Background: There is lack of data on the incidence of Parkinson’s disease (PD) based on repeat studies. Mortality rates of PD in Estonia have never been studied before. Objectives: To estimate the incidence and mortality rates of PD in -Estonia, to compare current incidence rates with those of the prior epidemiological study in Estonia, and to examine the reported causes of death of the study population. Methods: Eligible subjects were identified from multiple case-finding sources. Subjects were subsequently tracked on the Electronic-Health Record until either the end of the study, or their death. Incidence rates and standardized mortality ratios (SMR) were calculated. Causes of death were identified, based on the data from death certificates. Results: In the current study, the overall age-adjusted incidence rate was 28.0/100,000 person-years (95% CI 25.2–30.8). Compared with the previous study, the age-adjusted incidence rate inEstonia has not significantly changed (rate ratio 1.11; p = 0.19). Overall SMR for the inception cohort of PD cases with a median follow-up time of 5 years was 1.12 (95% CI 0.88–1.36; p = 0.3). For those deceased subjects known to have had clinically diagnosed PD, this was mentioned on 46.8% of death certificates. Conclusions: Over the last 20 years, the overall incidence of PD in Estonia has remained comparatively stable. The data did not show an excess mortality in PD patients (vs. general population) in the first 5 years of the disease.

Keywords:
Parkinson’s disease, Epidemiology, Incidence, Mortality, Death certificates
1.
Winter Y, Bezdolnyy Y, Katunina E, Avakjan G, Reese JP, Klotsche J, et al. Incidence of Parkinson’s disease and atypical parkinsonism: russian population-based study.
Mov Disord
. 2010 Feb; 25(3): 349–56.
2.
Hristova D, Zachariev Z, Mateva N, Grozdev I. Incidence of Parkinson’s disease in Bulgaria.
Neuroepidemiology
. 2010; 34(2): 76–82.
3.
Alves G, Müller B, Herlofson K, HogenEsch I, Telstad W, Aarsland D, et al.; Norwegian ParkWest study group. Incidence of Parkinson’s disease in Norway: the Norwegian ParkWest study.
J Neurol Neurosurg Psychiatry
. 2009 Aug; 80(8): 851–7.
4.
Linder J, Stenlund H, Forsgren L. Incidence of Parkinson’s disease and parkinsonism in northern Sweden: a population-based study.
Mov Disord
. 2010 Feb; 25(3): 341–8.
5.
Caslake R, Taylor K, Scott N, Gordon J, Harris C, Wilde K, et al. Age-, gender-, and socioeconomic status-specific incidence of Parkinson’s disease and parkinsonism in northeast Scotland: the PINE study.
Parkinsonism Relat Disord
. 2013 May; 19(5): 515–21.
6.
Heinzel S, Berg D, Binder S, Ebersbach G, Hickstein L, Herbst H, et al. Do we need to rethink the epidemiology and healthcare utilization of Parkinson’s disease in Germany?
Front Neurol
. 2018 Jun 29; 9: 500.
7.
Blin P, Dureau-Pournin C, Foubert-Samier A, Grolleau A, Corbillon E, Jové J, et al. Parkinson’s disease incidence and prevalence assessment in France using the national healthcare insurance database.
Eur J Neurol
. 2015 Mar; 22(3): 464–71.
8.
Van Den Eeden SK, Tanner CM, Bernstein AL, Fross RD, Leimpeter A, Bloch DA, et al. Incidence of Parkinson’s disease: variation by age, gender, and race/ethnicity.
Am J Epidemiol
. 2003 Jun; 157(11): 1015–22.
9.
Myall DJ, Pitcher TL, Pearson JF, Dalrymple-Alford JC, Anderson TJ, MacAskill MR. Parkinson’s in the oldest old: impact on estimates of future disease burden.
Parkinsonism Relat Disord
. 2017 Sep; 42: 78–84.
10.
Moisan F, Kab S, Mohamed F, Canonico M, Le Guern M, Quintin C, et al. Parkinson disease male-to-female ratios increase with age: french nationwide study and meta-analysis.
J Neurol Neurosurg Psychiatry
. 2016 Sep; 87(9): 952–7.
11.
Taba P, Asser T. Incidence of Parkinson’s disease in estonia.
Neuroepidemiology
. 2003 Jan-Feb; 22(1): 41–5.
12.
Allyson Jones C, Wayne Martin WR, Wieler M, King-Jesso P, Voaklander DC. Incidence and mortality of Parkinson’s disease in older Canadians.
Parkinsonism Relat Disord
. 2012 May; 18(4): 327–31.
13.
Chillag-Talmor O, Giladi N, Linn S, Gurevich T, El-Ad B, Silverman B, et al. Use of a refined drug tracer algorithm to estimate prevalence and incidence of Parkinson’s disease in a large israeli population.
J Parkinsons Dis
. 2011; 1(1): 35–47.
14.
Darweesh SK, Koudstaal PJ, Stricker BH, Hofman A, Ikram MA. Trends in the incidence of Parkinson Disease in the general population: the Rotterdam Study.
Am J Epidemiol
. 2016 Jun; 183(11): 1018–26.
15.
Horsfall L, Petersen I, Walters K, Schrag A. Time trends in incidence of Parkinson’s disease diagnosis in UK primary care.
J Neurol
. 2013 May; 260(5): 1351–7.
16.
Savica R, Grossardt BR, Bower JH, Ahlskog JE, Rocca WA. Time trends in the incidence of Parkinson disease.
