4-year cohort study

Abstract  The natural history of non-cardiac chest pain (NCCP) is poorly understood. We aimed to assess the 2- and 4-year outcomes of patients with chest pain, and determine whether baseline characteristics could predict outcomes (mortality, continued chest pain and quality of life). This was a prospective cohort study in a tertiary teaching hospital (Nepean Hospital), Sydney, Australia. All subjects who presented with acute chest pain to the emergency department were recruited at baseline ( n  = 197). Mortality data were obtained from death certificates on the entire cohort at 4 years; 129 (65%) patients responded to a 2 year follow-up and 92 (47%) to a 4-year follow-up questionnaire. At baseline, there were 126 (60%) NCCP patients and 71 cardiac patients. Chest pain continued to be reported in the majority of individuals (>65%) at follow-up. Over the 2-year period, NCCP disappeared among 10% ( n  = 9/88), but remained present in the remaining 90% ( n  = 79). In comparison, 69% ( n  = 28/41) of the cardiac chest pain (CCP) patients continued to have chest pain at the 2-year follow-up (NCCP vs CCP: P  < 0.001). At the 4-year follow-up, 71% ( n  = 45/64) and 81% (23/27) continued to have NCCP and CCP respectively. The mortality rate among the entire cohort over the 4-year study was 9% (17/197). The cardiac mortality rate for patients initially diagnosed with CCP was 11% (8/71); compared with 5.5% (7/126) ( P  = 0.16) among patients initially diagnosed with NCCP who subsequently died from a cardiac cause. Outcomes in terms of mortality did not significantly differ between cardiac and NCCP patients. Both groups experienced continued chest pain during the follow-up period. Non-cardiac chest pain does not always confer an excellent long-term prognosis.     

Mortality in patients with Parkinson's disease treated by stimulation of the subthalamic nucleus.

Subthalamic nucleus (STN) stimulation improves motor disability and quality of life in patients with advanced Parkinson's disease (PD). Short-term mortality is low, but little is known about long-term mortality. We assessed mortality and causes of death in 171 consecutive PD patients treated by STN stimulation. Surgery was performed after a median lagtime of 13 years from PD onset at a median age of 57 years. The median follow-up after surgery was 41 months. Sixteen patients died 8 to 83 months after neurosurgery. Poorer cognitive function was the only predictive factor for mortality (standardized mortality ratio = 2.9; 95% confidence interval [CI], 1.6-4.7; P < 0.0001). Based on a historical comparison of 118 operated patients with 39 nonoperated patients from a different population, survival among operated patients was not better (hazard ratio = 1.2; 95% CI, 0.7-2.1).     

Mortality among first-admission patients with psychosis

OBJECTIVE: This study compared 5- and 10-year survival and absolute and relative mortality rates among first-admission patients with 1 of 4 psychotic disorders: schizophrenia/schizoaffective disorder, bipolar disorder, major depression, and other nonorganic psychoses. METHOD: The authors conducted a prospective 10-year follow-up of subjects first admitted with a diagnosis of nonorganic psychosis to any of 12 hospitals in Suffolk County, New York, during the period 1989 to 1995. Information on their death status since study entry was ascertained from the Social Security Death Index and the National Death Index. Survival analyses were conducted using the Kaplan-Meier product-limit estimator. RESULTS: There were no significant differences in survival rates among the 4 diagnostic groups at 5-year (range, 96.3%-97.8%) or 10-year (range, 90.2%-97.8%) follow-up. Absolute mortality over the study period ranged from 2.8% of bipolars to 6.7% of those with major depression. About 60% of deaths among schizophrenic/schizoaffective subjects were due to unnatural causes, whereas for the other 3 groups, deaths were more evenly split between natural and unnatural causes. Suicides comprised most deaths from unnatural causes, most of which occurred during the 2- to 5-year follow-up period. Deaths due to natural causes tended to be related to lifestyle factors. CONCLUSIONS: First-admission patients with psychosis experience similar patterns of mortality risk over the first 10 years after index admission regardless of underlying diagnosis. Causes of death (both natural and unnatural) were potentially preventable with more intensive medical and psychiatric follow-up and intervention. Many deaths from unnatural causes occurred during or shortly after discharge from an inpatient or residential treatment setting, highlighting this period as one needing close scrutiny by treating clinicians.     

