title: Estimation of Parkinson's disease survival in Israeli men and women, using health maintenance organization pharmacy data in a unique approach.
abstract: The aim of this work was to estimate in an incident cohort of pharmacy-based PD patients the survival of men and women accounting for age at treatment initiation and to compare their gender-specific survival with that of the general Israeli population. A population-based cohort of 4,848 incident pharmacy-based PD cases with definite/probable/possible certainty was previously identified using a drug-tracer approach for 1999-2008. Survival analysis was performed for two time scales: survival after treatment initiation (disease duration), and life-time survival (life expectancy). Kaplan-Meier curves and Cox regressions were used to compare survival across gender. Gender-specific SMRs were calculated from national rates and were compared using Poisson regression. During the follow-up from first purchase of any anti-parkinsonian drug (mean 4.0 ± 2.6 years, range 2 months-10 years), 1,266 (26 %) of the cases died. Younger age at first anti-parkinsonian drug purchase and female gender were associated with increased survival after treatment initiation (HR = 1.089, 95 % CI 1.080-1.098 for 1-year age increase; HR = 0.716, 95 % CI 0.640-0.800, females vs. males). Life-time survival increased with older age at first anti-parkinsonian drug purchase and female gender (HR = 0.759, 95 % CI 0.746-0.771 for 1-year age increase; HR = 0.694, 95 % CI 0.621-0.776, females vs. males). Sensitivity analysis on a sub-cohort of definite cases (n = 2501) yielded similar results. In comparison to the general Israeli population, mortality among pharmacy-based PD patients was significantly increased (SMR(men) = 1.69, 95 % CI 1.57-1.81, SMR(women) = 1.49, 95 % CI 1.37-1.62), differently between genders (p < 0.01). Female gender was associated with longer, perhaps more benign disease course, and longer life expectancy. Earlier age at anti-parkinsonian drug initiation increased disease duration, but was associated with shorter life expectancy.
authors: School of Public Health, University of Haifa, Haifa, Israel.
authors: O
authors: O
authors: Chillag-Talmor
authors: N
authors: N
authors: Giladi
authors: S
authors: S
authors: Linn
authors: T
authors: T
authors: Gurevich
authors: B
authors: B
authors: El-Ad
authors: B
authors: B
authors: Silverman
authors: N
authors: N
authors: Friedman
authors: C
authors: C
authors: Peretz
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000978:Antiparkinson Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018672:Community Health Planning; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality*; D010604:Pharmacy; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D012727:Sex Characteristics; D016019:Survival Analysis; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000978:Antiparkinson Agents