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Vol. 34, No. 3, 2010
Issue release date: April 2010
Section title: Original Paper
Free Access
Neuroepidemiology 2010;34:143–151
(DOI:10.1159/000275491)

Geographic and Ethnic Variation in Parkinson Disease: A Population-Based Study of US Medicare Beneficiaries

Wright Willis A.a · Evanoff B.A.b · Lian M.b · Criswell S.R.a · Racette B.A.a
Departments of aNeurology and bInternal Medicine, Washington University School of Medicine, St. Louis, Mo., USA
email Corresponding Author

Abstract

Background: Parkinson disease is a common neurodegenerative disease. The racial, sex, age, and geographic distributions of Parkinson disease in the US are unknown. Methods: We performed a serial cross-sectional study of US Medicare beneficiaries aged 65 and older from the years 1995, and 2000–2005. Using over 450,000 Parkinson disease cases per year, we calculated Parkinson disease prevalence and annual incidence by race, age, sex, and county. Spatial analysis investigated the geographic distribution of Parkinson disease. Results: Age-standardized Parkinson disease prevalence (per 100,000) was 2,168.18 (±95.64) in White men, but 1,036.41 (±86.01) in Blacks, and 1,138.56 (±46.47) in Asians. The incidence ratio in Blacks as compared to Whites (0.74; 95% CI = 0.732–0.748) was higher than the prevalence ratio (0.58; 95% CI = 0.575–0.581), whereas the incidence ratio for Asians (0.69; 95% CI = 0.657–0.723) was similar to the prevalence ratio (0.62; 95% CI = 0.617–0.631). Bayesian mapping of Parkinson disease revealed a concentration in the Midwest and Northeast regions. Mean county incidence by quartile ranged from 279 to 3,111, and prevalence from 1,175 to 13,800 (per 100,000). Prevalence and incidence in urban counties were greater than in rural ones (p < 0.01). Cluster analysis supported a nonrandom distribution of both incident and prevalent Parkinson disease cases (p < 0.001). Conclusions: Parkinson disease is substantially more common in Whites, and is nonrandomly distributed in the Midwest and Northeastern US.

© 2010 S. Karger AG, Basel


  

Key Words

  • Parkinson disease
  • Geographical information systems
  • Environment
  • Prevalence study
  • Incidence study

