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Having a Heart, Lung, Kidney, or Bone-Marrow Transplant May Lower Risk of Developing Parkinson’s

transplant

People who have had kidney, heart, lung, or bone-marrow transplants are less likely to develop Parkinson’s disease than the general population, research suggests.

The study, “Transplant and risk of Parkinson disease” was published recently in Parkinsonism & Related Disorders

Chronic neuroinflammation is a hallmark of Parkinson’s disease with studies suggesting that inflammatory processes contribute to disease risk and progression, although such biological response is unlikely to be the primary cause of neuronal death. That is why researchers suspect that reducing inflammation in the brain has the potential to slow neurodegeneration.

Anti-rejection drugs, also known as immunosuppressant medications, inhibit the immune system’s activity and reduce overall inflammation in the body, including the central nervous system.

Patients who undergo organ transplants usually are given these types of medicines to lower their body’s ability to reject the transplanted organ.

“Because inflammation may play a role in the pathophysiology of PD [Parkinson’s disease], it is possible that immunosuppressants could reduce the risk” of the disease, researchers wrote.

A team led by Washington University School of Medicine in St. Louis researchers investigated the risk of Parkinson’s disease in relation to tissue transplant. This same team had shown previously that individuals taking selected immunosuppressants had a lower risk of Parkinson’s disease than the general population Medicare beneficiaries who were studied.

In the most recent study they assessed Medicare beneficiaries (age 66–90 years) data from 2004 to 2009 and identified 89,790 Parkinson’s disease cases. For the control group, researchers selected a 0.5% random sample of all Medicare beneficiaries included in the study period, totaling 118,095 subjects.

History of kidney, heart, lung, bone-marrow, pancreas or cornea transplant was then registered. There were 278 transplants in the Parkinson’s sample and 302 in the control group.

Statistical analysis revealed patients who underwent transplants had a 37% lower risk of developing Parkinson’s than the general Medicare population.

“Overall, patients who had undergone tissue transplant more than five years prior to PD [Parkinson’s disease] diagnosis or reference had lower risk of PD,” researchers wrote.

This correlation was consistent for kidney, heart, lung, and bone-marrow transplants. Liver or corneal (the transparent layer that makes up the front of the eye) transplant was not linked to Parkinson’s disease risk.

When adjusting for underlying cause of the transplants, such as valvular heart disease, diabetes with renal complications, or chronic hepatitis infection, organ transplant remained inversely correlated with Parkinson’s risk. However, the association with kidney transplant became statistically non-significant.

“This study provides evidence that tissue transplant may be associated with a lower PD [Parkinson’s disease] risk, warranting further investigation to identify factors that mediate this relationship, including a potential effect of immunosuppressive therapy on PD risk,” researchers concluded.

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In US, Parkinson’s Diagnosis Linked to Higher Healthcare Use, Spending, Study Shows

healthcare costs, use

A diagnosis of Parkinson’s disease is associated with greater Medicare costs and out-of-pocket spending, according to a population-based study in the U.S.

These findings also revealed substantial geographic variation in prevalence and health service use and spending among Medicare beneficiaries.

The study, “State-level prevalence, health service use, and spending vary widely among Medicare beneficiaries with Parkinson disease,” appeared in the journal npj Parkinson’s Disease.

State-level variations in clinical outcomes, disease prevalence and healthcare use, quality and spending among Medicare beneficiaries have influenced healthcare planning at both federal and state levels. In the U.S., healthcare and reimbursement are being governed at the state level more and more.

“Medicare is a federally administered program providing health insurance to individuals over the age of 65, while Medicaid, which provides coverage to individuals below the poverty line, is funded by individual states,” the researchers wrote in the study.

Parkinson’s patients on Medicare often qualify for Medicaid due to having to spend more on healthcare and/or long-term care associated with the disease. However, Medicare remains the main payer for office visits, hospitalizations, home care, and nursing facility assistance for individuals older than 65 who are considered dual-eligible, meaning they are covered by both Medicare and Medicaid.

Data on how Parkinson’s care and spending vary across the U.S. are lacking. This information would help guide health policy and planning in a time when the prevalence of Parkinson’s is increasing with the aging population, as shown by the Parkinson’s Foundation’s Parkinson’s Prevalence Project, which estimates that 1.2 million people will be living with the disease by 2030.

To address this lack of information, the current Parkinson’s Foundation study looked at differences among states in disease prevalence, patient characteristics, spending, out-of-pocket costs, and health service use for 27.5 million Medicare beneficiaries in 2014.

“This study highlights the growing importance of optimizing care and treatment for people with the disease today,” John L. Lehr, the foundation’s CEO, said in a press release.

The analysis found 392,214 individuals diagnosed with Parkinson’s nationwide. New York, Connecticut, Florida, District of Columbia, and Rhode Island had the highest prevalence, encompassing 20.7% of all Parkinson’s patients on Medicare.

Among the potential reasons for the higher prevalence in these states, the researchers cite a possible “larger proportion of high-risk factor patient groups, a higher concentration of providers who recognize and document [Parkinson’s], increased public awareness of [Parkinson’s] symptoms, or increased health care seeking behaviors.”

Women represented 45.8% of the total number of Parkinson’s patients on Medicare. West Virginia, Kentucky, Mississippi, Louisiana and Arkansas had the largest proportions of women, each with more than 48.5%.

“Although women diagnosed with [Parkinson’s] are a sizable portion of the patient population, they are highly underrepresented in [Parkinson’s] research and clinical trials,” said Allison W. Willis, MD, the study’s senior author. Willis, a professor at the Perelman School of Medicine at the University of Pennsylvania, added that more attention needs to be paid to women, who have less access to specialized care, to improve disease outcomes.