Causes of death in a community-based study of Parkinson's disease

INTRODUCTION: The aim of this community-based study of Parkinson's disease (PD) was to investigate the causes of death among PD patients over a 4-year period and to examine the quality of death certificates with regard to PD. PATIENTS AND METHODS: A total of 245 patients were diagnosed with PD on Jan 1st 1993 in a defined geographical area in Norway. This patient cohort was followed from 1993 until Dec 31st 1996. Some 84 patients died in the 4-year period of follow-up. Their death certificates were collected, and causes of death were registered. A control group with the same age and sex distribution as the decedents, from the same geographical area, were also examined for causes of death. RESULTS: We found that the deceased PD patients at baseline were older, had a higher Unified Parkinson's Disease Rating Scale (UPDRS) score and Hoehn and Yahr staging than those patients who did not die during the observation period. Twice as many PD patients (20%) as controls (9%) died from pneumonia, whereas more controls than patients died from ischemic heart disease. There was a trend towards more deaths from malignant neoplasms in the control group than among PD patients. Only 56% of the death certificates of the deceased patients had PD registered as either underlying or contributing cause of death. CONCLUSION: We found that in an unselected group of PD patients there is a significant increase in deaths from pneumonia. The low frequency of PD on deceased patients' death certificates show that research based on these certificates should be evaluated with caution.     

Prospective study of phobic anxiety and risk of Parkinson's disease.

Anxiety disorders are common in Parkinson's disease (PD). However, the risk of PD among people with anxiety has not been examined in a prospective cohort study. We examined this relation prospectively within the Health Professionals Follow-Up Study, a cohort of US male health professionals. In 1988, anxiety was assessed using the Crown-Crisp phobic anxiety index in 35,815 men without PD, stroke, or cancer at baseline. There were 189 incident cases of PD during 12 years of follow-up. After adjusting for age, smoking, and caffeine intake, the relative risk of PD among men with the highest level of anxiety (Crown-Crisp index scores of 4 and above) was 1.5 (95% CI = 1.0-2.1; P-trend = 0.01) compared to men with the lowest level of anxiety. This positive association persisted after excluding cases of PD with onset in the first 2 years of follow-up. Use of anxiolytic medication was also associated with an elevated risk of PD (RR= 1.6; 95% CI = 0.9-3.1), but adjusting for this potential confounder did not materially affect the association between anxiety and risk of PD. Our results suggest that anxiety is a risk factor for PD. Whether this association is causal or the result of shared underlying biology remains a question.     

Comorbid Parkinson's disease,falls and fractures in the 2010 National Emergency Department Sample

IntroductionParkinson's disease (PD) is a progressive, neurodegenerative disorder of multifactorial etiology affecting ∼1% of older adults. Research focused on linking PD to falls and bone fractures has been limited in Emergency Department (ED) settings, where most injuries are identified. We assessed whether injured U.S. ED admissions with PD diagnoses were more likely to exhibit comorbid fall- or non-fall related bone fractures and whether a PD diagnosis with a concomitant fall or bone fracture is linked to worse prognosis.MethodsWe performed secondary analyses of 2010 Healthcare Utilization Project National ED Sample from 4,253,987 admissions to U.S. EDs linked to injured elderly patients. ED discharges with ICD-9-CM code (332.0) were identified as PD and those with ICD-9-CM code (800.0–829.0) were used to define bone fracture location. Linear and logistic regression models were constructed to estimate slopes (B) and odds ratios (OR) with 95% confidence intervals (CI).ResultsPD admissions had 28% increased adjusted prevalence of bone fracture. Non-fall injuries showed stronger relationship between PD and bone fracture (OR_adj = 1.33, 95% CI: 1.22–1.45) than fall injuries (OR_adj = 1.06, 95% CI: 1.01–1.10). PD had the strongest impact on hospitalization length when bone fracture and fall co-occurred, and total charges were directly associated with PD only for fall injuries. Finally, PD status was not related to in-hospital death in this population.ConclusionAmong injured U.S. ED elderly patient visits, those with PD had higher bone fracture prevalence and more resource utilization especially among fall-related injuries. No association of PD with in-hospital death was noted.     

