James B Wetmore1, Suying Li2, Heng Yan3, Muna Irfan4, Nazia Rashid5, Yi Peng6, David T Gilbertson7, Andrew Shim8. 1. Chronic Disease Research Group, Hennepin Healthcare Research Institute, 701 Park Ave., Suite S4.100, Minneapolis, MN, 55415, USA; Division of Nephrology, Department of Medicine, Hennepin Healthcare, 701 Park Ave., Minneapolis, MN, 55415, USA. Electronic address: James.Wetmore@hcmed.org. 2. Chronic Disease Research Group, Hennepin Healthcare Research Institute, 701 Park Ave., Suite S4.100, Minneapolis, MN, 55415, USA. Electronic address: sli@cdrg.org. 3. Chronic Disease Research Group, Hennepin Healthcare Research Institute, 701 Park Ave., Suite S4.100, Minneapolis, MN, 55415, USA. Electronic address: hyan@cdrg.org. 4. Department of Neurology, Hennepin Healthcare, 701 Park Ave., Minneapolis, MN, 55415, USA. Electronic address: Irfan007@umn.edu. 5. Department of Pharmacy, Keck Graduate Institute, 535 Watson Dr, Claremont, CA, 91711, USA. Electronic address: nazrashidpharmd@gmail.com. 6. Chronic Disease Research Group, Hennepin Healthcare Research Institute, 701 Park Ave., Suite S4.100, Minneapolis, MN, 55415, USA. Electronic address: ypeng@cdrg.org. 7. Chronic Disease Research Group, Hennepin Healthcare Research Institute, 701 Park Ave., Suite S4.100, Minneapolis, MN, 55415, USA. Electronic address: dgilbertson@cdrg.org. 8. ACADIA Pharmaceuticals Inc., 3611 Valley Centre Dr., San Diego, CA, 92130, USA. Electronic address: ashim@ACADIA-Pharm.com.
Abstract
INTRODUCTION: Patients with Parkinson disease (PD) often develop psychosis (P). The association of PDP with death and long-term custodial care (CC) has not been well studied. METHODS: Medicare Parts A, B, and D data, 2007-2015, were used to define cohorts of PD and PDP patients. PD was defined by ≥ 2 ICD-9-CM codes (332.0x) at least 30, but no more than 365, days apart, and PDP by ≥ 2 codes for psychotic symptoms. Outcomes were CC use, defined as nursing home stays of >100 consecutive days, and death. To compare the association of PDP with outcomes, PDP patients were matched to PD patients without psychosis. RESULTS: Within 1 year of PDP diagnosis, 12.1% of PDP patients used CC, versus 3.5% of non-PDP patients 1 year after the matching date; corresponding percentages at 5 years were 25.8% and 10.0%. Cumulative incidence curves for CC and for death differed significantly (P < 0.0001). PDP was associated with RRs of 3.38 (95% CI, 2.93-3.90) for CC and 1.34 (1.23-1.45) for death. Other factors associated with CC were age (3.57, 2.08-6.14, age ≥90 versus ≤70 years) and female sex (1.37, 1.18-1.58). Female sex was associated with a lower RR for death (0.76, 0.70-0.82). Health care utilization and costs were substantially higher for PDP than for non-PDP patients. CONCLUSION: In PD patients, psychosis was associated with a more than 3-fold increased risk of CC and a nearly one-third increased risk of death. Women entered CC more often than men, likely because they lived longer in the setting of PD.
INTRODUCTION:Patients with Parkinson disease (PD) often develop psychosis (P). The association of PDP with death and long-term custodial care (CC) has not been well studied. METHODS: Medicare Parts A, B, and D data, 2007-2015, were used to define cohorts of PD and PDPpatients. PD was defined by ≥ 2 ICD-9-CM codes (332.0x) at least 30, but no more than 365, days apart, and PDP by ≥ 2 codes for psychotic symptoms. Outcomes were CC use, defined as nursing home stays of >100 consecutive days, and death. To compare the association of PDP with outcomes, PDPpatients were matched to PDpatients without psychosis. RESULTS: Within 1 year of PDP diagnosis, 12.1% of PDPpatients used CC, versus 3.5% of non-PDPpatients 1 year after the matching date; corresponding percentages at 5 years were 25.8% and 10.0%. Cumulative incidence curves for CC and for death differed significantly (P < 0.0001). PDP was associated with RRs of 3.38 (95% CI, 2.93-3.90) for CC and 1.34 (1.23-1.45) for death. Other factors associated with CC were age (3.57, 2.08-6.14, age ≥90 versus ≤70 years) and female sex (1.37, 1.18-1.58). Female sex was associated with a lower RR for death (0.76, 0.70-0.82). Health care utilization and costs were substantially higher for PDP than for non-PDPpatients. CONCLUSION: In PDpatients, psychosis was associated with a more than 3-fold increased risk of CC and a nearly one-third increased risk of death. Women entered CC more often than men, likely because they lived longer in the setting of PD.