References

  1. von Campenhausen S, Bornschein B, Wick R, Botzel K, Sampaio C, Poewe W, Oertel W, Siebert U, Berger K, Dodel R: Prevalence and incidence of Parkinson’s disease in Europe. Eur Neuropsychopharmacol 2005;15:473–490.
  2. Kurtzke JF, Goldberg ID: Parkinsonism death rates by race, sex, and geography. Neurology 1988;38:1558–1561.
  3. Lanska DJ: The geographic distribution of Parkinson’s disease mortality in the United States. J Neurol Sci 1997;150:63–70.
  4. Lilienfeld DE, Sekkor D, Simpson S, Perl DP, Ehland J, Marsh G, Chan E, Godbold JH, Landrigan PJ: Parkinsonism death rates by race, sex and geography: a 1980s update. Neuroepidemiology 1990;9:243–247.
  5. Wooten GF, Currie LJ, Bovbjerg VE, Lee JK, Patrie J: Are men at greater risk for Parkinson’s disease than women? J Neurol Neurosurg Psychiatry 2004;75:637–639.
  6. Van Den Eeden SK, Tanner CM, Bernstein AL, Fross RD, Leimpeter A, Bloch DA, Nelson LM: Incidence of Parkinson’s disease: variation by age, gender, and race/ethnicity. Am J Epidemiol 2003;157:1015–1022.
  7. Mayeux R, Marder K, Cote LJ, Denaro J, Hemenegildo N, Mejia H, Tang MX, Lantigua R, Wilder D, Gurland B: The frequency of idiopathic Parkinson’s disease by age, ethnic group, and sex in northern Manhattan, 1988–1993. Am J Epidemiol 1995;142:820–827.
  8. Mayeux R, Marder K, Cote LJ, Denaro J, Hemenegildo N, Mejia H, Tang MX, Lantigua R, Wilder D, Gurland B: The frequency of idiopathic Parkinson’s disease by age, ethnic group, and sex in northern Manhattan, 1988–1993. Am J Epidemiol 1995;142:820–827.
  9. Van Den Eeden SK, Tanner CM, Bernstein AL, Fross RD, Leimpeter A, Bloch DA, Nelson LM: Incidence of Parkinson’s disease: variation by age, gender, and race/ethnicity. Am J Epidemiol 2003;157:1015–1022.
  10. Newman EJ, Grosset KA, Grosset DG: Geographical difference in Parkinson’s disease prevalence within West Scotland. Mov Disord 2009;24:401–406.
  11. Priyadarshi A, Khuder SA, Schaub EA, Priyadarshi SS: Environmental risk factors and Parkinson’s disease: a meta-analysis. Environ Res 2001;86:122–127.
  12. Rybicki BA, Johnson CC, Uman J, Gorell JM: Parkinson’s disease mortality and the industrial use of heavy metals in Michigan. Mov Disord 1993;8:87–92.
  13. French NP, Berriatua E, Wall R, Smith K, Morgan KL: Sheep scab outbreaks in Great Britain between 1973 and 1992: spatial and temporal patterns. Vet Parasitol 1999;83:187–200.
  14. Ernst JS: Mapping child maltreatment: looking at neighborhoods in a suburban county. Child Welfare 2000;79:555–572.
  15. Nkhoma ET, Hsu CE, Hunt VI, Harris AM: Detecting spatiotemporal clusters of accidental poisoning mortality among Texas counties, US, 1980–2001. Int J Health Geogr 2004;3:25.
  16. English P, Neutra R, Scalf R, Sullivan M, Waller L, Zhu L: Examining associations between childhood asthma and traffic flow using a geographic information system. Environ Health Perspect 1999;107:761–767.
  17. Reif JS, Burch JB, Nuckols JR, Metzger L, Ellington D, Anger WK: Neurobehavioral effects of exposure to trichloroethylene through a municipal water supply. Environ Res 2003;93:248–258.
  18. Nerriere E, Zmirou-Navier D, Desqueyroux P, Leclerc N, Momas I, Czernichow P: Lung cancer risk assessment in relation with personal exposure to airborne particles in four French metropolitan areas. J Occup Environ Med 2005;47:1211–1217.
  19. Larsen K, Merlo J: Appropriate assessment of neighborhood effects on individual health: integrating random and fixed effects in multilevel logistic regression. Am J Epidemiol 2005;161:81–88.
  20. Chaix B, Merlo J, Subramanian SV, Lynch J, Chauvin P: Comparison of a spatial perspective with the multilevel analytical approach in neighborhood studies: the case of mental and behavioral disorders due to psychoactive substance use in Malmo, Sweden, 2001. Am J Epidemiol 2005;162:171–182.
  21. Rybicki BA, Johnson CC, Uman J, Gorell JM: Parkinson’s disease mortality and the industrial use of heavy metals in Michigan. Mov Disord 1993;8:87–92.
  22. de Rijk MC, Breteler MM, Graveland GA, Ott A, Grobbee DE, van der Meche FG, Hofman A: Prevalence of Parkinson’s disease in the elderly: the Rotterdam Study. Neurology 1995;45:2143–2146.
  23. de Rijk MC, Tzourio C, Breteler MM, Dartigues JF, Amaducci L, Lopez-Pousa S, Manubens-Bertran JM, Alperovitch A, Rocca WA: Prevalence of parkinsonism and Parkinson’s disease in Europe: the EUROPARKINSON Collaborative Study. European Community Concerted Action on the Epidemiology of Parkinson’s Disease. J Neurol Neurosurg Psychiatry 1997;62:10–15.
  24. Tison F, Dartigues JF, Dubes L, Zuber M, Alperovitch A, Henry P: Prevalence of Parkinson’s disease in the elderly: a population study in Gironde, France. Acta Neurol Scand 1994;90:111–115.
  25. Marttila RJ, Rinne UK: Epidemiology of Parkinson’s disease in Finland. Acta Neurol Scand 1976;53:81–102.
  26. Taba P, Asser T: Incidence of Parkinson’s disease in estonia. Neuroepidemiology 2003;22:41–45.
  27. Benito-Leon J, Bermejo-Pareja F, Rodriguez J, Molina JA, Gabriel R, Morales JM: Prevalence of PD and other types of parkinsonism in three elderly populations of central Spain. Mov Disord 2003;18:267–274.
  28. Tanner CM, Ottman R, Goldman SM, Ellenberg J, Chan P, Mayeux R, Langston JW: Parkinson disease in twins: an etiologic study. JAMA 1999;281:341–346.
  29. Schrag A, Ben-Shlomo Y, Quinn NP: Prevalence of progressive supranuclear palsy and multiple system atrophy: a cross-sectional study. Lancet 1999;354:1771–1775.
  30. Bower JH, Maraganore DM, McDonnell SK, Rocca WA: Incidence of progressive supranuclear palsy and multiple system atrophy in Olmsted County, Minnesota, 1976 to 1990. Neurology 1997;49:1284–1288.

