Measuring the burden and mortality of hospitalisation in Parkinson's disease: A cross-sectional analysis of the English Hospital Episodes Statistics database 2009-2013.
BACKGROUND
Patients with Parkinson's disease have higher hospital admission rates than the general population. We examined the reasons for admission, length of stay, costs, and in-hospital mortality in a national sample of Parkinson's disease patients.


METHODS
We used hospital admission data from the English Hospital Episodes Statistics database (2009-2013). Patients with Parkinson's disease or Parkinson's disease dementia and aged over 35 years were compared to all other admissions, excluding the above, with the same age criteria. We examined reasons for admissions (ICD-10), length of stay and in-hospital mortality. We used indirect standardisation and Poisson modelling to derive proportional ratios adjusting for age group and sex.


RESULTS
There were 324,055 Parkinson's disease admissions in 182,859 patients over 4 years which included 232,905 non-elective admissions (72%). This resulted in expenditure of £907 million (£777 million for non-elective admissions). The main reasons for admission were pneumonia (13.5%), motor decline (9.4%), urinary tract infection (9.2%), and hip fractures (4.3%). These conditions occurred 1.5 to 2.6 times more frequently in patients than controls. Patients with Parkinson's disease were almost twice as likely to stay in hospital for more than 3 months (ratio 1.90, 95% CI 1.83, 1.97) and even more likely die in hospital (ratio 2.46, 95% CI 2.42, 2.49).


CONCLUSIONS
Parkinson's disease patients in England have higher rates of emergency admissions with longer hospital stays, higher costs and in-hospital mortality. Urgent attention should be given to developing cost-effective interventions to reduce the burden of hospitalisation for patients, carers and healthcare systems.
UCB Pharma Ltd, 208 Bath Road, Slough SL1 3WE, UK.
Vincent
V
Low
School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, UK.
Yoav
Y
Ben-Shlomo
UCB Pharma Ltd, 208 Bath Road, Slough SL1 3WE, UK.
Elena
E
Coward
UCB Pharma Ltd, 208 Bath Road, Slough SL1 3WE, UK.
Suzanne
S
Fletcher
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear NE29 8NH, UK; Institute of Health and Society, Newcastle University, Framlington Place, Newcastle upon Tyne NE1 7RU, UK.
Richard
R
Walker
School of Clinical and Experimental Medicine, College of Medicine and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Birmingham B18 7QH, UK. Electronic address: carlclarke@nhs.net.
Carl E
CE
Clarke
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D016208:Databases, Factual / Q000639:trends*; D004739:England / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis / Q000191:economics* / Q000401:mortality*; D012189:Retrospective Studies
Health economics; Hospitalisation; Mortality; Parkinson's disease