In addition, the data showed that 26.1% of the patients were 85 years or older. Connecticut (33.2%), Pennsylvania (31.2%), Hawaii (31.2%), and Rhode Island (31.1%) were the states with the highest proportions of this age group.

Dual-eligible patients made up less than 10% of the total patients in North Dakota, Minnesota, New Hampshire, Arizona, Wisconsin and Utah, but more than 25% in Connecticut, Maine, Mississippi, California, and the District of Columbia.

Throughout 2014, Parkinson’s patients on Medicare had 219,049 hospitalizations, 37,839 readmissions, 3,699,767 outpatient doctor’s office visits, 34,159 hospice stays, 113,027 skilled nursing facility stays, 466,160 emergency room visits, 1,308,934 durable medical equipment events, 6,676,119 laboratory tests, 2,435,654 imaging assessments, and 4,879,538 home health visits.

Hospitalization rates were highest in New York, Michigan, Illinois, West Virginia and Florida, and lowest in Hawaii, Alaska, Utah, North Dakota, and Idaho. Readmission rates were highest in Florida, though with less variation by state.

Medicare paid nearly $7.9 billion for healthcare services for people with Parkinson’s. Inpatient care ($2.1 billion), skilled nursing facility care ($1.4 billion), hospital outpatient care ($881 million) and home health ($776.5 million) were the costliest services. For all services, Medicare and out-of-pocket spending were higher for beneficiaries with Parkinson’s than those without this disease.

Nevada, Texas, Massachusetts, Florida and New York were the top five states in spending, all greater than $22,000 per beneficiary with Parkinson’s. The highest out-of-pocket costs were found in the Great Lakes, Northeast, and South Central regions.

“Our study provides initial evidence that there is substantial geographic variation in health service use and spending for [Parkinson’s],” the researchers wrote.

“This state-level analysis will help inform policymakers on the societal costs of [Parkinson’s] and target areas where [Parkinson’s] patients may have more needs,” said James Beck, PhD, the Parkinson’s Foundation’s chief scientific officer. “We must realign our national priorities to support increased funding for research and care for people living with [Parkinson’s].”

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Gout May Increase Parkinson’s Risk in Older People, Study of US Medicare Data Suggests

gout, Parkinson's risk

Gout appears to be associated with a higher risk of incident Parkinson’s disease in older adults, according to a study that looked at Medicare data in the U.S.

The study, “Gout and the risk of Parkinson’s disease in older adults: a study of U.S. Medicare data” was published in BMC Neurology.

Parkinson’s disease is a progressive neurological disorder that mainly affects motor function due to the loss of nerve cells in the brain that produce dopamine. When dopamine-producing neurons die, it causes symptoms such as tremors, stiffness, and balance problems.

About 1 percent of the population older than 60 are diagnosed with Parkinson’s. Due to this low incidence, risk factors for the disease have not been fully explored. It is known, however, that herbicide or pesticide exposure, along with hypertension, are potential risk factors for developing Parkinson’s. Inversely, use of statins (lipid-lowering medicines) and smoking are thought to lower the risk of developing the disease.

Previous studies have attempted to associate the levels of urate — a salt derived from uric acid — in the blood with the risk of developing Parkinson’s. Urate has an antioxidant effect that researchers think may help prevent the disease. As a result, lower levels of serum urate could lead to a higher Parkinson’s prevalence. However, so far, studies have not been able to confirm this association.

Gout is an inflammatory arthritis disease caused by increased oxidative stress and chronic inflammation, factors that can potentially increase the risk for Parkinson’s disease. Oxidative stress is an imbalance between the production of free radicals and the ability of cells to detoxify them. These free radicals or reactive oxygen species are harmful to cells and are associated with a number of diseases.

However, in a patient who has gout, serum urate levels are actually increased. “Acute and chronic inflammatory state in gout might potentially negate the anti-oxidant effects of urate, if one exists physiologically,” the researchers wrote.

Whether there is an association between urate and Parkinson’s risk in gout patients is still a matter of controversy.

In this study, researchers at the University of Alabama at Birmingham aimed to clarify the existence of a possible association between gout and Parkinson’s, taking into account other known risks for the disease such as age, sex, hypertension, hyperlipidemia (high levels of fat, also called lipids, in the blood), statin use, and demographic variables.

Using a random sample encompassing 5% of Medicare claims data, acquired from 2006 to 2012, a total of 1.72 million people — 1.63 million without gout and 94,133 with gout — were analyzed. Their mean age was 75.3 years, 58% were female, 36% were white, and they had a mean Charlson-Romano comorbidity index score — which predicts 10-year mortality — of 1.6.

The analysis was adjusted for statin use and cardiovascular disease, two potential confounding variables of Parkinson’s risk, as well as for the use of urate-lowering therapy.

A total of 22,636 people developed incident Parkinson’s disease — 21,507 without gout and 1,129 with gout. Older age, male gender, white race, and higher Charlson-Romano comorbidity index score were associated with a higher risk of Parkinson’s.

The analysis revealed that gout was independently linked to a 1.14 times higher risk of Parkinson’s. The risk differed significantly by age, with patients between the ages of 65 and 75 having the highest risk (1.27 times higher) and those older than 85 having a smaller risk (0.97). There was no risk association with gender or race/ethnicity for gout patients with incident Parkinson’s.

“Gout is associated with a modest increase in the risk of Prkinson’s for adults 65 years or older as a group, independent of other factors,” the researchers wrote, concluding that the “mechanisms of this increased risk of Parkinson’s in patients with gout needs to be investigated further.”

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