  

Author Contacts

Allison Wright Willis, MD
Washington University School of Medicine
660 South Euclid Avenue, Campus Box 8111
St. Louis, MO 63110 (USA)
Tel. +1 314 362 6908, E-Mail wrighta@neuro.wustl.edu

  

Article Information

Received: July 26, 2009
Accepted: October 14, 2009
Published online: January 15, 2010
Number of Print Pages : 9
Number of Figures : 2, Number of Tables : 4, Number of References : 30

  

Publication Details

Neuroepidemiology

Vol. 34, No. 3, Year 2010 (Cover Date: April 2010)

Journal Editor: Feigin V.L. (Auckland)
ISSN: 0251-5350 (Print), eISSN: 1423-0208 (Online)

For additional information: http://www.karger.com/NED


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Background: Parkinson disease is a common neurodegenerative disease. The racial, sex, age, and geographic distributions of Parkinson disease in the US are unknown. Methods: We performed a serial cross-sectional study of US Medicare beneficiaries aged 65 and older from the years 1995, and 2000–2005. Using over 450,000 Parkinson disease cases per year, we calculated Parkinson disease prevalence and annual incidence by race, age, sex, and county. Spatial analysis investigated the geographic distribution of Parkinson disease. Results: Age-standardized Parkinson disease prevalence (per 100,000) was 2,168.18 (±95.64) in White men, but 1,036.41 (±86.01) in Blacks, and 1,138.56 (±46.47) in Asians. The incidence ratio in Blacks as compared to Whites (0.74; 95% CI = 0.732–0.748) was higher than the prevalence ratio (0.58; 95% CI = 0.575–0.581), whereas the incidence ratio for Asians (0.69; 95% CI = 0.657–0.723) was similar to the prevalence ratio (0.62; 95% CI = 0.617–0.631). Bayesian mapping of Parkinson disease revealed a concentration in the Midwest and Northeast regions. Mean county incidence by quartile ranged from 279 to 3,111, and prevalence from 1,175 to 13,800 (per 100,000). Prevalence and incidence in urban counties were greater than in rural ones (p < 0.01). Cluster analysis supported a nonrandom distribution of both incident and prevalent Parkinson disease cases (p < 0.001). Conclusions: Parkinson disease is substantially more common in Whites, and is nonrandomly distributed in the Midwest and Northeastern US.

