Vlaanderen Floris Pieter, de Man Yvonne, Krijthe Jesse H, Tanke Marit A C, Groenewoud A S, Jeurissen Patrick P T, Oertelt-Prigione Sabine, Munneke Marten, Bloem Bastiaan R, Meinders Marjan J
Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, Netherlands.
Institute for Computing and Information Sciences, Radboud University, Nijmegen, Netherlands.
Front Neurol. 2019 Jul 30;10:794. doi: 10.3389/fneur.2019.00794. eCollection 2019.
To reconstruct a sex-specific patient journey for Dutch persons with Parkinson's disease (PD) during the first 5 years after diagnosis. We analyzed a national administrative medical claims database containing data of all patients newly diagnosed with PD between 2012 and 2016 in the Netherlands. We performed time-to-event analysis to identify the moments when patients received care from neurologists, allied healthcare therapists or general practitioners. We also extracted relevant clinical milestones: unexpected hospitalization for PD, pneumonia, orthopedic injuries, nursing home admission, and death. Using these data, we constructed the patient journey stratified for sex. We included claims data of 13,518 men and 8,775 women with newly diagnosed PD in the Netherlands. While we found little difference in neurologist consultations, women visited general practitioners and physiotherapists significantly earlier and more often (all -values < 0.001). After 5 years, 37.9% ( = 3,326) of women had visited an occupational therapist and 18.5% ( = 1,623) a speech and language therapist at least once. This was 33.1% ( = 4,474) and 23.7% ( = 3,204) for men. Approximately 2 years after diagnosis, PD-related complications (pneumonia, orthopedic injuries, and PD-related hospitalization) occurred for the first time (women: 1.8 years; men: 2.3 years), and after 5 years, 72.9% ( = 6,397) of women, and 68.7% ( = 9,287) of men had experienced at least one. Considering the strengths and limitations of our methods, our findings suggest that women experience complications and access most healthcare services sooner after diagnosis and more frequently than men. The identified sex differences extend the debate about phenotypical differences in PD between men and women.
为重构荷兰帕金森病（PD）患者确诊后前5年的性别特异性就医历程。我们分析了一个全国性行政医疗索赔数据库，其中包含2012年至2016年在荷兰新确诊为PD的所有患者的数据。我们进行了事件发生时间分析，以确定患者接受神经科医生、专职医疗治疗师或全科医生治疗的时间点。我们还提取了相关临床里程碑事件：因PD意外住院、肺炎、骨科损伤、入住养老院和死亡。利用这些数据，我们构建了按性别分层的患者就医历程。我们纳入了荷兰13518名新确诊为PD的男性和8775名女性的索赔数据。虽然我们发现神经科医生会诊方面差异不大，但女性更早且更频繁地就诊于全科医生和物理治疗师（所有P值<0.001）。5年后，37.9%（n = 3326）的女性至少拜访过一次职业治疗师，18.5%（n = 1623）的女性至少拜访过一次言语和语言治疗师。男性的这一比例分别为33.1%（n = 4474）和23.7%（n = 3204）。确诊后约2年，首次出现与PD相关的并发症（肺炎、骨科损伤和与PD相关的住院）（女性：1.8年；男性：2.3年），5年后，72.9%（n = 6397）的女性和68.7%（n = 9287）的男性至少经历过一次。考虑到我们方法的优点和局限性，我们的研究结果表明，女性在确诊后比男性更早且更频繁地出现并发症并获得大多数医疗服务。所确定的性别差异扩展了关于男性和女性PD表型差异的争论。
