Postdoctoral researcher Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
Background: Parkinson’s disease and other types of parkinsonism pose a great challenge to public health, especially for countries with aging populations. Tracking the temporal trends of disease burden and treatments could inform healthcare strategies.
Objectives: To determine the incidence and prevalence of Parkinson’s disease (PD), drug induced parkinsonism (DIP) and vascular parkinsonism (VP). Use of antiparkinson drugs was described for these disease populations.
Methods: We included people aged ≥18 years between January 2007 and December 2019 from the Clinical Practice Research Datalink (CPRD) GOLD database. We used a population cohort study design to calculate the annual incidence rates (IR) and prevalence of PD, DIP and VP among the adult population. Subsequently, we calculated antiparkinson drug incidence and prevalence within these disease groups. Annual IR per 100,000 person-years (py) at risk and prevalence (%) were stratified by gender and age (10-year age bands).
Results: Annual IR of Parkinson's disease slightly decreased between 2007 to 2019 (33 to 30/100,000py) whilst prevalence slightly increased during the same time. For VP, IR and prevalence increased from 2007, while estimates remained stable for DIP (IR ~1.5/100,000py, prevalence 0.009%). For PD and VP, IR and prevalence were higher in males whereas for DIP, they were higher in females. All IR and prevalence were highest in older age groups for PD and VP. For PD, IR decreased in those aged >50 years old. The only age strata that saw an increase in prevalence was 61-70 years old. For VP, prevalence increased in those over 80 years old, however, for those aged 61 to 80 prevalence stabilized after 2017. For DIP, IR remained stable in all age groups, however prevalence slightly increased in those aged 61-70 years but decreased in other age groups.
In patients with PD, levodopa had the highest IR and prevalence which increased over the study period compared to other antiparkinson drugs. Prevalence of levodopa was >75%, whereas prevalence of other drugs was ≤ 50%. IR of levodopa was ~20000 per 100,000py whereas it was ≤ 5000 for other drugs. IR and prevalence for levodopa was higher in older age groups, whereas other drugs were prescribed more in younger age groups. In patients with DIP, levodopa was the most frequently prescribed treatment (prevalence ~20%) compared to dopamine agonists (prevalence ~5%), MAO-B Inhibitors (2%) and COMT inhibitors (~1%), and all remained stable over time.
Conclusions: While incidence of Parkinson’s disease slightly decreased during the study period, prevalence slightly increased, potentially due to improved standard of care and survival. As expected, levodopa was the most commonly used drug, especially in the older population in all disease subtypes.
