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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.

ABSTRACT: OBJECTIVE:This investigation reports the cause and the quality of death certification in a community cohort of patients with Parkinson's disease (PD) and controls at 18 years. SETTING:Denbighshire North Wales, UK. PARTICIPANTS:The community-based cohorts consisted of 166 patients with PD and 102 matched controls. PRIMARY OUTCOMES:All-cause mortality was ascertained at 18?years by review of hospitals' primary care records and examination of death certificates obtained from the UK General Register Office. Mortality HRs were estimated using Cox proportional regression, controlling for covariates including age at study entry, age at death, gender, motor function, mood, health-related quality of life (HRQoL) and cognitive function. RESULTS:After 18?years, 158 (95%) of patients in the PD cohort and 34 (33%) in the control cohort had died. Compared with the general UK population, the PD cohort had a higher risk of mortality (standard mortality rate, 1.82, 95%?CI 1.55 to 2.13). As the primary or underlying cause of death, PD was not reported in 75/158 (47%) of the death certificates. In addition, although 144/158 (91%) of the PD cohort had a diagnosis of dementia, this was reported in less than 10% of death certificates. The main cause of death reported in the PD cohort was pneumonia (53%), followed by cardiac-related deaths (21%). Compared with controls, patients with PD had a greater risk of pneumonia (2.03, 95%?CI 1.34 to 3.6), poorer HRQoL and more likely to reside in institutional care at death (P<0.01). CONCLUSION:This investigation found that PD was associated with an excess risk of mortality compared with the general population. However, PD as a primary or underlying cause of death recorded on certificates was found to be suboptimal. This suggests that the quality of mortality statistics drawn from death certificates alone is not a valid or reliable source of data.

SUBMITTER: Hobson P

PROVIDER: S-EPMC5829780 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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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.

Hobson Peter P Meara Jolyon J

BMJ open 20180214 2

<h4>Objective</h4>This investigation reports the cause and the quality of death certification in a community cohort of patients with Parkinson's disease (PD) and controls at 18 years.<h4>Setting</h4>Denbighshire North Wales, UK.<h4>Participants</h4>The community-based cohorts consisted of 166 patients with PD and 102 matched controls.<h4>Primary outcomes</h4>All-cause mortality was ascertained at 18 years by review of hospitals' primary care records and examination of death certificates obtained ...[more]

PMID: 29444783

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Project description:BackgroundPopulation-level information on dispensed medication provides insight on the distribution of treated morbidities, particularly if linked to other population-scale data at an individual-level.ObjectiveTo evaluate the impact of COVID-19 on dispensing patterns of medications.MethodsRetrospective observational study using population-scale, individual-level dispensing records in Wales, UK. Total dispensed drug items for the population between 1 st January 2016 and 31 st December 2019 (3-years, pre-COVID-19) were compared to 2020 with follow up until 27 th July 2021 (COVID-19 period). We compared trends across all years and British National Formulary (BNF) chapters and highlighted the trends in three major chapters for 2019-21: 1-Cardiovascular system (CVD); 2-Central Nervous System (CNS); 3-Immunological & Vaccine. We developed an interactive dashboard to enable monitoring of changes as the pandemic evolves.ResultAmongst all BNF chapters, 73,410,543 items were dispensed in 2020 compared to 74,121,180 items in 2019 demonstrating -0.96% relative decrease in 2020. Comparison of monthly patterns showed average difference (D) of -59,220 and average Relative Change (RC) of -0.74% between the number of dispensed items in 2020 and 2019. Maximum RC was observed in March 2020 (D = +1,224,909 and RC = +20.62), followed by second peak in June 2020 (D = +257,920, RC = +4.50%). A third peak was observed in September 2020 (D = +264,138, RC = +4.35%). Large increases in March 2020 were observed for CVD and CNS medications across all age groups. The Immunological and Vaccine products dropped to very low levels across all age groups and all months (including the March dispensing peak).ConclusionsReconfiguration of routine clinical services during COVID-19 led to substantial changes in community pharmacy drug dispensing. This change may contribute to a long-term burden of COVID-19, raising the importance of a comprehensive and timely monitoring of changes for evaluation of the potential impact on clinical care and outcomes.

Dataset Information

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.

Publications

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.

Similar Datasets

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