title: Incidence and remaining lifetime risk of Parkinson disease in advanced age.
abstract: OBJECTIVE
  To estimate the incidence and lifetime risk (LTR) of Parkinson disease (PD) in a large cohort of men.
  
  
  BACKGROUND
  Age is the strongest risk factor for PD, but whether its incidence continues to increase after age 80 years remains unclear.
  
  
  METHODS
  Prospective cohort of 21,970 US male physicians aged 40-84 years at baseline who did not report PD before study entry. Participants self-reported PD on yearly follow-up questionnaires, and all deaths were confirmed. We calculated incidence rates and cumulative incidence using a modified Kaplan-Meier analysis. LTR was estimated by adjusting cumulative incidence for competing risks of death.
  
  
  RESULTS
  Five hundred sixty-three cases of PD were identified over 23 years of follow-up. The crude incidence rate of PD was 121 cases/100,000 person-years. Age-specific incidence rates increased sharply beginning at age 60 years, peaked in those aged 85-89 years, and declined beginning at age 90 years. Cumulative incidence substantially overestimated the long-term risk of PD, particularly in those aged 80 years and older. Cumulative incidence was 9.9% (95% confidence interval [CI] 8.48%-11.30%) from ages 45 to 100 years, whereas LTR for the same period was 6.7% (95% CI 6.01%-7.43%). The incidence and LTR of PD decreased with increasing exposure to smoking.
  
  
  CONCLUSIONS
  Our study provides evidence that the incidence of Parkinson disease (PD) in men increases through age 89 years. Whether the subsequent decline represents a true decrease in risk remains to be established. A history of smoking substantially decreased the incidence and lifetime risk of PD. Incidence studies that do not adjust for competing risks of death may overestimate the true risk of PD in the elderly.
authors.affiliation: Division of Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA. jdriver@partners.org
authors.forename: Jane A
authors.initials: JA
authors.lastname: Driver
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Logroscino
authors.forename: J Michael
authors.initials: JM
authors.lastname: Gaziano
authors.forename: Tobias
authors.initials: T
authors.lastname: Kurth
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D015331:Cohort Studies; D016001:Confidence Intervals; D003627:Data Interpretation, Statistical; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000453:epidemiology*; D011446:Prospective Studies; D020379:Risk Adjustment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology