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Disease Complications and Healthcare Use More Common in Women Than Men, Dutch Study Finds

gender differences

Women with Parkinson’s are more likely than men to have disease-related complications within five years of diagnosis and more likely to access healthcare services sooner, findings from a Dutch study suggest.

The study, “Sex-Specific Patient Journeys in Early Parkinson’s Disease in the Netherlands,” was published in Frontiers in Neurology.

Throughout their disease’s course, Parkinson’s patients need to rely on various healthcare providers, from general practitioners to therapists and neurologists, to maintain a quality of life.

“This ‘journey through the healthcare system’ varies per individual because of heterogeneity of symptoms, differences in disease progression rate, and the occurrence of PD-related complications. One important source of this variation might be sex differences in the presentation of PD [Parkinson’s disease],” the researchers wrote.

Evidence indicates that Parkinson’s affects more men than women, and that the disease starts at earlier ages and progresses faster in men. Women are known to have more tremor-dominant Parkinson’s, while men most often experience the akinetic-rigid kind — that typified by a slowness of movement, accompanied by muscle stiffness, postural instability and gait difficulties.

Nonetheless, it remains to be understood if these sex differences translate into “patient journeys” distinct to Parkinson’s. Knowing these journeys can help to improve access to services, and enhance coordination and quality of care.

Medical data today are routinely collected and stored in administrative healthcare databases, and typically cover both a patient’s health status and healthcare-related services. Such information can be found through electronic health records, medical claims, and drug and disease registries.

Investigators at Radboud University Medical Center used national medical claims data to reconstruct the sex-specific journey of Dutch Parkinson’s patients over the first five years after a diagnosis. (The study notes that the Netherland has “compulsory health insurance … [and] comparatively low out-of-pocket payments.”)

The claims database chosen for analysis contained data of all people diagnosed with Parkinson’s disease between 2012 and 2016 in the Netherlands. Researchers analyzed the time it took for patients to receive care from neurologists, allied healthcare therapists, or primary care physicians. They also studied the occurrence of Parkinson’s-related hospitalizations, incidences of pneumonia, orthopedic injuries, enrollment in a nursing home, and death.

In total, 22,293 medical claims regarding early Parkinson’s were analyzed: 13,518 (60.6%) involving male patients and 8,775 (39.4%) for females. At the time of diagnosis, men had a mean age of 71.6 years, and women 72.5.

The first Parkinson’s-related complications, such as pneumonia, orthopedic injuries, and hospitalization, began to be reported at a median of 1.8 years for women and 2.3 years for men.

Five years post-diagnosis, 68.7% of the men had at least one Parkinson’s disease-related complication, 22.5% lived in a nursing home, and 18.3% had died. Among the women, a greater percentage had at least one Parkinson’s complication ( 73%) and lived in a nursing home (27.2%), but a lesser percentage (14.6%) had died.

Female patients were more likely to visit their general practitioners earlier and more often than did male patients, starting about one month after diagnosis. Women began to doctor visits 31 days post-diagnosis and returned for checks-ups ever six weeks, men made a first visit at 41 days post-diagnosis and returned every eight to nine weeks.

Women also started their physiotherapy treatment earlier and returned more often: five months after diagnosis and once every five to six weeks thereafter; among men, physiotherapy started at eight months and continued once every seven to eight weeks.

“After 5 years, 37.9% … of women had visited an occupational therapist and 18.5% … a speech and language therapist at least once,” compared to 33.1% and 23.7%, respectively, for men, the researchers wrote. These differences were statistically significant.

Overall, gender differences among Parkinson’s patients were found to be related not only disease manifestations or progression, but also with the use of healthcare services.

“[O]ur findings suggest that women experience complications and access most healthcare services sooner after diagnosis and more frequently than men,” the researchers wrote.

“We hope these insights can lead to better and more personalized care for [Parkinson’s disease] patients of both sexes,” they concluded.

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Female Counselors, Teachers and Healthcare Workers at Higher Disease Risk, Study Suggests

women and work risks

Women working in fields that include teaching, healthcare, and — especially — social work “defined broadly” may be at a higher risk of Parkinson’s disease, a large observational study has found.

The study, “Occupation and Parkinson disease in the Women’s Health Initiative Observational Study,” was published in the American Journal of Industrial Medicine.

An individual’s risk of developing Parkinson’s is influenced by a variety of factors. Among these are workplace exposures, the most obvious being pesticides and other chemicals used in a job and linked to Parkinson’s risk.

Most studies into workplace-related risks for Parkinson’s involve men, and these data do not necessarily hold for other populations, both due to biological differences and because of differences among people drawn to specific fields.

Researchers used data from the Women’s Health Initiative Observational Study (WHI-OS) to assess Parkinson’s risk as a factor of career choice in 80,646 postmenopausal (ages 50 to 79) female workers in the United States who were followed for an average of 11 years after enrollment.

