Hobson Peter, Meara Jolyon
Betsi Cadwaladr University Health Board, Glan Clwyd Hospital, Bodelwyddan, UK.
BMJ Open. 2018 Feb 14;8(2):e018969. doi: 10.1136/bmjopen-2017-018969.
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.
Denbighshire North Wales, UK.
The community-based cohorts consisted of 166 patients with PD and 102 matched controls.
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.
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).
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.
本研究报告了一个社区帕金森病（PD）患者队列及对照组18年的死亡原因和死亡证明质量。
英国北威尔士登比郡。
基于社区的队列包括166例PD患者和102例匹配的对照组。
通过查阅医院的初级保健记录和审查从英国总登记处获得的死亡证明，确定18年时的全因死亡率。使用Cox比例回归估计死亡率HR，控制包括研究入组年龄、死亡年龄、性别、运动功能、情绪、健康相关生活质量（HRQoL）和认知功能等协变量。
18年后，PD队列中的158例（95%）患者和对照组中的34例（33%）患者死亡。与英国普通人群相比，PD队列的死亡风险更高（标准化死亡率为1.82，95%CI为1.55至2.13）。作为主要或根本死亡原因，158份死亡证明中有75份（47%）未报告PD。此外，虽然PD队列中有144例（91%）被诊断为痴呆，但死亡证明中报告的不到10%。PD队列中报告的主要死亡原因是肺炎（53%），其次是心脏相关死亡（21%）。与对照组相比，PD患者患肺炎的风险更高（2.03，95%CI为1.34至3.6），HRQoL较差，死亡时更有可能住在机构护理中（P<0.01）。
本研究发现，与普通人群相比，PD与更高的死亡风险相关。然而，发现证书上记录的PD作为主要或根本死亡原因并不理想。这表明仅从死亡证明得出的死亡率统计质量不是有效或可靠的数据来源。
