Okunoye, Olaitan Christiana; (2021) Factors associated with hospitalisation and mortality among people with Parkinson's disease: Analysis of a large UK primary care database. Doctoral thesis (Ph.D), UCL (University College London).

Preview

Text Okunoye_10138643_thesis_redacted.pdf Download (13MB) | Preview

Abstract

Background: Parkinson’s disease (PD) is characterised by worsening motor symptoms, falls/fractures and infections with disease progression, leading to hospitalisation and in some instances, death. Quality data on hospitalisation and mortality in PD is lacking. Objective: To investigate hospitalisation, mortality and incidence of PD over time in UK primary care setting. Methods: Through a systematic review and meta-analysis, estimates of the pooled prevalence of common reasons for hospitalisation was calculated. Three cohort studies using data from The Health Improvement Network (THIN) were conducted in the period 2006-2016: [1] Incidence of PD; [2] Mortality and [3] Hospitalisation in PD. Findings: In the review, from the nine included eligible studies, the main reasons for hospitalisation and their pooled prevalence among PwPD were infections (22%,95%CI:16%-30%), worsening motor features(19%,95%CI:13%- 27%), falls/fractures(18%,95%CI:14%to21%), cardiovascular comorbidities (13%,95%CI:9%-18%), neuropsychiatric (8%,95%CI:4%-13%) and gastrointestinal complications(7%,95%CI:4%-11%). In my empirical studies, the incidence of recorded PD gradually decreased using the stricter case definitions but remained stable using the broadest case definition over time. For the strictest case definition (diagnostic Read code and at least two prescriptions of antiparkinsonian medication), the incidence of PD was 60.42 in 2006 and dropped to 42.24 cases per 100,000 person years at risk (PYAR) in 2016 and for the broadest case definition (diagnosis Read code or symptom Read code or at least one prescription of antiparkinsonian medication), the incidence of PD was 149.20 cases in 2006 and this reduced slightly to 143.70 cases per 100,000 PYAR in 2016. 10,104 incident PD cases were identified and matched with 55,664 people without PD. Overall, rates of hospitalisation (IRR:1.33, 95%CI:1.29-1.37) and mortality (IRR:1.14, 95%CI:1.09-1.20) were higher in PwPD than those without. Hospitalisation rates were higher among people with PD (PwPD) in the younger age-group than those without PD in the same age-group. Other sociodemographic factors had no impact on hospitalisation and mortality in PD. PwPD were more often admitted with falls/fractures, infections, gastrointestinal complications, dementia, psychosis/hallucinations, postural hypotension, electrolyte disturbances, stroke, and surgical procedures compared to those without PD. Further results showed a widening mortality gap between PwPD and the general population. Conclusions: PD is associated with increased hospitalisation and mortality. The complications of motor and non-motor features of PD are amongst the main reasons for admission, some of which could be managed pro-actively to avoid admissions and maybe prevent death. Future studies should be directed at exploring effectiveness of preventive strategies to reduce hospitalisations and maybe mortality among PwPD.

Download activity - last month

Export as CSVJSONXML

Download activity - last 12 months

Export as XMLCSVJSON

Downloads by country - last 12 months

Export as XMLCSVJSON

Archive Staff Only

View Item