A follow-up of elderly depressed patients

The study aims to establish the predictive value of a diagnosis of depression among elderly according to the 10th revision of the International Statistical Classification of Diseases (ICD-10) by measuring morbidity, medication usage, health service utilization and mortality during an 8-year follow-up of depressed elderly inpatients (n=76) and community-living depressed patients (n=38) compared with controls (n=116). The data were taken from GPs' medical records and health statistics registers. At baseline, no significant differences were observed between the two cohorts of depressed patients and the controls in terms of prevalence of cardiovascular, respiratory or cerebrovascular morbidity. During follow-up, both cohorts of depressed patients had significantly increased rates of recurrent depressions, consumption of antidepressants, psychiatric in- and outpatient admissions, and home visits; inpatients used more psychiatric hospital days. Health service utilization in somatic hospitals and somatic diagnoses was not significantly increased. Inpatients used significantly fewer GP office-hour services but more out-of-hours services than the control group. Community-living depressed patients experienced no significant increase in use of GP services. Survival was unaffected in both cohorts. In agreement with other studies, especially inpatient depression predicted increased rates of recurrent depressions and increased use of psychiatric hospital services, indicating poor long-term outcome. Inpatients consumed fewer GP office-hour services but more out-of-hours services, possibly due to less office-hour contact. Contrasting with other studies, ICD-10 depression among elderly predicted no increase in the use of somatic hospital facilities.     

Survival of Parkinson's disease patients in a large prospective cohort of male health professionals.

Parkinson's disease (PD) patients have higher mortality than individuals without PD. However, most of the previous studies were based on prevalent cases and few examined the potential effects of duration and smoking on the survival of PD patients. We compared the survival experience of 288 men with incident PD diagnosed between 1986 and 2000 with that of 51,012 men free of PD in the Health Professionals Follow-up Study. As of January 2002, 92 deaths occurred among PD cases and 8,485 among men without PD. After controlling for age, men with PD had 60% higher mortality than those without PD (95% CI: 1.3-2.0). PD mortality was strongly related to disease duration: compared with men without PD, the age-adjusted relative risk for PD patients was 1.1 during the first 5 years from diagnosis, 2.3 from 5 to 10 years, and 3.5 after 10 years (P < 0.0001 for trend). As expected, cigarette smoking was strongly and positively associated with total mortality among men free of PD (comparing >30 pack-years vs. never smokers, relative risk, 2.0; P < 0.0001 for trend), but this association was not observed among PD patients (RR: 1.0; P = 0.95 for trend). This study confirms that PD patients have a higher mortality than individuals without PD and that the excess mortality increases with disease duration. However, smoking seems to impose little additional risk among PD patients in this large cohort of health professionals.     

Mortality among psychiatric patients--the groups at risk

This study examined standardized mortality ratios (SMR) among the patients who had undergone psychiatric hospitalization in Israel in 1978. The size of the sample (83,175 person-years) allowed us to calculate simultaneously SMR by age, sex, diagnosis and cause of death. The global SMR was 2.3 and decreased with age. Excess mortality was found in patients from all diagnostic groups for death from both natural and unnatural causes. Excess mortality from cancer was found only among patients aged under 40. The SMR for death by suicide was lower than that reported in the literature. The highest excess mortality was due to respiratory and infectious diseases in all groups and especially among young alcoholics and drug addicts (SMR = 273). This points to the importance of an ongoing follow-up of the physical health of psychiatric patients.     

