Co-morbidity burden in Parkinson’s disease: Comparison with controls and its influence on prognosis

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Abstract

Background

Many aspects of co-morbidity burden in Parkinson’s disease (PD) are unclear, but it may be an important predictor of prognosis or confounder of associations in epidemiological studies.

Objectives

To determine how best to assess co-morbidity burden in PD, to compare with matched controls, and investigate its association with prognostic outcomes.

Methods

Data from an incident, community-based cohort with prospective follow-up (the PINE study) were used (198 patients with PD and 151 controls). The reliability of three co-morbidity scales (the Charlson co-morbidity index (CCI), the Cumulative Illness Rating scale and a simple disease count) were evaluated. The association with mortality and development of dependency was assessed with Cox regression. The co-morbidity burden in PD and controls was compared at baseline and over 5 years of follow-up using linear mixed modelling.

Results

The CCI was more reliable and was an independent predictor of mortality with a time-dependent effect (hazard ratio = 1.27 [1.08–1.49] in first four years of follow-up; no significant association after four years). Associations between the other scales and mortality and between each scale and development of dependency were non-significant once adjusted for confounders. Co-morbidity burden was similar between cases and controls at baseline and there was no evidence of differential accrual of co-morbidity between patients and controls (p = 0.94).

Conclusions

The CCI is probably the better scale for measuring co-morbidity burden in PD. There were no differences between PD and controls. Co-morbidity burden at diagnosis was associated with mortality in the early part of the disease course, but not later.
Original languageEnglish
Pages (from-to)124-129
Number of pages6
JournalParkinsonism & Related Disorders
Volume28
Early online date14 May 2016
DOIs
Publication statusPublished - Jul 2016

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Parkinson Disease
Morbidity
Mortality
Epidemiologic Studies

Keywords

  • Parkinson’s disease
  • co-morbidity
  • Charlson
  • mortality
  • dependency

Cite this

@article{750801a2adcd4ea4acbb07f33e2f59a1,
title = "Co-morbidity burden in Parkinson’s disease: Comparison with controls and its influence on prognosis",
abstract = "BackgroundMany aspects of co-morbidity burden in Parkinson’s disease (PD) are unclear, but it may be an important predictor of prognosis or confounder of associations in epidemiological studies.ObjectivesTo determine how best to assess co-morbidity burden in PD, to compare with matched controls, and investigate its association with prognostic outcomes.MethodsData from an incident, community-based cohort with prospective follow-up (the PINE study) were used (198 patients with PD and 151 controls). The reliability of three co-morbidity scales (the Charlson co-morbidity index (CCI), the Cumulative Illness Rating scale and a simple disease count) were evaluated. The association with mortality and development of dependency was assessed with Cox regression. The co-morbidity burden in PD and controls was compared at baseline and over 5 years of follow-up using linear mixed modelling.ResultsThe CCI was more reliable and was an independent predictor of mortality with a time-dependent effect (hazard ratio = 1.27 [1.08–1.49] in first four years of follow-up; no significant association after four years). Associations between the other scales and mortality and between each scale and development of dependency were non-significant once adjusted for confounders. Co-morbidity burden was similar between cases and controls at baseline and there was no evidence of differential accrual of co-morbidity between patients and controls (p = 0.94).ConclusionsThe CCI is probably the better scale for measuring co-morbidity burden in PD. There were no differences between PD and controls. Co-morbidity burden at diagnosis was associated with mortality in the early part of the disease course, but not later.",
keywords = "Parkinson’s disease, co-morbidity, Charlson, mortality, dependency",
author = "MacLeod, {Angus D.} and Hannah Goddard and Counsell, {Carl E.}",
note = "Financial support This study was funded by Parkinson’s UK, the Scottish Chief Scientist Office, NHS Grampian endowments, the BMA Doris Hillier award, RS Macdonald Trust, the BUPA Foundation, and SPRING. The funders had no involvement in the study. Acknowledgements We acknowledge funding for the PINE study from Parkinson’s UK (G-0502, G-0914, G-1302), the Scottish Chief Scientist Office(CAF/12/05), the BMA Doris Hillier award, RS Macdonald Trust, the BUPA Foundation, NHS Grampian endowments and SPRING. We thank the patients and controls for their participation and the research staff who collected data and supported the study database.",
year = "2016",
month = "7",
doi = "10.1016/j.parkreldis.2016.05.013",
language = "English",
volume = "28",
pages = "124--129",
journal = "Parkinsonism & Related Disorders",
issn = "1353-8020",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Co-morbidity burden in Parkinson’s disease

T2 - Comparison with controls and its influence on prognosis

AU - MacLeod, Angus D.

