Risk of Hospitalization and Death for COVID-19 in People with Parkinson's Disease or Parkinsonism

Abstract

Background: The risk of COVID-19 and related death in people with Parkinson's disease or parkinsonism is uncertain. The aim of the study was to assess the risk of hospitalization for COVID-19 and death in a cohort of patients with Parkinson's disease or parkinsonism compared with a control population cohort, during the epidemic bout (March-May 2020) in Bologna, northern Italy.

Methods: Participants of the ParkLink study with the clinical diagnosis of Parkinson's disease or parkinsonism and people anonymously matched (ratio 1:10) for sex, age, district, and Charlson Index were included. The hospital admission rate for COVID-19 (February 26-May 31, 2020) and the death rate for any cause were the outcomes of interest.

Results: The ParkLink cohort included 696 subjects with Parkinson's disease and 184 with parkinsonism, and the control cohort had 8590 subjects. The 3-month hospitalization rate for COVID-19 was 0.6% in Parkinson's disease, 3.3% in parkinsonism, and 0.7% in controls. The adjusted hazard ratio (age, sex, district, Charlson Index) was 0.8 (95% CI, 0.3-2.3, P = 0.74) in Parkinson's disease and 3.3 (1.4-7.6, P = 0.006) in parkinsonism compared with controls. Twenty-nine of the infected subjects died; 30-day fatality rate was 35.1%, without difference among the 3 groups. Six of 10 Parkinson's disease/parkinsonism patients had the infection during hospitalization or in a nursing home.

Conclusions: Parkinson's disease per se probably is not a risk factor for COVID-19 hospitalization. Conversely, parkinsonism is an independent risk factor probably because of a more severe health status, entailing higher care dependence and placement in high-infection-risk accommodations. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Keywords: COVID-19; Parkinson's disease; cohort studies; frail elderly; parkinsonism.

FIG. 1

Description of the epidemic bout in the local health trust of Bologna from February 26, 2020, to May 31, 2020: crude number of hospital admissions for COVID‐19 in the whole population. The reported calendar days correspond to the Italian government emergency dispositions: March 10, 2020, “I stay home” decree law (decreto legge “#io resto a casa”); March 22, 2020, “Lock Italy down” decree law (decreto legge “Chiudi Italia”); May 18, 2020, “Phase 2” decree law (decreto legge “Fase 2,” with intraregional mobility permitted for the whole population).

FIG. 2

Kaplan‐Meier curves reporting the risk of hospitalization in the group of people with Parkinson's disease (dashed line), people with parkinsonism (dotted line), control cohort (solid line), during the epidemic bout, from February 26, 2020, to May 31, 2020. The reported calendar days correspond to the Italian government emergency dispositions: March 10, 2020, “I stay home” decree law (decreto legge “#io resto a casa”); March 22, 2020, “Lock Italy down” decree law (decreto legge “Chiudi Italia”); May 18, 2020, “Phase 2” decree law (decreto legge “Fase 2”, with intraregional mobility permitted for the whole population).