Mortality in adults with newly diagnosed and chronic epilepsy: a retrospective comparative study

BACKGROUND: People with epilepsy are at increased risk of premature death compared with the general population. Many clinicians are unsure whether and when this issue should be broached with their patients. We analysed mortality in patients with newly diagnosed and chronic epilepsy over a 20-year period. METHODS: Patients who attended the epilepsy service at the Western Infirmary in Glasgow, UK between 1981 and 2001, with newly diagnosed epilepsy (n=890) or referred after receiving unsuccessful treatment elsewhere (n=2689) were included in the study. Mortality data were obtained from the General Registrar Office for Scotland. Causes of death were ascertained from death certificates and primary care and health authority records. The two patient cohorts were compared with age-matched and sex-matched Scottish comparison groups. Standardised mortality ratios (SMR) were calculated for each epilepsy type, 10-year age band, and cause of death category. FINDINGS: Newly diagnosed patients had a 42% increase in mortality (SMR 1.42, 95% CI 1.16-1.72) compared with the comparison group. Increased mortality was recorded in those who had not responded to treatment, with no increase in risk observed in patients who were seizure free. In the chronic epilepsy cohort, there was more than double the expected number of deaths (2.05, 1.83-2.26). The incidence of sudden unexpected death in epilepsy was 1.08 and 2.46 per 1000 patient-years in patients with newly diagnosed and chronic epilepsy, respectively. The greatest excess in mortality was reported in patients younger than 30 years. INTERPRETATION: Mortality risks and preventive strategies should be discussed with patients with epilepsy when treatment fails or is refused despite recurrent seizures.     

Suicide and other causes of death in a five-year follow-up of patients treated for self-poisoning in Oslo

This 5-year follow-up study includes all patients (n = 934; 50% females) treated for self-poisoning in Oslo during 1 year. Seventeen percent were considered suicide attempts upon admission, 25% among the nonabusers and 8% among the abusers. At follow-up, 122 patients were dead (61% males). The mortality rate was highest among the abusers. The mortality rate was similar (13%) among those who were considered to be suicidal on admittance and those who were not. The causes of death were suicide (28%), opiate abuse (16%), heart disease (14%), accidents or wounds (11%), alcoholism (9%) and others (22%). The standard mortality rate was highly increased in all groups (8 times on average), highest among the female opiate abusers, whose rate was 63 times higher than expected. The increased suicide rates (87 times for females, 27 times for males), however, may be a more relevant measure of mental morbidity than the standard mortality rate. Logistic regression analysis demonstrated that male sex, age above 50 years and the lowest social group were factors on admission associated with death in the follow-up period. Age above 50 years and suicidal attempt on admission were associated with subsequent suicide. The study strongly supports the idea of self-destructiveness and slow suicide in substance abuse.     

Smokeless tobacco use and the risk of Parkinson's disease mortality.

We examined the association between smokeless tobacco use and Parkinson's disease (PD) mortality as assessed by death certificate in a prospective cohort of 95,981 never-smoking men. In this cohort, smokeless tobacco use is inversely associated with PD mortality, with an age-adjusted risk of 0.22 (0.07-0.67) among current users compared to never users.     

Stroke mortality in São Paulo (1997-2003): a description using the Tenth Revision of the International Classification of Diseases

Stroke mortality rates are higher in Brazil when compared to other countries. The city of S?o Paulo has a good system of mortality surveillance that allow us to describe the epidemiology of the stroke in the city. Our aim was to describe the stroke mortality pattern by gender and age characterizing the ischemic/ hemorrhagic ratio. We categorized mortality data by gender and a 10-year age-strata from 30-39 years-old to 70-79 years-old. To avoid random variations, we calculated the mean of all deaths occurred during the period of 1997 to 2003. Mortality rates were calculated using the population from the Brazilian National Census occurred in 2000. The proportion of deaths from all types of stroke related to all cardiovascular among women was higher when compared to men, mainly during middle-age. In other hand, the risk of stroke death is always higher among men during all ages. Ill-defined stroke certification is more common as underlying cause of death above the 60 years-old (40 percent). Intracerebral hemorrhage was the most frequent cause of stroke death for both sexes from 30 to 59 years-old. Subarachnoideal hemorrhage was much more frequent as cause of death among women than in men. The ratio between ischemic/hemorrhagic (both subtypes) was 0.59 for men and 0.56 for women. Concluding, the magnitude of hemorrhagic stroke is still higher in Sao Paulo city, with an special burden to middle-aged people for both gender.