After adjusting for possible confounding factors like smoking history, income or ethnicity, they divided participants into broad career categories, like teaching (preschool through post-secondary), sales, counseling and social work, cleaning and maintenance, top executives, nurses, doctors and other healthcare professionals, etc.

They then determined whether any of these categories were significantly linked to Parkinson’s by calculating relative risk (RR; a value that is significantly higher or lower than 1 suggests an increased or decreased risk, respectively).

In total, 2,590 women (3.21%) in the study had Parkinson’s; 186 cases at its start and the rest diagnosed over the course of study follow-up.

There was a statistically significant increase in Parkinson’s risk among “counselors, social workers, and other community and social service specialists,” with a relative risk of 1.18, the researchers wrote, calling it an “excess risk.”

“Resonating with our findings, social work, defined broadly, has been associated with PD in studies of diverse designs, including an excess risk among white female religious workers,” the study said. “[A]lso there is evidence that women with PD are more likely to have a history of work that requires complex interpersonal interactions.”

Trends toward a higher Parkinson’s risk was found among “top executives” (RR of 1.18), “postsecondary teachers” (RR of 1.17), and workers in “building and grounds cleaning and maintenance” (RR of 1.21). But none of these associations reached statistical significance.

There was also a non-significant trend toward a lower Parkinson’s risk among people in sales, particularly “retail salespersons” (RR 0.87).

Researchers also looked at these risks broken down by how long participants had worked in these fields. For “counselors, social workers, and other community and social service specialists,” Parkinson’s risk increased with longer time spent on the job (from RR of 1.09 at 1–5 years of work to RR of 1.27 with 20 or more years). There was no consistent trend for time spent on the job for other career categories.

Based on 39 cases, they also noted evidence of an excessive risk among “health technologists and technicians” with more than 20 years of employment (RR of 1.46).

“Our findings paint a largely reassuring picture of occupational risks for PD [Parkinson’s disease] among U.S. women,” the researchers concluded.

They propose that future studies more closely examine the identified career paths to more specifically determine what factors might be influencing Parkinson’s risk for people in these fields.

As this study focused on older individuals, it may not be reflective of risks encountered by younger workers, particularly in fields with rapidly changing technology like healthcare, the researchers added.

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Experts Propose Ways to Stem Rising Number of Parkinson’s Deaths in England

Parkinson's deaths in England

Experts are proposing ways to stanch the number of deaths from Parkinson’s disease and related disorders in England, including establishing dedicated nursing homes and giving Parkinson’s patients personal case managers, according to a recent report by Public Health England.

According to the study, more than 6.5 million England residents age 20 and older died between 2001 and 2014. Of those deaths, more than 90,000 were associated with a neurological condition. Some 31 percent of those were attributed to Parkinson’s disease.

Titled “Deaths Associated with Neurological Conditions in England 2001-2014,” the report was issued by the National Neurology Intelligence Network. The study looks at death rates related to neurological conditions, demographic characteristics, underlying causes, and place of death.

Now, an international team of experts led by Bastiaan R. Bloem, MD, PhD, who teaches at Radboud University Medical Center, Nijmegen, The Netherlands, evaluated these findings in the study “Parkinson Matters,” published in the Journal of Parkinson’s Disease.

 “These statistics are important and should be used to inform and guide those who make long-term decisions about the practicalities of how Parkinson’s patients are managed by the various healthcare systems involved, working together to improve quality of care and quality of life,” Bloem said in a press release.

Bloem said the data correspond with a remarkable increase in the incidence of new patients with Parkinson’s disease, and should be used by those who decide how Parkinson’s patients are cared for by the various healthcare systems involved, with the aim of enhancing both the quality of care and life.

The study also shows that eight of 10 Parkinson’s patients die in hospitals or care homes — not a happy finding, according to the study’s first author Sirwan Darweesh, MD, Radboud University, Harvard T.H. Chan School of Public Health. “Being able to die at home is a core wish of most patients with Parkinson’s disease,” Darweesh said.

“Our current healthcare system is sometimes unable to meet this essential wish of patients and their families, particularly when medical issues requiring hospitalization occur.”

The authors suggest multiple ways to better manage Parkinson’s patients and increase standards of care in care homes and hospitals. In addition to the creation of nursing homes exclusively for those with the disease, and assigning case managers to Parkinson’s patients, they call for a network of specifically trained healthcare professionals with expertise in Parkinson’s management.

 They also suggest tailoring collaborative plans of care with patients and their families.

“Parkinson’s disease is a matter of serious concern for our future generations,” Bloem said. “Future efforts should be focused on providing resources for vulnerable elderly Parkinson patients, avoiding unplanned hospital admissions and out-of-home deaths as much as possible.”

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Source: Parkinson's News Today