Posttraumatic parkinsonism would increase the mortality risk in elderly patients with traumatic brain injury

Abstract

Background: We used data from the National Health Insurance Research Database (NHIRD) of Taiwan to determine whether patients who develop posttraumatic parkinsonism (PTP) after traumatic brain injury (TBI) have an increased mortality risk.

Methods: We analyzed data from the NHIRD of patients aged ≥20 years who had received a diagnosis of and admitted for head injury with TBI (ICD-9-CM 850-854, 959.01) from 2000 to 2012. The TBI cohort was further divided into PTP and posttraumatic non-parkinsonism (PTN) cohorts and compared against a sex-, age-, comorbidity-, and index-date-matched comparison cohort. We calculated the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of all-cause mortality risk in these cohorts after adjustment for age, sex, and comorbidities.

Results: There were 23,504 and 744 patients enrolled in the PTN cohort and the PTP cohort. Subsequent parkinsonism happened with an incidence of 3.07% in patients with TBI, and 11.59% in those aged over 65 years. The PTP cohort (aHR =1.67, 95% CI: 1.47-1.90) other than PTN (aHR =1.37, 95% CI: 1.29-1.45) cohort had a higher risk of mortality. In ones aged 65-74 years (aHR =2.08, 95% CI: 1.41-3.07), there was a more increased mortality risk in patients with PTP when compared to the PTN cohort.

Conclusions: PTP would increase the long-term mortality risk of patients with TBI, especially in whom aged 65-74 years. Our findings provide vital information for clinicians and the government to improve the long-term prognosis of TBI.

Keywords: Cohort study; National Health Insurance; mortality; parkinsonism; traumatic brain injury (TBI).

Figure 1

The flow chart shows the selection procedures of participants in this study.

Figure 2

Comparison of cumulative incidence of mortality among patients with posttraumatic parkinsonism, those with traumatic brain injury without parkinsonism, and comparisons.