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Spatial distribution of Parkinson's disease mortality in Spain, 1989-1998, as a guide for focused aetiological research or health-care intervention.
BMC Public Health. 2009 Dec 02; 9:445.BP

Abstract

BACKGROUND

Aetiologically, genetic and environmental factors having an uneven spatial distribution may underlie Parkinson's disease (PD). Undiagnosis of PD in selected regions might have limited access to treatment with levodopa and simultaneously, if present at death, determined PD underreporting at the death record. The purpose of this study was to describe and analyse municipal mortality due to PD in Spain in aetiological and interventional perspective.

METHODS

PD mortality at a municipal level was modelled using the Besag-York- Molliè autoregressive spatial model, combining demographic information with cause-of-death diagnostic data (International Classification of Diseases 9th Revision (ICD-9) code 332.0). Municipal relative risks (RRs) were independently estimated for women, men and both sexes, and plotted on maps depicting smoothed RR estimates and the distribution of the posterior probability of RR>1.

RESULTS

A south-north gradient, with large geographical areas suggesting clustered towns with high mortality, was seen in Asturias, the Basque Country, Balearic Islands and, particularly, in the Lower Ebro valley around Tarragona. Similarly, there was a suggestion that lowest mortality was clustered in the south-east and south-west. We identified some isolated or clustered municipalities with high mortality that were situated near industrial plants reported to be associated with environmental xenobiotic emissions. However, the same pattern was also observed for some cities with low mortality.

CONCLUSION

Municipal PD mortality in Spain was unevenly distributed. Patterns were roughly similar to reported provincial PD mortality and use of levodopa. While the overall pattern appears to result from spatially selective PD undiagnosis, and can not be ascribed to industrial emissions, it can not be excluded that selected "hot spots" reflect genetic factors and/or environmental exposures inducing parkinsonism. A few municipal populations, located in low-mortality-risk areas in the vicinity of polluting plants or registering high excess PD mortality, might constitute a priority for conducting direct etiological studies. Additionally, interventions aimed to reduce potential PD undiagnosis might be most appropriate in the South.

Authors+Show Affiliations

Department of Applied Epidemiology, National Centre for Epidemiology, and Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Carlos III Institute of Health, C/ Sinesio Delgado 6, 28029 Madrid, Spain. jpedro@isciii.esNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19954536

Citation

Pedro-Cuesta, Jesús de, et al. "Spatial Distribution of Parkinson's Disease Mortality in Spain, 1989-1998, as a Guide for Focused Aetiological Research or Health-care Intervention." BMC Public Health, vol. 9, 2009, p. 445.
Pedro-Cuesta Jd, Rodríguez-Farré E, Lopez-Abente G. Spatial distribution of Parkinson's disease mortality in Spain, 1989-1998, as a guide for focused aetiological research or health-care intervention. BMC Public Health. 2009;9:445.
Pedro-Cuesta, J. d., Rodríguez-Farré, E., & Lopez-Abente, G. (2009). Spatial distribution of Parkinson's disease mortality in Spain, 1989-1998, as a guide for focused aetiological research or health-care intervention. BMC Public Health, 9, 445. https://doi.org/10.1186/1471-2458-9-445
Pedro-Cuesta Jd, Rodríguez-Farré E, Lopez-Abente G. Spatial Distribution of Parkinson's Disease Mortality in Spain, 1989-1998, as a Guide for Focused Aetiological Research or Health-care Intervention. BMC Public Health. 2009 Dec 2;9:445. PubMed PMID: 19954536.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Spatial distribution of Parkinson's disease mortality in Spain, 1989-1998, as a guide for focused aetiological research or health-care intervention. AU - Pedro-Cuesta,Jesús de, AU - Rodríguez-Farré,Eduard, AU - Lopez-Abente,Gonzalo, Y1 - 2009/12/02/ PY - 2009/06/18/received PY - 2009/12/02/accepted PY - 2009/12/4/entrez PY - 2009/12/4/pubmed PY - 2010/8/31/medline SP - 445 EP - 445 JF - BMC public health JO - BMC Public Health VL - 9 N2 - BACKGROUND: Aetiologically, genetic and environmental factors having an uneven spatial distribution may underlie Parkinson's disease (PD). Undiagnosis of PD in selected regions might have limited access to treatment with levodopa and simultaneously, if present at death, determined PD underreporting at the death record. The purpose of this study was to describe and analyse municipal mortality due to PD in Spain in aetiological and interventional perspective. METHODS: PD mortality at a municipal level was modelled using the Besag-York- Molliè autoregressive spatial model, combining demographic information with cause-of-death diagnostic data (International Classification of Diseases 9th Revision (ICD-9) code 332.0). Municipal relative risks (RRs) were independently estimated for women, men and both sexes, and plotted on maps depicting smoothed RR estimates and the distribution of the posterior probability of RR>1. RESULTS: A south-north gradient, with large geographical areas suggesting clustered towns with high mortality, was seen in Asturias, the Basque Country, Balearic Islands and, particularly, in the Lower Ebro valley around Tarragona. Similarly, there was a suggestion that lowest mortality was clustered in the south-east and south-west. We identified some isolated or clustered municipalities with high mortality that were situated near industrial plants reported to be associated with environmental xenobiotic emissions. However, the same pattern was also observed for some cities with low mortality. CONCLUSION: Municipal PD mortality in Spain was unevenly distributed. Patterns were roughly similar to reported provincial PD mortality and use of levodopa. While the overall pattern appears to result from spatially selective PD undiagnosis, and can not be ascribed to industrial emissions, it can not be excluded that selected "hot spots" reflect genetic factors and/or environmental exposures inducing parkinsonism. A few municipal populations, located in low-mortality-risk areas in the vicinity of polluting plants or registering high excess PD mortality, might constitute a priority for conducting direct etiological studies. Additionally, interventions aimed to reduce potential PD undiagnosis might be most appropriate in the South. SN - 1471-2458 UR - https://www.unboundmedicine.com/medline/citation/19954536/Spatial_distribution_of_Parkinson's_disease_mortality_in_Spain_1989_1998_as_a_guide_for_focused_aetiological_research_or_health_care_intervention_ L2 - https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-9-445 DB - PRIME DP - Unbound Medicine ER -