title: Co-morbidities of persons dying of Parkinson's disease.
abstract: BACKGROUND
  Disease interactions can alter functional decline near the end of life (EOL). Parkinson's disease (PD) is characterized by frequent occurrences of co-morbidities but data challenges have limited studies investigating co-morbidities across a broad range of diseases. The goal of this study was to describe disease associations with PD.
  
  
  METHODS
  We conducted an analysis of death certificate data from 1998 to 2005 in Nova Scotia. All death causes were utilized to select individuals dying of PD and compare with the general population and an age-sex-matched sample without PD. We calculated the mean number of death causes and frequency of disease co-occurrence. To account for the chance occurrence of co-morbidities and measure the strength of association, observed to expected ratios were calculated.
  
  
  RESULTS
  PD decedents had a higher mean number of death causes (3.37) than the general population (2.77) and age-sex-matched sample (2.88). Cancer was the most common cause in the population and matched sample but fifth for those with PD. Cancer was one of nine diseases that occurred less often than what would be expected by chance while four were not correlated with PD. Dementia and pneumonia occurred with PD 2.53 ([CI] 2.21-2.85) and 1.83 (CI 1.58-2.08) times more often than expected. The strength of association for both is reduced but remains statistically significant when controlling for age and sex.
  
  
  CONCLUSIONS
  Those with PD have a higher number of co-morbidities even after controlling for age and sex. Individuals dying with PD are more likely to have dementia and pneumonia, which has implications for the provision of care at EOL.
authors.affiliation: School of Health Administration, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Lynn
authors.initials: L
authors.lastname: Lethbridge
authors.forename: Grace M
authors.initials: GM
authors.lastname: Johnston
authors.forename: George
authors.initials: G
authors.lastname: Turnbull
keywords: Advance care planning; Co-morbidity; Death certificates; Palliative care; Parkinson disease