© 2010 S. Karger AG, Basel


  

Author Contacts

Allison Wright Willis, MD
Washington University School of Medicine
660 South Euclid Avenue, Campus Box 8111
St. Louis, MO 63110 (USA)
Tel. +1 314 362 6908, E-Mail wrighta@neuro.wustl.edu

  

Article Information

Received: July 26, 2009
Accepted: October 14, 2009
Published online: January 15, 2010
Number of Print Pages : 9
Number of Figures : 2, Number of Tables : 4, Number of References : 30

  

Publication Details

Neuroepidemiology

Vol. 34, No. 3, Year 2010 (Cover Date: April 2010)

Journal Editor: Feigin V.L. (Auckland)
ISSN: 0251-5350 (Print), eISSN: 1423-0208 (Online)

For additional information: http://www.karger.com/NED


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 7/26/2009
Accepted: 10/14/2009
Published online: 1/15/2010
Issue release date: April 2010

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 4

ISSN: 0251-5350 (Print)
eISSN: 1423-0208 (Online)

For additional information: http://www.karger.com/NED


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. von Campenhausen S, Bornschein B, Wick R, Botzel K, Sampaio C, Poewe W, Oertel W, Siebert U, Berger K, Dodel R: Prevalence and incidence of Parkinson’s disease in Europe. Eur Neuropsychopharmacol 2005;15:473–490.
  2. Kurtzke JF, Goldberg ID: Parkinsonism death rates by race, sex, and geography. Neurology 1988;38:1558–1561.
  3. Lanska DJ: The geographic distribution of Parkinson’s disease mortality in the United States. J Neurol Sci 1997;150:63–70.
  4. Lilienfeld DE, Sekkor D, Simpson S, Perl DP, Ehland J, Marsh G, Chan E, Godbold JH, Landrigan PJ: Parkinsonism death rates by race, sex and geography: a 1980s update. Neuroepidemiology 1990;9:243–247.
  5. Wooten GF, Currie LJ, Bovbjerg VE, Lee JK, Patrie J: Are men at greater risk for Parkinson’s disease than women? J Neurol Neurosurg Psychiatry 2004;75:637–639.
  6. Van Den Eeden SK, Tanner CM, Bernstein AL, Fross RD, Leimpeter A, Bloch DA, Nelson LM: Incidence of Parkinson’s disease: variation by age, gender, and race/ethnicity. Am J Epidemiol 2003;157:1015–1022.
  7. Mayeux R, Marder K, Cote LJ, Denaro J, Hemenegildo N, Mejia H, Tang MX, Lantigua R, Wilder D, Gurland B: The frequency of idiopathic Parkinson’s disease by age, ethnic group, and sex in northern Manhattan, 1988–1993. Am J Epidemiol 1995;142:820–827.
  8. Mayeux R, Marder K, Cote LJ, Denaro J, Hemenegildo N, Mejia H, Tang MX, Lantigua R, Wilder D, Gurland B: The frequency of idiopathic Parkinson’s disease by age, ethnic group, and sex in northern Manhattan, 1988–1993. Am J Epidemiol 1995;142:820–827.
  9. Van Den Eeden SK, Tanner CM, Bernstein AL, Fross RD, Leimpeter A, Bloch DA, Nelson LM: Incidence of Parkinson’s disease: variation by age, gender, and race/ethnicity. Am J Epidemiol 2003;157:1015–1022.
  10. Newman EJ, Grosset KA, Grosset DG: Geographical difference in Parkinson’s disease prevalence within West Scotland. Mov Disord 2009;24:401–406.
  11. Priyadarshi A, Khuder SA, Schaub EA, Priyadarshi SS: Environmental risk factors and Parkinson’s disease: a meta-analysis. Environ Res 2001;86:122–127.
  12. Rybicki BA, Johnson CC, Uman J, Gorell JM: Parkinson’s disease mortality and the industrial use of heavy metals in Michigan. Mov Disord 1993;8:87–92.
  13. French NP, Berriatua E, Wall R, Smith K, Morgan KL: Sheep scab outbreaks in Great Britain between 1973 and 1992: spatial and temporal patterns. Vet Parasitol 1999;83:187–200.
