Compared with women, men are more likely to be diagnosed with Parkinson’s disease and to be treated more aggressively with medication, while overall treatment initiation patterns are also influenced by patient age and physician specialty.
HONOLULU—Treatment patterns among patients with Parkinson’s disease differ significantly based on gender, as well as age, according to research presented at the 63rd Annual Meeting of the American Academy of Neurology. Physician specialty was also shown to affect patients’ diagnosis and treatment.
“The features and progression of Parkinson’s disease vary from patient to patient,” the investigators reported, noting that sex- and age-related differences have been observed in the clinical characteristics of Parkinson’s disease.
Jane Castelli-Haley, PhD, and Marcy L. Tarrants, PhD, from Teva Neuroscience Inc in Kansas City, Missouri, and Maureen J. Lage, PhD, from HealthMetrics Outcomes Research in Groton, Connecticut, conducted three separate analyses of a population of patients with Parkinson’s disease to examine how these factors influenced treatment patterns.
Men Are Treated More Aggressively
“Given the complexity of Parkinson’s disease treatment, as well as the potential for patient characteristics to affect Parkinson’s disease symptoms and progression, the goal of this research is to examine, in a real-world setting, how the treatment of Parkinson’s disease may differ according to the patient’s sex,” the researchers stated.
Dr. Castelli-Haley and colleagues included 14,001 men (mean age, 74.81) and 11,443 women (mean age, 75.47) in their study population. In addition to being slightly younger than female patients, male patients were more likely to receive a diagnosis of Parkinson’s disease and were in poorer general health, according to scores on the Charlson Comorbidity Index.
“Men were more likely to be diagnosed with comorbid cardiovascular disease, diabetes, or hypercholesterolemia,” the investigators reported. Women, on the other hand, were more likely to be diagnosed with psychiatric comorbidities—including anxiety, dementia, depression, or psychoses—and hypertension or thyroid disease.
Of the study population, 17,930 patients received an anti–Parkinson’s disease medication, including dopamine agonist, catechol-O-methyltransferase (COMT) inhibitor, levodopa, monoamine oxidase type B (MAO-B) inhibitor, anticholinergic, or carbidopa/levodopa/entacapone (CLE); men were more likely than women (72.87% vs 67.53%) to be treated in the first year after diagnosis. Among those patients who received any of these medications, “men were significantly more likely to switch classes of anti–Parkinson’s disease medications or to adjunctively use multiple classes of anti–Parkinson’s disease medications,” according to the investigators.
“This analysis of demographic information and treatment patterns among a large, nationwide sample of patients with Parkinson’s disease revealed significant differences based on sex,” Dr. Castelli-Haley and her colleagues wrote, noting that further research into the long-term implications of these disparities is needed.
Older Patients Are More Likely to Receive Anti–Parkinson’s Disease Medication
Using the same study population, Drs. Lage, Tarrants, and Castelli-Haley conducted a separate analysis to determine if age similarly affected diagnosis and treatment of Parkinson’s disease. The study population was grouped according to age; the majority of patients (20,839) were older than 65, while 4,605 patients were 65 or younger.
“Older individuals were more likely to be female, [to have] comprehensive insurance, and to be in poorer general health,” the researchers reported. “Compared with individuals younger than 65, those 65 or older were more likely to be diagnosed with cardiovascular disease, cerebrovascular disease, dementia, diabetes, or hypertension.” Younger individuals, in contrast, had higher rates of anxiety and depression, as well as hypercholesterolemia or thyroid disease.
Dr. Lage and colleagues observed significant differences between older and younger patients regarding time to initial receipt of anti–Parkinson’s disease medication, particularly that older individuals were more likely to receive medications. “In contrast, younger patients were generally treated more aggressively,” the investigators wrote, “with those individuals age 65 or younger more likely to switch classes of anti–Parkinson’s disease medication or to be treated adjunctively with multiple classes of anti–Parkinson’s disease medication.”
Physician Specialty Influences Treatment Patterns
In addition to disease differences based on age and sex, the researchers investigated whether the specialty of the physician who made the initial Parkinson’s disease diagnosis affected treatment patterns. “Given that neurologists see and treat patients with Parkinson’s disease more often than do other doctors,” the investigators wrote, “we hypothesized that patients treated by neurologists would be more likely to receive treatment consistent with American Academy of Neurology guidelines.”
They found that patients diagnosed by a neurologist were younger and more likely to be male, and that there was no difference in patients’ general health. There were, however, significant differences between the two groups regarding timing of receipt of initial Parkinson’s disease medication. “Those diagnosed by a neurologist were significantly more likely to be treated with an anti–Parkinson’s disease medication and more likely to receive medication at the time of initial diagnosis,” the researchers reported. This group of patients was also more likely to be prescribed a dopamine agonist, MAO-B inhibitor, an anticholinergic, or CLE.