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. 2021 Jan 27;16(1):e0246121.
doi: 10.1371/journal.pone.0246121. eCollection 2021.

Increased risk of falls and fractures in patients with psychosis and Parkinson disease

Joan Forns  1 , J Bradley Layton  2 , Jennifer Bartsch  3 , Mary Ellen Turner  4 , Colleen Dempsey  4 , Mary Anthony  2 , Mary E Ritchey  2 , George Demos  4
Affiliations

Increased risk of falls and fractures in patients with psychosis and Parkinson disease

Joan Forns et al. PLoS One. .

Abstract

Objective: Evaluate whether the risk of falls and fractures differs between patients with Parkinson disease with psychosis (PDP) and patients with Parkinson disease (PD) without psychosis at similar disease stages.

Methods: Patients with PD without psychosis were identified in the Medicare claims databases (2008-2018) and followed from the first PD diagnosis date during the study period. Patients with a subsequent diagnosis of psychosis were included in the PDP group. Patients with PDP and PD without psychosis were propensity score-matched based on characteristics within blocks of time since cohort entry. The incidence rates (IRs), expressed per 100 person-years, and 95% confidence intervals (CIs) of falls and fractures were evaluated as composite and separate outcomes. Incidence rate ratios (IRRs) were used to compare patients with PDP and PD without psychosis in the matched cohort.

Results: 154,306 patients had PD without psychosis and no falls or fractures before cohort entry; the IR for falls and fractures was 11.41 events (95% CI, 11.29-11.53). 12,127 patients (7.8%) had a subsequent PDP diagnosis. PDP patients had a higher prevalence of most comorbidities and risk factors for falls and fractures than those without psychosis. The crude IR for falls and fractures among PDP patients was 29.03 events (95% CI, 28.27-29.81). PD without psychosis and PDP groups had more falls than fractures. After matching, 24,144 PD patients without psychosis (15.6%) and 12,077 PDP patients (99.6%) were retained. Matched PDP patients had a higher incidence of falls and fractures than PD patients without psychosis (IRR = 1.44; 95% CI, 1.39-1.49). The higher increased rate was noted separately for falls (IRR = 1.48; 95% CI, 1.43-1.54) and any fractures (IRR = 1.17; 95% CI, 1.08-1.27) as well as within specific types of fracture, including pelvis and hip fractures.

Conclusions: Our findings suggest a modest but consistently higher increased risk of falls and fractures in PDP patients compared with PD patients without psychosis.

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Conflict of interest statement

This study was funded by ACADIA Pharmaceuticals Inc. The authors JF, JBL, JB, MEB, and MA are full-time salaried employees of RTI Health Solutions. MET, CD, and GD are full-time salaried employees of ACADIA. Affiliations and funding do not alter our adherence to PLOS ONE policies on sharing data and materials. This manuscript is the result of a study conducted by RTI Health Solutions, sponsored by ACADIA Pharmaceuticals, the maker of pimavanserin (an antipsychotic approved by the US Food and Drug Administration for the treatment of patients with PDP). However, there are no patents, products in development or marketed products associated with this research to declare.

Figures

Fig 1
Fig 1. Attrition of the Parkinson disease cohort by application of eligibility criteria.
PD = Parkinson disease; PDP = Parkinson disease with psychosis. a Those 502 patients with a PD diagnosis and all eligibility criteria could not contribute time to the PD without psychosis group because they were diagnosed with psychosis on the cohort eligibility date.
Fig 2
Fig 2. Incidence rate ratios of falls and fractures for the matched PD-PDP cohort, overall and by time interval.
CI = confidence interval; IRR, incidence rate ratio; matched PD-PDP cohort = cohort of patients with PD without PDP matched to patients with PDP; PD = Parkinson disease; PDP = Parkinson disease with psychosis.
See this image and copyright information in PMC

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