The Epidemiological Investigation Of Parkison’s Disease In Chinese Eldely Veterans

Objective:In order to provide the information about the prevalence of Parkinson’s disease (PD) in Chinese eldely veterans. We conducted this study to investigate the prevalence of PD in Chinese eldely veterans and its characters, and analyzed the relevant risk/protective factors of PD.Methods:A two-stage, multi-center, cross-sectional stratified cluster sampling approach was employed, and the veterans at age of>60years living in veterans’ communities continuously for1month were recruited. This study was approved by the ethics committee of General Hospital of the People’s Liberation Army, and written informed consent was obtained from the veterans enrolled in the current study or their guardians. Qualified medical staff from the department of neurology and geriatrics through the unified training served as investigators. At the first stage, the early symptoms of PD were screened using a PD screening scale, and the demographic characteristics including age, gender, education level, history of smoking and alcohol consumption, and personal hobbies, previous history of chronic diseases including hypertension, diabetes, coronary heart disease and cerebrovascular disease, history of drug use, and family history were collected. Those with PD screening scale scores of>1were enrolled in the second stage, when the clinical diagnosis of PD was made by qualified senior physicians in the department of neurology. The history of PD-related diseases was collected, and systematical physical examinations were performed. In addition, the patients with suspected Parkinsonism underwent brain computed tomography (CT) or magnetic resonance imaging (MRI), and received routine blood test, liver and kidney function tests, thyroid function test and detection of blood glucose. The clinical diagnosis of PD or other Parkinsonism was finally made by an expert panel consisted of the heads of the participating institutions, based on the disease history, physical examinations and auxiliary examinations, and the diagnosis of PD was performed according to the United Kingdom Parkinson’s Disease Society Brain Bank (UKPDSBB) diagnostic criteria. All data were double entered into the software EpiData version3.1(The EpiData Association, Odense, Denmark) and checked for consistency. The prevalence, age-specific prevalence and region-specific prevalence of PD were calculated. Differences of proportions were tested for statistical significance with Pearson chi-square test, Fisher’s exact probability test and the chi-square test for trends.The univariate analysis of qualitative data were analyzed by Pearson chi square test/Fisher exact test. The univariate analysis of quantitative data were analyzed by Mann-Whitney U nonparametric test. Multivariate analysis were analyzed by Logistic regression.The value of odds ratio (OR) and the95%confidence interval of OR value (95%CI) were calculated. All statistical analyses were performed using the statistical software SPSS version18.0(SPSS Inc.; Chicago, IL, USA).Results:The study was conducted during the period from December2009through December2012. Totally277veterans’communities in18cities were sampled. There were11593subjects enrolled in this study, and9676subjects responded, with a response rate of83.46%. The subjects responding to the study involved6722(69.47%) elderly aged≥80years, and9096(94.01%) men. There were228subjects with clinical diagnosis of PD, and the prevalence of PD was2.36%and2.65%in veterans at ages of≥60and80years, respectively. The highest prevalence of PD was detected in the western regions (3.15%), followed by the central regions (2.41%), while the lowest prevalence was found in the eastern regions of China (2.12%). The prevalence of PD significantly increased with the age, being0,1.84%,2.60%and3.68%in the subjects aged<70,70-79,80-89and>90years, respectively, and the chi-square test for trends revealed significant difference in the PD prevalence (χ2=10.891, P=0.001). The prevalence of PD was higher in men (2.44%) than in women (1.46%) on the surface. However, no significant difference was detected (P=0.241).There were9676subjects enrolled in the study on PD related factors, including228PD patients,183PD syndrome, non PD control group9265. Age (OR:1.343,95%CI:1.028-1.755), economic region (OR:1.261,95%CI:1.083-1.468) and a history of Essential Tremor (OR:1.228,95%CI:1.081-1.396) were the independent risk factors of PD in Chinese eldely veterans. Age was the most important risk factor. Physical exercise (OR:0.478,95%CI:0.355-0.643) and reading (OR:0.513,95%CI:0.357-0.735) were the independent protective factors of PD in Chinese eldely veterans. Physical exercise was better than reading on the protective effect of PD in Chinese eldely veterans. Smoking, drinking, anemia, head trauma, level of education, the electromagnetic exposure and some other factors were not confirmed independent associated with PD risk in Chinese eldely veterans.Conclusions:1. The prevalence of PD in Chinese eldely veterans is2.36%, not lower than that in other countries and regions.2. The prevalence of PD in Chinese eldely veterans is variation in different region, and higher in the western regions and lower in the eastern regions of China.3. The prevalence of PD in Chinese eldely veterans continues to increase beyond the age of80years.4. Age, economic region and history of Essential Tremor are the independent risk factors of PD in Chinese eldely veteran. Age is the most important risk factor of PD in Chinese eldely veterans.5. Physical examination and reading are the independent protective factors of the PD in Chinese eldely veterans. Physical examination is better than reading on the protective effect of PD in Chinese eldely veterans.6. Smoking, drinking, anemia, head trauma, level of education, the electromagnetic exposure and some other factors were not confirmed independent associated with PD risk in Chinese eldely veterans.