title: Use of a VA pharmacy database to screen for areas at high risk for disease: Parkinson's disease and exposure to pesticides.
abstract: The purpose of this study was to assess whether pharmacy database information from US Department of Veterans Affairs (VA) medical centers could be used to screen for areas of higher Parkinson's disease prevalence in patients exposed to pesticides. The authors used pharmacy data sets and compared the use of antiparkinsonian medications at 2 VA medical centers in California: one in Palo Alto, near the ocean, and one in Fresno, downwind from extensively farmed parts of the Central Valley. They found that patients at Fresno had higher odds ratios (1.5-1.8) for the use of Parkinson's disease medications than patients at Palo Alto. These data are consistent with the observations of prior epidemiologic studies and suggest that VA pharmacy databases can prioritize locations for further epidemiologic research. However, a thorough exploration of alternative explanations is needed to reach definitive conclusions regarding the findings suggested by this method.
authors.affiliation: Sierra-Pacific Mental Illness Research, Education, and Clinical Center, Palo Alto VA Health Care System, Palo Alto, CA 94304, USA. yesavage@stanford.edu
authors.forename: J A
authors.initials: JA
authors.lastname: Yesavage
authors.forename: J
authors.initials: J
authors.lastname: Sheikh
authors.forename: A
authors.initials: A
authors.lastname: Noda
authors.forename: G
authors.initials: G
authors.lastname: Murphy
authors.forename: R
authors.initials: R
authors.lastname: O'Hara
authors.forename: R
authors.initials: R
authors.lastname: Hierholzer
authors.forename: M
authors.initials: M
authors.lastname: Battista
authors.forename: J W
authors.initials: JW
authors.lastname: Ashford
authors.forename: H C
authors.initials: HC
authors.lastname: Kraemer
authors.forename: J
authors.initials: J
authors.lastname: Tinklenberg
mesh_terms: D000978:Antiparkinson Agents / Q000627:therapeutic use*; D002140:California / Q000453:epidemiology; D019992:Databases as Topic / Q000706:statistics & numerical data*; D004781:Environmental Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D006751:Hospital Information Systems / Q000706:statistics & numerical data*; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D016017:Odds Ratio; D010302:Parkinson Disease, Secondary / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology; D010575:Pesticides / Q000633:toxicity*; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data*; D018570:Risk Assessment / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D000978:Antiparkinson Agents; D010575:Pesticides