title: [Geographical distribution of mortality by Parkinson's disease and its association with air lead levels in Spain].
abstract: OBJECTIVE
  Parkinson's disease (PD) is the second most common neurodegenerative disease, and the etiology of its sporadic form is unknown. The present study analyzes the temporal and spatial variations of mortality by PD in Spain over a period of 14 years and its relationship with lead concentration levels in the atmosphere.
  
  
  METHODS
  An ecological study was performed, in which deaths by PD and age group in 50 Spanish provinces between 2000 and 2013 were analyzed. The annual trend of PD mortality was assessed using the non-parametric Spearman's Rho test. Finally, the relationship between lead concentration levels in the air and mortality by PD was evaluated.
  
  
  RESULTS
  Between 2000 and 2013, 36,180 patients with PD died in Spain. There is an increasing trend in mortality through PD over the study period (P<.0001). La Rioja, Asturias, Basque Country and the Lower Ebro valley were the regions with the highest values of PD mortality. Those regions with the highest lead concentrations also showed higher mortality by this disease in people over 64 (P=.02).
  
  
  CONCLUSIONS
  Over our period of study, there has been an increase in mortality through PD in Spain, with the northernmost half of the country registering the highest values. Mortality in men was higher than mortality in women. Moreover, a direct correlation was found between lead levels in the air and mortality through PD.
authors.affiliation: Unidad de Medicina Legal, Departamento de Fisiología y Farmacología, Universidad de Cantabria, Santander, España. Electronic address: ana.santurtun@unican.es.
authors.forename: Ana
authors.initials: A
authors.lastname: Santurtún
authors.affiliation: Área de Investigación de Neurociencias, Instituto de Investigación Sanitaria Biodonostia, San Sebastián, Guipúzcoa, España.
authors.forename: Manuel
authors.initials: M
authors.lastname: Delgado-Alvarado
authors.affiliation: TICNOR S. L., Santander, España.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Villar
authors.affiliation: Servicio de Neurología, Hospital Universitario Marqués de Valdecilla-IDIVAL (CIBERNED), Santander, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Riancho
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000032:analysis / Q000633:toxicity*; D000397:Air Pollution / Q000009:adverse effects* / Q000032:analysis / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007854:Lead / Q000032:analysis / Q000633:toxicity*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000209:etiology / Q000401:mortality*; D012307:Risk Factors; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology
chemical_list: D000393:Air Pollutants; D007854:Lead
keywords: Enfermedad de Parkinson; Lead; Material particulado; Parkinson's disease; Particulate matter; Plomo