title: How can the national burden of Parkinson's disease comorbidity and mortality be estimated for the Japanese population?
abstract: BACKGROUND
  Good medical care results in long survival for patients with Parkinson's disease (PD). However, little is known about the burden of PD comorbidity and mortality in Japan. This is the first study to examine comorbid diseases of PD decedents and extrapolate PD death rates from multiple-cause coding mortality data for the total population of Japan.
  
  
  METHODS
  Data for 4589 certified deaths due to PD as the underlying cause of death (ICD-10 code: G20) were obtained from the 2008 Japanese vital statistics. Of those, comorbidities listed in the death certificates of 477 randomly selected decedents were analyzed. All diseases or conditions mentioned on death certificates were counted and ranked in descending order of frequency. The death rates (per 100,000 population) from PD were calculated using Japanese National Vital Statistics. The estimated rate of deaths with PD was extrapolated using US death data from a multiple-cause coding system, as no such system is available in Japan, with adjustment for the difference in disease structure between countries.
  
  
  RESULTS
  Average age at death was 80.9 years. The top 5 comorbid diseases ranked as contributory causes of death were cerebrovascular diseases (4.0%), dementia (3.8%), diabetes mellitus (3.6%), malignant neoplasm (2.5%), and heart diseases (2.3%). Overall, the death rates from and with PD were 3.6 and 5.8, respectively.
  
  
  CONCLUSIONS
  Analysis restricted to data from the underlying-cause coding system underestimated the national burden of PD comorbidity and mortality. Use of death certificates and multiple-cause mortality data complement the existing system.
authors.affiliation: Department of Education and Training Technology, National Institute of Public Health, Wako, Saitama, Japan. yuriko@niph.go.jp
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Doi
authors.forename: Tetsuji
authors.initials: T
authors.lastname: Yokoyama
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Masaki
authors.initials: M
authors.lastname: Nagai
authors.forename: Kenichi
authors.initials: K
authors.lastname: Fujimoto
authors.forename: Imaharu
authors.initials: I
authors.lastname: Nakano
mesh_terms: D000369:Aged, 80 and over; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D017281:Cost of Illness; D003644:Death Certificates; D003704:Dementia / Q000453:epidemiology* / Q000401:mortality; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality; D010300:Parkinson Disease / Q000453:epidemiology* / Q000401:mortality