  14. Ernst JS: Mapping child maltreatment: looking at neighborhoods in a suburban county. Child Welfare 2000;79:555–572.
  15. Nkhoma ET, Hsu CE, Hunt VI, Harris AM: Detecting spatiotemporal clusters of accidental poisoning mortality among Texas counties, US, 1980–2001. Int J Health Geogr 2004;3:25.
  16. English P, Neutra R, Scalf R, Sullivan M, Waller L, Zhu L: Examining associations between childhood asthma and traffic flow using a geographic information system. Environ Health Perspect 1999;107:761–767.
  17. Reif JS, Burch JB, Nuckols JR, Metzger L, Ellington D, Anger WK: Neurobehavioral effects of exposure to trichloroethylene through a municipal water supply. Environ Res 2003;93:248–258.
  18. Nerriere E, Zmirou-Navier D, Desqueyroux P, Leclerc N, Momas I, Czernichow P: Lung cancer risk assessment in relation with personal exposure to airborne particles in four French metropolitan areas. J Occup Environ Med 2005;47:1211–1217.
  19. Larsen K, Merlo J: Appropriate assessment of neighborhood effects on individual health: integrating random and fixed effects in multilevel logistic regression. Am J Epidemiol 2005;161:81–88.
  20. Chaix B, Merlo J, Subramanian SV, Lynch J, Chauvin P: Comparison of a spatial perspective with the multilevel analytical approach in neighborhood studies: the case of mental and behavioral disorders due to psychoactive substance use in Malmo, Sweden, 2001. Am J Epidemiol 2005;162:171–182.
  21. Rybicki BA, Johnson CC, Uman J, Gorell JM: Parkinson’s disease mortality and the industrial use of heavy metals in Michigan. Mov Disord 1993;8:87–92.
  22. de Rijk MC, Breteler MM, Graveland GA, Ott A, Grobbee DE, van der Meche FG, Hofman A: Prevalence of Parkinson’s disease in the elderly: the Rotterdam Study. Neurology 1995;45:2143–2146.
  23. de Rijk MC, Tzourio C, Breteler MM, Dartigues JF, Amaducci L, Lopez-Pousa S, Manubens-Bertran JM, Alperovitch A, Rocca WA: Prevalence of parkinsonism and Parkinson’s disease in Europe: the EUROPARKINSON Collaborative Study. European Community Concerted Action on the Epidemiology of Parkinson’s Disease. J Neurol Neurosurg Psychiatry 1997;62:10–15.
  24. Tison F, Dartigues JF, Dubes L, Zuber M, Alperovitch A, Henry P: Prevalence of Parkinson’s disease in the elderly: a population study in Gironde, France. Acta Neurol Scand 1994;90:111–115.
  25. Marttila RJ, Rinne UK: Epidemiology of Parkinson’s disease in Finland. Acta Neurol Scand 1976;53:81–102.
  26. Taba P, Asser T: Incidence of Parkinson’s disease in estonia. Neuroepidemiology 2003;22:41–45.
  27. Benito-Leon J, Bermejo-Pareja F, Rodriguez J, Molina JA, Gabriel R, Morales JM: Prevalence of PD and other types of parkinsonism in three elderly populations of central Spain. Mov Disord 2003;18:267–274.
  28. Tanner CM, Ottman R, Goldman SM, Ellenberg J, Chan P, Mayeux R, Langston JW: Parkinson disease in twins: an etiologic study. JAMA 1999;281:341–346.
  29. Schrag A, Ben-Shlomo Y, Quinn NP: Prevalence of progressive supranuclear palsy and multiple system atrophy: a cross-sectional study. Lancet 1999;354:1771–1775.
  30. Bower JH, Maraganore DM, McDonnell SK, Rocca WA: Incidence of progressive supranuclear palsy and multiple system atrophy in Olmsted County, Minnesota, 1976 to 1990. Neurology 1997;49:1284–1288.