Lethbridge Lynn, Johnston Grace M, Turnbull George
School of Health Administration, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada.
Prog Palliat Care. 2013 Jul;21(3):140-145. doi: 10.1179/1743291X12Y.0000000037.
Disease interactions can alter functional decline near the end of life (EOL). Parkinson's disease (PD) is characterized by frequent occurrences of co-morbidities but data challenges have limited studies investigating co-morbidities across a broad range of diseases. The goal of this study was to describe disease associations with PD.
We conducted an analysis of death certificate data from 1998 to 2005 in Nova Scotia. All death causes were utilized to select individuals dying of PD and compare with the general population and an age-sex-matched sample without PD. We calculated the mean number of death causes and frequency of disease co-occurrence. To account for the chance occurrence of co-morbidities and measure the strength of association, observed to expected ratios were calculated.
PD decedents had a higher mean number of death causes (3.37) than the general population (2.77) and age-sex-matched sample (2.88). Cancer was the most common cause in the population and matched sample but fifth for those with PD. Cancer was one of nine diseases that occurred less often than what would be expected by chance while four were not correlated with PD. Dementia and pneumonia occurred with PD 2.53 ([CI] 2.21-2.85) and 1.83 (CI 1.58-2.08) times more often than expected. The strength of association for both is reduced but remains statistically significant when controlling for age and sex.
Those with PD have a higher number of co-morbidities even after controlling for age and sex. Individuals dying with PD are more likely to have dementia and pneumonia, which has implications for the provision of care at EOL.
疾病间的相互作用会改变临终前的功能衰退情况。帕金森病（PD）常伴有多种合并症，但数据方面的挑战限制了对广泛疾病合并症的研究。本研究的目的是描述与PD相关的疾病关联。
我们对新斯科舍省1998年至2005年的死亡证明数据进行了分析。利用所有死因来选择死于PD的个体，并与一般人群以及年龄和性别匹配的无PD样本进行比较。我们计算了死因的平均数量和疾病共现的频率。为了考虑合并症的偶然发生并衡量关联强度，计算了观察值与预期值的比率。
PD死者的平均死因数量（3.37）高于一般人群（2.77）和年龄与性别匹配的样本（2.88）。癌症是总体人群和匹配样本中最常见的死因，但在PD患者中排第五。癌症是九种发生频率低于偶然预期的疾病之一，而另外四种与PD无关。痴呆症和肺炎与PD同时发生的频率分别比预期高2.53倍（[CI] 2.21 - 2.85）和1.83倍（CI 1.58 - 2.08）。在控制年龄和性别后，两者的关联强度虽有所降低，但仍具有统计学意义。
即使在控制年龄和性别后，PD患者仍有更多的合并症。死于PD的个体更有可能患有痴呆症和肺炎，这对临终关怀具有重要意义。