JAMA Neurol
. 2016 Aug; 73(8): 981–9.
17.
Kuopio AM, Marttila RJ, Helenius H, Rinne UK. Changing epidemiology of Parkinson’s disease in southwestern Finland.
Neurology
. 1999 Jan; 52(2): 302–8.
18.
Williams-Gray CH, Mason SL, Evans JR, Foltynie T, Brayne C, Robbins TW, et al. The CamPaIGN study of Parkinson’s disease: 10-year outlook in an incident population-based cohort.
J Neurol Neurosurg Psychiatry
. 2013 Nov; 84(11): 1258–64.
19.
Hobson P, Meara J. Mortality and quality of death certification in a cohort of patients with Parkinson’s disease and matched controls in North Wales, UK at 18 years: a community-based cohort study.
BMJ Open
. 2018 Feb; 8(2):e018969.
20.
Benito-León J, Louis ED, Villarejo-Galende A, Romero JP, Bermejo-Pareja F. Under-reporting of Parkinson’s disease on death certificates: a population-based study (NEDICES).
J Neurol Sci
. 2014 Dec; 347(1-2): 188–92.
21.
Moscovich M, Boschetti G, Moro A, Teive HA, Hassan A, Munhoz RP. Death certificate data and causes of death in patients with parkinsonism.
Parkinsonism Relat Disord
. 2017 Aug; 41: 99–103.
22.
Zhang Y, Wang C, Wang Y, Xiao Q, Liu J, Ma J, et al. Mortality from Parkinson’s disease in China: findings from a ten-year follow up study in Shanghai.
Parkinsonism Relat Disord
. 2018 Oct; 55: 75–80.
23.
Statistics Estonia [Accessed August 1, 2018)]. Available from: http://www.stat.ee/ee.
24.
Kadastik-Eerme L, Taba N, Asser T, Taba P. The increasing prevalence of Parkinson’s disease in Estonia.
Acta Neurol Scand
. 2018 Sep; 138(3): 251–8.
25.
Lees AJ, Hardy J, Revesz T. Parkinson’s disease.
Lancet
. 2009 Jun; 373(9680): 2055–66.
26.
Yamawaki M, Kusumi M, Kowa H, Nakashima K. Changes in prevalence and incidence of Parkinson’s disease in Japan during a quarter of a century.
Neuroepidemiology
. 2009; 32(4): 263–9.
27.
Liu WM, Wu RM, Lin JW, Liu YC, Chang CH, Lin CH. Time trends in the prevalence and incidence of Parkinson’s disease in -Taiwan: A nationwide, population-based study.
J Formos Med Assoc
. 2016 Jul; 115(7): 531–8.
28.
Evans JR, Cummins G, Breen DP, Foltynie T, Mason SL, Brayne CE, et al. Comparative epidemiology of incident Parkinson’s disease in Cambridgeshire, UK.
J Neurol Neurosurg Psychiatry
. 2016 Sep; 87(9): 1034–6.
29.
Hirsch L, Jette N, Frolkis A, Steeves T, Pringsheim T. The incidence of Parkinson’s disease: a systematic review and meta-analysis.
Neuroepidemiology
. 2016; 46(4): 292–300.
30.
Macleod AD, Henery R, Nwajiugo PC, Scott NW, Caslake R, Counsell CE. Age-related selection bias in Parkinson’s disease research: are we recruiting the right participants?
Parkinsonism Relat Disord
. 2018 Oct; 55: 128–33.
31.
Gillies GE, Pienaar IS, Vohra S, Qamhawi Z. Sex differences in Parkinson’s disease.
Front Neuroendocrinol
. 2014 Aug; 35(3): 370–84.
32.
Martino R, Candundo H, Lieshout PV, Shin S, Crispo JA, Barakat-Haddad C. Onset and progression factors in Parkinson’s disease: A systematic review.
Neurotoxicology
. 2017 Jul; 61: 132–41.
33.
National Institute for Health Development website [Accessed August 1, 2018]. Available from: http://www.tai.ee/et/tegevused/tervisestatistika.
34.
Noyce AJ, Bestwick JP, Silveira-Moriyama L, Hawkes CH, Giovannoni G, Lees AJ, et al. Meta-analysis of early nonmotor features and risk factors for Parkinson disease.
Ann Neurol
. 2012 Dec; 72(6): 893–901.
35.
Pinter B, Diem-Zangerl A, Wenning GK, Scherfler C, Oberaigner W, Seppi K, et al. Mortality in Parkinson’s disease: a 38-year follow-up study.
Mov Disord
. 2015 Feb; 30(2): 266–9.
36.
de Lau LM, Verbaan D, Marinus J, van Hilten JJ. Survival in Parkinson’s disease. Relation with motor and non-motor features.
Parkinsonism Relat Disord
. 2014 Jun; 20(6): 613–6.
37.
Diem-Zangerl A, Seppi K, Wenning GK, Trinka E, Ransmayr G, Oberaigner W, et al. Mortality in Parkinson’s disease: a 20-year follow-up study.
Mov Disord
. 2009 Apr; 24(6): 819–25.
38.
Macleod AD, Taylor KS, Counsell CE. Mortality in Parkinson’s disease: a systematic review and meta-analysis.
Mov Disord
. 2014 Nov; 29(13): 1615–22.
39.
Hely MA, Morris JG, Reid WG, Trafficante R. Sydney Multicenter Study of Parkinson’s disease: non-L-dopa-responsive problems dominate at 15 years.
Mov Disord
. 2005 Feb; 20(2): 190–9.
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