Sex disparities in health and health care utilization after Parkinson diagnosis: Rethinking PD associated disability
Fullard M, Thibault D, Todaro V, Foster S, Katz L, Morgan R, Kern D, Schwalb J, Mendoza EU, Shulman L, Dahodwala N, and Willis A. Sex disparities in health and health care utilization after parkinson diagnosis: Rethinking PD associated disability. Neurology 2018; 90(15).
Objective: To examine sex differences and trends in comorbid disease and health care utilization in individuals with newly diagnosed Parkinson disease. Background: There are known sex differences in the incidence of PD, as well as the burden of nonmotor symptoms, however, less is known about differences in health and health care utilization after PD diagnosis. Increased use of health care services may suggest barriers to preventative and therapeutic disease management, increased susceptibility to adverse outcomes or lack of social support. Improving quality survivorship for Parkinson's disease (PD) requires a better understanding of how health and health care use changes after PD diagnosis. Design/Methods: This is a retrospective cohort study of 131, 950 Medicare beneficiaries diagnosed with PD in the year 2002 and followed through December 31, 2008. The primary outcomes were comorbid disease diagnosis and health service use. Survival through 2008 was a secondary outcome. We compared the prevalence and cumulative incidence of common medical conditions, trends in survival and health care utilization between men and women with PD. Results: Female PD patients had higher adjusted incidence rate ratio (IRR) of depression (IRR: 1.52, 1.49-1.55), diabetes (IRR: 1.14, 1.10-1.18), glaucoma (IRR: 1.12, 1.06-1.17), hip fracture (IRR: 1.59, 1.53-1.66), osteoporosis (2.73, 2.64-2.81), rheumatoid/osteoarthritis (IRR: 1.51, 1.47-1.55), and stroke/TIA (IRR: 1.05, 1.02-1.08) than men. In spite of greater survival, women with PD used home health and skilled nursing facility care more often, and had less outpatient physician contact than men throughout the study period. Conclusions: Women experience a unique health trajectory after PD diagnosis as suggested by differing comorbid disease burden and health care utilization compared to men. Future studies of sex differences in care needs, care quality, comorbidity related disability, PD progression, and nonclinical factors associated with disability are needed to inform research agendas and clinical guidelines that may improve quality survival for women with PD.