Objective: To describe the epidemiology of Parkinson’s disease (PD) in Israel during a 20-year period, 2000–2019, and to characterize initial symptoms and comorbidities of PD patients.

Background: PD is diagnosed based on medical history and clinical manifestations [1]. However, initial presentation may vary substantially, making early PD diagnosis a challenge. We explored PD patients’ characteristics using the computerized, comprehensive database of Maccabi Healthcare Services (MHS), a nationally representative insurer and provider covering 25% of Israel’s population [2].

Method: “eNLIGHTEN” is a retrospective population-based study, capturing all MHS PD patients diagnosed by neurologists or hospitals. Index date was defined as the earliest coded diagnosis. Study variables included demographics, smoking, family history of PD,  symptoms and comorbidities extracted from inpatient and outpatient visits as well as validated chronic disease registries.

Results: A total of 9,936 PD patients were identified, (annual incidence of ~500 cases), 56% male, with a mean age at diagnosis of 75 years (SD=11). Seven percent had a family history of PD and 7% were ever smokers. PD prevalence among MHS members aged >60 years on December 2019 was 1%.
Frequently documented initial symptoms prior to index date included constipation (36%), tremor (33%), gait abnormality (20%) and urinary urgency (19%). Less frequently documented initial symptoms were voice disturbances (7%), dysphagia (7%) and dysarthria (4%). Ataxia, dystonia, postural instability, hypersalivation, hyposmia, and akinesia were documented in ≤2% of cases.
Most frequent comorbidities at baseline and within one year post-index date were hypertension (68%), chronic kidney disease (54%), degenerative arthritis (35%), cardiovascular disease (31%), osteoporosis (30%), diabetes (29%), cancer (21%) and stroke (10%, CVA and TIA included). Depression and COPD were documented in ≤5% of cases.

Conclusion: PD epidemiology and frequency of PD cases with underlying family history in MHS population matches previously published global estimates [3]. Our study provides insight into initial identification and documentation of PD and associated comorbidities in routine healthcare settings.

References: 1. Armstrong MJ, Okun MS. JAMA. Diagnosis and Treatment of Parkinson Disease: A Review. 2020 Feb;323(6):548-560. 2. Cohen R and Damari N. 2018. Membership in Sick Funds 2017. National Insurance Institute of Israel, 2018. Retrieved September, 2019, from https://www.btl.gov.il/Publications/survey/Documents/seker_303.pdf (in Hebrew). 3. Balestrino R, Schapira AHV. Parkinson disease. Eur J Neurol. 2020 Jan;27(1):27-42.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/parkinsons-disease-in-israel-initial-symptoms-and-comorbidities-from-20-years-of-follow-up-in-a-population-based-cohort/