Do We Need to Rethink the Epidemiology and Healthcare Utilization of Parkinson's Disease in Germany?

Abstract

Epidemiological aspects of Parkinson's disease (PD), co-occurring diseases and medical healthcare utilization of PD patients are still largely elusive. Based on claims data of 3.7 million statutory insurance members in Germany in 2015 the prevalence and incidence of PD was determined. PD cases had at least one main hospital discharge diagnosis of PD, or one physician diagnosis confirmed by a subsequent or independent diagnosis or by PD medication in 2015. Prevalence of (co-)occurring diseases, mortality, and healthcare measures in PD cases and matched controls were compared. In 2015, 21,714 prevalent PD cases (standardized prevalence: 511.4/100,000 persons) and 3,541 incident PD cases (standardized incidence: 84.1/100,000 persons) were identified. Prevalence of several (co-)occurring diseases/complications, e.g., dementia (PD/controls: 39/13%), depression (45/22%), bladder dysfunction (46/22%), and diabetes (35/31%), as well as mortality (10.7/5.8%) differed between PD cases and controls. The annual healthcare utilization was increased in PD cases compared to controls, e.g., regarding mean ± SD physician contacts (15.2 ± 7.6/12.2 ± 7.3), hospitalizations (1.3 ± 1.8/0.7 ± 1.4), drug prescriptions (overall: 37.7 ± 24.2/21.7 ± 19.6; anti-PD medication: 7.4 ± 7.4/0.1 ± 0.7), assistive/therapeutic devices (47/30%), and therapeutic remedies (57/16%). The standardized prevalence and incidence of PD in Germany as well as mortality in PD may be substantially higher than reported previously. While frequently diagnosed with co-occurring diseases/complications, such as dementia, depression, bladder dysfunction and diabetes, the degree of healthcare utilization shows large variability between PD patients. These findings encourage a rethinking of the epidemiology and healthcare utilization in PD, at least in Germany. Longitudinal studies of insurance claims data should further investigate the individual and epidemiological progression and healthcare demands in PD.

Keywords: Parkinson's disease; comorbidity; epidemiology; healthcare; incidence; insurance claims; mortality; prevalence.

Figure 1

Flow-chart of PD case identification criteria. Of the four different criteria at least one had to be fulfilled in prevalent PD cases in 2015.

Figure 2

The prevalence and incidence of Parkinson's disease in Germany in 2015. Stratified by age groups and sex (A) the percentages of prevalent Parkinson's disease (PD) cases (within sex groups percentages add up to 100%), (B) the crude prevalence of PD per 100,000 persons, and (C) the crude incidence of PD per 100,000 persons in Germany in 2015 are shown.

Figure 3

The first diagnosis of PD. Type of physician or medical institution (in percent) giving an initial diagnosis of Parkinson's disease in incident cases.