Risk factors for pneumonia among patients with Parkinson's disease: a Taiwan nationwide population-based study

doi:10.2147/NDT.S99365

. 2016 Apr 27:12:1037-46.

doi: 10.2147/NDT.S99365. eCollection 2016.

Risk factors for pneumonia among patients with Parkinson's disease: a Taiwan nationwide population-based study

Yang-Pei Chang¹, Chih-Jen Yang², Kai-Fang Hu³, A-Ching Chao⁴, Yu-Han Chang⁵, Kun-Pin Hsieh⁶, Jui-Hsiu Tsai⁷, Pei-Shan Ho⁸, Shen-Yang Lim⁹

Affiliations

¹ Department of Neurology, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
² Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
³ Department of Dentistry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
⁴ Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
⁵ Department of Management, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
⁶ School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
⁷ Department of Psychiatry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
⁸ Faculty of Dental Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; Cancer Center, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan, Republic of China.
⁹ Faculty of Medicine, University of Malaya, Kuala lumpur, Malaysia.

PMID: 27175081
PMCID: PMC4854270
DOI: 10.2147/NDT.S99365

Risk factors for pneumonia among patients with Parkinson's disease: a Taiwan nationwide population-based study

Yang-Pei Chang et al. Neuropsychiatr Dis Treat. 2016.

. 2016 Apr 27:12:1037-46.

doi: 10.2147/NDT.S99365. eCollection 2016.

Authors

Yang-Pei Chang¹, Chih-Jen Yang², Kai-Fang Hu³, A-Ching Chao⁴, Yu-Han Chang⁵, Kun-Pin Hsieh⁶, Jui-Hsiu Tsai⁷, Pei-Shan Ho⁸, Shen-Yang Lim⁹

Affiliations

¹ Department of Neurology, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
² Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
³ Department of Dentistry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
⁴ Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
⁵ Department of Management, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
⁶ School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
⁷ Department of Psychiatry, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
⁸ Faculty of Dental Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; Cancer Center, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan, Republic of China.
⁹ Faculty of Medicine, University of Malaya, Kuala lumpur, Malaysia.

PMID: 27175081
PMCID: PMC4854270
DOI: 10.2147/NDT.S99365

Abstract

Objective: Pneumonia is the leading cause of death in patients with Parkinson's disease (PD). However, few studies have been performed to explore the risk factors for pneumonia development in patients with PD.

Methods: We conducted a nationwide population-based cohort study of patients with PD to identify the risk factors for these patients developing pneumonia. Participants with newly diagnosed PD between 2000 and 2009 were enrolled from the 2000-2010 National Health Insurance Research Database in Taiwan. We compared patients with PD with an incidence of hospitalization with pneumonia vs those without, and Cox proportional hazard models were used to estimate the risk of pneumonia.

Results: Of the 2,001 enrolled patients (mean follow-up duration 5.8 years, range: 2.7-14.7 years), 381 (19.0%) had an incidence of hospitalization with pneumonia during the study period. Multivariate Cox proportional hazards analysis identified older age group (≥80 years of age, hazard ratio [HR] =3.15 [95% confidence interval 2.32-4.28]), male sex (HR =1.59 [1.29-1.96]), certain geographic regions (northern, HR =1.36 [1.04-1.78], southern and eastern, HR =1.40 [1.05-1.88]), rural areas (HR =1.34 [1.05-1.72]), chronic heart failure (HR =1.53 [1.02-2.29]), and chronic kidney disease (HR =1.39 [1.03-1.90]) as risk factors for hospitalization with pneumonia in patients with PD. However, treatment for dental caries was a protective factor (HR =0.80 [0.64-0.99]).

Conclusion: The results of this study highlight risk factors that are associated with hospitalization with pneumonia, and, for the first time, suggest a link between treated dental caries and a diminished risk of hospitalization with pneumonia in patients with PD.

Keywords: Parkinson’s disease; chronic heart failure; chronic kidney disease; dental caries; pneumonia.

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Figures

**Figure 1**
Flowchart of the study cohort assembly from medical records in Taiwan’s National Health Insurance Research Database. **Abbreviations:** PD, Parkinson’s disease; ICD, International classification of disease.

**Figure 2**
Kaplan–Meier analysis for incidence of pneumonia in patients with PD by sex. **Abbreviation:** PD, Parkinson’s disease.

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References

1. de Lau LM, Breteler MM. Epidemiology of Parkinson’s disease. Lancet Neurol. 2006;5(6):525–535. - PubMed
1. Leibson CL, Maraganore DM, Bower JH, Ransom JE, O’brien PC, Rocca WA. Comorbid conditions associated with Parkinson’s disease: a population-based study. Mov Disord. 2006;21(4):446–455. - PubMed
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[1] de Lau LM, Breteler MM. Epidemiology of Parkinson’s disease. Lancet Neurol. 2006;5(6):525–535. - PubMed

[2] de Lau LM, Breteler MM. Epidemiology of Parkinson’s disease. Lancet Neurol. 2006;5(6):525–535. - PubMed

[3] Leibson CL, Maraganore DM, Bower JH, Ransom JE, O’brien PC, Rocca WA. Comorbid conditions associated with Parkinson’s disease: a population-based study. Mov Disord. 2006;21(4):446–455. - PubMed

[4] Leibson CL, Maraganore DM, Bower JH, Ransom JE, O’brien PC, Rocca WA. Comorbid conditions associated with Parkinson’s disease: a population-based study. Mov Disord. 2006;21(4):446–455. - PubMed

[5] Scheife RT, Schumock GT, Burstein A, Gottwald MD, Luer MS. Impact of Parkinson’s disease and its pharamacologic treatment on quality of life and economic outcomes. Am J Health Syst Pharm. 2000;57(10):953–962. - PubMed

[6] Scheife RT, Schumock GT, Burstein A, Gottwald MD, Luer MS. Impact of Parkinson’s disease and its pharamacologic treatment on quality of life and economic outcomes. Am J Health Syst Pharm. 2000;57(10):953–962. - PubMed

[7] Rodrigues B, Nóbrega AC, Sampaio M, Argolo N, Melo A. Silent saliva aspiration in Parkinson’s disease. Mov Disord. 2011;26(1):138–141. - PubMed

[8] Rodrigues B, Nóbrega AC, Sampaio M, Argolo N, Melo A. Silent saliva aspiration in Parkinson’s disease. Mov Disord. 2011;26(1):138–141. - PubMed

[9] Kalf JG, de Swart BJ, Bloem BR, Munneke M. Prevalence of oropharyngeal dysphagia in Parkinson’s disease: a meta-analysis. Parkinsonism Relat Disord. 2012;18(4):311–315. - PubMed

[10] Kalf JG, de Swart BJ, Bloem BR, Munneke M. Prevalence of oropharyngeal dysphagia in Parkinson’s disease: a meta-analysis. Parkinsonism Relat Disord. 2012;18(4):311–315. - PubMed

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Risk factors for pneumonia among patients with Parkinson's disease: a Taiwan nationwide population-based study

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Risk factors for pneumonia among patients with Parkinson's disease: a Taiwan nationwide population-based study

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