Hill Emily J, Marcucci Samuel Blaise, DeLano Kelly, Abanto Jesus, Sawyer Russell P, Marsili Luca, Duque Kevin R, Sun Qin, Woo Daniel, Langefeld Carl D, Hall Deborah A, Skirpan Dawn, Paredes Nathaly Chinchihualpa, Spikes Cynthia, Bajaj Deepa Agrawal, Gregor Nathan, Stivers Shea, Mahajan Abhimanyu, Woo Jessica G, Espay Alberto J
Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH.
Department of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH.
Neurol Clin Pract. 2025 Aug;15(4):e200506. doi: 10.1212/CPJ.0000000000200506. Epub 2025 Jun 26.
The relationship between socioeconomic factors and Parkinson disease (PD) is unclear. Previous literature suggests a potential disconnect between the effect of socioeconomic status (SES) on PD risk and severity. A recent study found that people with PD in the United States were more likely to come from well-resourced communities. Multiple possible explanations were proposed, including that lower SES could be protective against PD risk. Other studies have found worsened PD symptoms and outcomes associated with lower individual SES. If environmental factors associated with lower SES influence PD biology in a way that worsens symptoms, those processes should also increase PD risk. We set out to determine whether community disadvantage, rather than individual SES, is associated with motor or cognitive symptom severity in PD and atypical parkinsonisms.
Community disadvantage was defined using the Material Community Deprivation Index, a compound score of multiple poverty markers. In our Cincinnati Cohort Biomarkers Program, a cohort that includes PD and atypical parkinsonisms, we tested for associations between community disadvantage and motor symptom severity (Movement Disorders Society Unified PD Rating Scale part III; MDS-UPDRS III), motor disability (Hoehn and Yahr stage [HY]), and cognition (Montreal Cognitive Assessment [MoCA]). We considered age, sex, disease duration, levodopa equivalent daily dose, education years, and race as covariates in multiple regression analyses.
A total of 565 people with PD or atypical parkinsonisms were included (458 idiopathic PD and 107 atypical parkinsonisms). Their mean age was 69 years, and 65% were men. The mean disease duration was 7 years, and the mean MDS-UPDRS III score was 30. The majority (75%) were HY stage 2, and the mean cognitive screening score was nondemented (MoCA 25/30). Worse community disadvantage was significantly associated with worse MDS-UPDRS III score (β 1.58, = 0.01; adjusted for age, sex, and disease duration) and HY stage (OR 1.27, = 0.04, adjusted for age, sex, disease duration, and education years). Community disadvantage was not significantly associated with MoCA score ( = 0.45).
Community disadvantage was associated with worse motor symptom severity and motor disability in PD, suggesting that there are modifiable social and environmental factors that can affect parkinsonian symptom severity.
社会经济因素与帕金森病（PD）之间的关系尚不清楚。既往文献表明，社会经济地位（SES）对PD风险和严重程度的影响之间可能存在脱节。最近一项研究发现，美国的PD患者更有可能来自资源丰富的社区。研究提出了多种可能的解释，包括较低的SES可能对PD风险具有保护作用。其他研究发现，个体SES较低与PD症状及预后恶化有关。如果与较低SES相关的环境因素以某种会使症状恶化的方式影响PD生物学，那么这些过程也应该会增加PD风险。我们旨在确定社区劣势而非个体SES是否与PD及非典型帕金森综合征的运动或认知症状严重程度相关。
使用物质社区剥夺指数来定义社区劣势，该指数是多个贫困指标的综合评分。在我们的辛辛那提队列生物标志物项目中，该队列包括PD和非典型帕金森综合征患者，我们测试了社区劣势与运动症状严重程度（运动障碍协会统一PD评定量表第三部分；MDS-UPDRS III）、运动残疾（Hoehn和Yahr分期[HY]）以及认知（蒙特利尔认知评估[MoCA]）之间的关联。在多元回归分析中，我们将年龄、性别、病程、左旋多巴等效日剂量、受教育年限和种族作为协变量。
共纳入565例PD或非典型帕金森综合征患者（458例特发性PD和107例非典型帕金森综合征）。他们的平均年龄为69岁，65%为男性。平均病程为7年，平均MDS-UPDRS III评分为30分。大多数患者（75%）为HY 2期，平均认知筛查分数未达到痴呆标准（MoCA 25/30）。更严重的社区劣势与更差的MDS-UPDRS III评分（β = 1.58，P = 0.01；校正年龄、性别和病程）以及HY分期（OR = 1.27，P = 0.04，校正年龄、性别、病程和受教育年限）显著相关。社区劣势与MoCA评分无显著关联（P = 0.45）。
社区劣势与PD患者更差的运动症状严重程度和运动残疾相关，这表明存在一些可改变的社会和环境因素会影响帕金森症状的严重程度。