AU - Goddard, Hannah

AU - Counsell, Carl E.

N1 - Financial support This study was funded by Parkinson’s UK, the Scottish Chief Scientist Office, NHS Grampian endowments, the BMA Doris Hillier award, RS Macdonald Trust, the BUPA Foundation, and SPRING. The funders had no involvement in the study. Acknowledgements We acknowledge funding for the PINE study from Parkinson’s UK (G-0502, G-0914, G-1302), the Scottish Chief Scientist Office(CAF/12/05), the BMA Doris Hillier award, RS Macdonald Trust, the BUPA Foundation, NHS Grampian endowments and SPRING. We thank the patients and controls for their participation and the research staff who collected data and supported the study database.

PY - 2016/7

Y1 - 2016/7

N2 - BackgroundMany aspects of co-morbidity burden in Parkinson’s disease (PD) are unclear, but it may be an important predictor of prognosis or confounder of associations in epidemiological studies.ObjectivesTo determine how best to assess co-morbidity burden in PD, to compare with matched controls, and investigate its association with prognostic outcomes.MethodsData from an incident, community-based cohort with prospective follow-up (the PINE study) were used (198 patients with PD and 151 controls). The reliability of three co-morbidity scales (the Charlson co-morbidity index (CCI), the Cumulative Illness Rating scale and a simple disease count) were evaluated. The association with mortality and development of dependency was assessed with Cox regression. The co-morbidity burden in PD and controls was compared at baseline and over 5 years of follow-up using linear mixed modelling.ResultsThe CCI was more reliable and was an independent predictor of mortality with a time-dependent effect (hazard ratio = 1.27 [1.08–1.49] in first four years of follow-up; no significant association after four years). Associations between the other scales and mortality and between each scale and development of dependency were non-significant once adjusted for confounders. Co-morbidity burden was similar between cases and controls at baseline and there was no evidence of differential accrual of co-morbidity between patients and controls (p = 0.94).ConclusionsThe CCI is probably the better scale for measuring co-morbidity burden in PD. There were no differences between PD and controls. Co-morbidity burden at diagnosis was associated with mortality in the early part of the disease course, but not later.

AB - BackgroundMany aspects of co-morbidity burden in Parkinson’s disease (PD) are unclear, but it may be an important predictor of prognosis or confounder of associations in epidemiological studies.ObjectivesTo determine how best to assess co-morbidity burden in PD, to compare with matched controls, and investigate its association with prognostic outcomes.MethodsData from an incident, community-based cohort with prospective follow-up (the PINE study) were used (198 patients with PD and 151 controls). The reliability of three co-morbidity scales (the Charlson co-morbidity index (CCI), the Cumulative Illness Rating scale and a simple disease count) were evaluated. The association with mortality and development of dependency was assessed with Cox regression. The co-morbidity burden in PD and controls was compared at baseline and over 5 years of follow-up using linear mixed modelling.ResultsThe CCI was more reliable and was an independent predictor of mortality with a time-dependent effect (hazard ratio = 1.27 [1.08–1.49] in first four years of follow-up; no significant association after four years). Associations between the other scales and mortality and between each scale and development of dependency were non-significant once adjusted for confounders. Co-morbidity burden was similar between cases and controls at baseline and there was no evidence of differential accrual of co-morbidity between patients and controls (p = 0.94).ConclusionsThe CCI is probably the better scale for measuring co-morbidity burden in PD. There were no differences between PD and controls. Co-morbidity burden at diagnosis was associated with mortality in the early part of the disease course, but not later.

KW - Parkinson’s disease

KW - co-morbidity

KW - Charlson

KW - mortality

KW - dependency

U2 - 10.1016/j.parkreldis.2016.05.013

DO - 10.1016/j.parkreldis.2016.05.013

M3 - Article

VL - 28

SP - 124

EP - 129

JO - Parkinsonism & Related Disorders

JF - Parkinsonism & Related Disorders

SN - 1353-8020

ER -