A systematic review and meta-analysis of the prevalence of Parkinson's disease in lower to upper-middle-income countries

Abstract

Parkinson's disease (PD) is a common neurodegenerative disease that is a growing public health challenge. Estimates of the burden of PD have focused on data from high-income countries, with lower-income countries poorly described. We reviewed and examined the prevalence of PD reported by studies in low- to upper-middle-income countries. A systematic literature search was performed in the Medline/PubMed, Embase, LILACS, and Web of Science databases. Age group, sex, and geographic region were considered when analyzing the data. Of the 4327 assessed articles, 57 met the inclusion criteria for qualitative review, and 36 were included in the meta-analysis. Heterogeneity measures were high both as a whole and in each geographic region. Data analysis by geographic region showed that reported prevalence differed across regions, ranging from 49 per 100,000 (Sub-Saharan Africa) to 1081 per 100,000 (Latin America and the Caribbean). There was an increasing prevalence of PD with advancing age (per 100,000): 7 in 40-49 years, 158 in 50-59 years, 603 in 60-69 years, 1251 in 70-79 years, and 2181 in over the age of 80. The prevalence of PD in men and women was similar. There was a greater PD prevalence in populations with a higher 5-year GDP per capita and a higher life expectancy. Our findings suggest a higher prevalence of PD in lower and upper-middle-income countries than previously reported. Comparisons between regions are difficult, as the sociocultural differences and lack of methodological standardization hinder understanding key epidemiological data in varied populations.

Fig. 1

Flowchart of the selection process for eligible articles in the PubMed, Embase, and Cochrane databases.

Fig. 2. Global distribution of Parkinson's Disease (PD) prevalence.

a PD prevalence categorized by the minimum age of participants included in the studies. b PD prevalence according to the number of participants in studies across different global regions. c Temporal distribution of PD prevalence based on the publication year of each study. d PD prevalence stratified by the use of diagnostic criteria to identify cases in the studies conducted globally.

Fig. 3

Prevalence rate according to the geographic region.

Fig. 4. Prevalence of PD vs.

a GDP per capita and (b) life expectancy according to globe region.*Differences observed in prevalence across regions herein presented are not directly comparable between regions due to a series of methodological caveats.