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Association of Parkinsonism or Parkinson Disease with Polypharmacy in the Year Preceding Diagnosis: A Nested Case–Control Study in South Korea

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Abstract

Introduction

Published studies on the association between polypharmacy and parkinsonism or Parkinson disease are very limited.

Objective

The objective of this study was to investigate whether polypharmacy is associated with parkinsonism or Parkinson disease in elderly patients.

Methods

From a South Korean national health insurance sample cohort database for 2002–2013, we matched parkinsonism cases (defined by diagnosis codes for parkinsonism/Parkinson disease) and Parkinson disease cases (patients who had records for both Parkinson disease diagnosis and anti-Parkinson disease drug prescriptions) with controls. Logistic regression analysis evaluated the associations of parkinsonism/Parkinson disease with polypharmacy (i.e., five or more prescribed daily drugs) during the year preceding parkinsonism/Parkinson disease diagnosis, medications potentially associated with parkinsonism, and comorbidity status (using the Charlson Comorbidity Index score and hospitalization records).

Results

The study population included 6209 cases and 24,836 controls for parkinsonism and 1331 cases and 5324 controls for Parkinson disease. In univariate logistic regression, odds ratios for parkinsonism/Parkinson disease increased significantly with increased polypharmacy, medications potentially associated with parkinsonism, Charlson Comorbidity Index score, or prior hospitalizations. In multiple logistic regression, odds ratios for parkinsonism/Parkinson disease (adjusted for medications potentially associated with parkinsonism and comorbidities) also increased with increased polypharmacy. Odds ratios (95% confidence interval) for Parkinson disease were higher than those for parkinsonism with stronger statistical significance: 1.41 (1.28–1.55) and 2.17 (1.84–2.57) for parkinsonism and 2.87 (2.30–3.58) and 4.75 (3.39–6.66) for Parkinson disease for between five and ten prescribed daily drugs and ten or more drugs, respectively.

Conclusions

Polypharmacy in the year preceding diagnosis may be associated with an increased risk for parkinsonism/Parkinson disease. Medications potentially associated with parkinsonism were assumed to increase the risk for parkinsonism/Parkinson disease, but more studies are required to confirm this relationship.

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Acknowledgements

This study used National Health Insurance Service (NHIS) National Sample Cohort data (REQ0000008895). The authors thank the NHIS for the support.

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Authors and Affiliations

  1. College of Pharmacy and Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu, 41566, Republic of Korea

    Hae-Young Park & Jin-Won Kwon

  2. College of Natural Science, Kyungpook National University, Daegu, 41566, Republic of Korea

    Ji-Won Park

  3. College of Pharmacy, CHA University, Sungnam-si, Kyunggi-do, 11160, Republic of Korea

    Hyun Soon Sohn

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Contributions

HP, HS, and JK were involved with conception, JK directed organization, and HP and JK executed the research project. HP, JP, and JK designed the statistical analysis, JP and JK executed the analysis, and all authors reviewed the statistical analysis. HP wrote the first draft. All authors contributed to the review, critical analysis, and finalization of this manuscript.

Corresponding author

Correspondence to Jin-Won Kwon.

Ethics declarations

Funding

The National Research Foundation of Korea grant funded by the Korean government (MSIP) (No. 2015R1C1A2A01052768) provided funding for the study. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Conflict of interest

Hae-Young Park, Ji-Won Park, Hyun Soon Sohn, and Jin-Won Kwon have no conflicts of interest directly relevant to the contents of this study.

Ethical approval

The Kyungpook National University Institutional Review Board (KNU 2014-85-0) approved the study.

Informed consent

A secondary electronic database, which maintained de-identification and patient anonymity, was used for the analyses in this study. The patients were not involved throughout the research. Thus, informed consent was not required.

Electronic supplementary material

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40264_2017_559_MOESM1_ESM.docx

Supplementary material 1 (DOCX 26 kb) Summary table of ICD-10 codes and medications potentially associated with parkinsonism used in the analysis

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Park, HY., Park, JW., Sohn, H.S. et al. Association of Parkinsonism or Parkinson Disease with Polypharmacy in the Year Preceding Diagnosis: A Nested Case–Control Study in South Korea. Drug Saf 40, 1109–1118 (2017). https://doi.org/10.1007/s40264-017-0559-5

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