Age-, gender-, and socioeconomic status-specific incidence of Parkinson's disease and parkinsonism in North East Scotland: The PINE study
Introduction
Knowledge of the incidence of a condition is important both in terms of planning the allocation of healthcare resources and, when compared between populations, in identifying potential aetiological factors. A systematic review of incidence studies of Parkinson's disease (PD) carried out in 2001 [1], found only five comparable, high quality studies, none of which had prospective follow-up of the incident cohort. Follow-up is required to improve the accuracy of the diagnosis of PD, which may be poor in the early stages of the condition [2], [3] and to provide the most accurate and representative data on prognosis.
We undertook a large, two-phase, prospective, community-based incidence study of Parkinson's disease and other degenerative or vascular parkinsonian conditions with planned long-term follow-up of the incident cohort in order to calculate age-gender specific incidence figures. Further, as the role of socioeconomic status in the aetiology of PD has not been extensively studied, we aimed to calculate incidence by socioeconomic group. A previous study in the same area carried out 20 years previously found a prevalence of around 165 per 100,000 but did not report a figure for incidence [4].
Section snippets
Methods
The Parkinsonism Incidence in North-East Scotland (PINE) study attempted to identify all incident patients with degenerative or vascular parkinsonism in a well-defined population in and around Aberdeen, UK. This was done in two phases: a pilot phase in 148,600 people registered with 18 general (primary care) practices over 18 months from November 2002, and the main phase extended to 317,357 people from all 37 general practices in the area over 36 months from April 2006 (Fig. S1). Everyone in
Results
The study profile is shown in Fig. 1. Out of 828 potentially incident patients assessed, 697 were assessed in the study outpatient clinic, 41 (mean age 81.0 (standard deviation (SD) 7.7), 61% of whom became incident patients) were assessed at home or in their nursing home and a further 72 (mean age 79.0 (SD 9.2); 65% became incident patients) were initially assessed as hospital inpatients. All but eighteen patients (2% of those identified) were assessed in person by a study doctor. Four died
Discussion
This study found the crude incidence of clinically probable PD in the North East of Scotland to be 17.9/100,000/year, and of clinically probable vascular or neurodegenerative parkinsonism to be 28.7/100,000/year. These are likely to be underestimates given that some older patients remain undiagnosed in the community [6], [7].
As expected, the incidence both of PD and parkinsonism was higher in men [30] and increased with age, peaking in the 9th decade. However, given there were only 5644.5
Conclusion
This study found a similar incidence of PD and parkinsonism in north-east Scotland to the few other high quality studies with no variation by socioeconomic status. Ongoing follow-up of this and other incident cohorts will yield important new information regarding the prognosis of these conditions, which up until now has largely been based on younger non-representative cohorts of patients. Further high quality incidence studies are required especially from Asia, North America and the southern
Author contributions
R. Caslake performed the literature search and updated the systematic review, recruited participants and collected data, analysed data and wrote the first draft of the paper.
K. Taylor performed the initial systematic review, recruited patients and collected data.
N. Scott provided statistical support.
J. Gordon and C. Harris recruited participants and collected data and performed electronic database searching.
K. Wilde provided IT and data management support.
A. Murray provided diagnostic radiology
Funders
Parkinson's UK, Doris Hillier BMA Award, BUPA Foundation, SPRING, NHS Grampian Endowments.
Conflicts of interest
None declared.
Acknowledgements
We thank our funders (Parkinson's UK, Doris Hillier BMA Award, the BUPA Foundation, SPRING, NHS Grampian Endowments), Susan Kilpatrick for secretarial support, and all the patients and general practices that took part.
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