Trends in health service use among persons with Parkinson’s disease by rurality: A population-based repeated cross-sectional study

Background The global burden of Parkinson’s disease (PD) has more than doubled over the past three decades, and this trend is expected to continue. Despite generally poorer access to health care services in rural areas, little previous work has examined health system use in persons with PD by rurality. We examined trends in the prevalence of PD and health service use among persons with PD by rurality in Ontario, Canada. Methods We conducted a repeated, cross-sectional analysis of persons with prevalent PD aged 40+ years on April 1st of each year from 2000 to 2018 using health administrative databases and calculated the age-sex standardized prevalence of PD. Prevalence of PD was also stratified by rurality and sex. Negative binomial models were used to calculate rate ratios with 95% confidence intervals comparing rates of health service use in rural compared to urban residents in 2018. Results The age-sex standardized prevalence of PD in Ontario increased by 0.34% per year (p<0.0001) and was 459 per 100,000 in 2018 (n = 33,479), with a lower prevalence in rural compared to urban residents (401 vs. 467 per 100,000). Rates of hospitalizations and family physician visits declined over time in both men and women with PD in rural and urban areas, while rates of emergency department, neurologist, and other specialist visits increased. Adjusted rates of hospitalizations were similar between rural and urban residents (RR = 1.04, 95% CI [0.96, 1.12]), while rates of emergency department visits were higher among rural residents (RR = 1.35, 95% CI [1.27, 1.42]). Rural residents had lower rates of family physician (adjusted RR = 0.82, (95% CI [0.79, 0.84]) and neurologist visits (RR = 0.74, 95% CI [0.72, 0.77]). Interpretation Lower rates of outpatient health service use among persons residing in rural regions, contrasting with higher rates of emergency department visits suggest inequities in access. Efforts to improve access to primary and specialist care for persons with PD in rural regions are needed.

[1]  D. Jannat-Khah,et al.  Capitated versus fee-for-service reimbursement and quality of care for chronic disease: a US cross-sectional analysis , 2022, BMC Health Services Research.

[2]  P. Austin,et al.  Trends in Health Service Use for Canadian Adults With Dementia and Parkinson Disease During the First Wave of the COVID-19 Pandemic , 2022, JAMA health forum.

[3]  C. Tanner,et al.  Prevalence of parkinsonism and Parkinson disease in urban and rural populations from Latin America: A community based study , 2021, Lancet Regional Health. Americas.

[4]  Yong Ji,et al.  Prevalence of Parkinson’s Disease in Adults Aged 65 Years and Older in China: A Multicenter Population-Based Survey , 2021, Neuroepidemiology.

[5]  Dakota Peacock,et al.  Perception of Healthcare Access and Utility of Telehealth Among Parkinson’s Disease Patients , 2020, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[6]  Reshmi L. Singh,et al.  Considering Health Care Needs in a Rural Parkinson Disease Community , 2020, Progress in community health partnerships : research, education, and action.

[7]  F. Blandini,et al.  Parkinson’s Disease in Women and Men: What’s the Difference? , 2019, Journal of Parkinson's disease.

[8]  Narelle Warren,et al.  Parkinson's disease prevalence and the association with rurality and agricultural determinants. , 2019, Parkinsonism & related disorders.

[9]  Yoshihiro Kokubo,et al.  Global, regional, and national burden of Parkinson's disease, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 , 2018, The Lancet Neurology.

[10]  Alla Yakerson.  Home Care in Ontario: Perspectives on Equity , 2018, International journal of health services : planning, administration, evaluation.

[11]  C. Tanner,et al.  Prevalence of Parkinson’s disease across North America , 2018, npj Parkinson's Disease.

[12]  J. Volkmann,et al.  Do We Need to Rethink the Epidemiology and Healthcare Utilization of Parkinson's Disease in Germany? , 2018, Front. Neurol..

[13]  A. Gruneir,et al.  Multimorbidity and healthcare utilization among home care clients with dementia in Ontario, Canada: A retrospective analysis of a population-based cohort , 2017, PLoS medicine.

[14]  J. Tu,et al.  Recent Temporal Changes in Atherosclerotic Cardiovascular Diseases in Ontario: Clinical and Health Systems Impact. , 2017, The Canadian journal of cardiology.

[15]  Wayne Warry,et al.  Clinical Telemedicine Utilization in Ontario over the Ontario Telemedicine Network , 2016, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[16]  C. Clarke,et al.  A systematic review of interventions to reduce hospitalisation in Parkinson's disease. , 2016, Parkinsonism & related disorders.

[17]  N. Jetté,et al.  The prevalence of Parkinson's disease: A systematic review and meta‐analysis , 2014, Movement disorders : official journal of the Movement Disorder Society.

[18]  Jacqueline Young,et al.  A Validation Study of Administrative Data Algorithms to Identify Patients with Parkinsonism with Prevalence and Incidence Trends , 2014, Neuroepidemiology.

[19]  R. Reid,et al.  Cardiac rehabilitation barriers by rurality and socioeconomic status: a cross-sectional study , 2013, International Journal for Equity in Health.

[20]  K. Walters,et al.  Time trends in incidence of Parkinson’s disease diagnosis in UK primary care , 2013, Journal of Neurology.

[21]  K. Kieburtz,et al.  Parkinson's disease: Evidence for environmental risk factors , 2013, Movement disorders : official journal of the Movement Disorder Society.

[22]  J. Perlmutter,et al.  Neurologist-associated reduction in PD-related hospitalizations and health care expenditures , 2012, Neurology.

[23]  L. Lix,et al.  Healthcare utilization in patients with Parkinson's disease: a population-based analysis. , 2012, Parkinsonism & related disorders.

[24]  J. Perlmutter,et al.  Neurologist care in Parkinson disease , 2011, Neurology.

[25]  K. Bötzel,et al.  Costs of illness and care in Parkinson's Disease: An evaluation in six countries , 2011, European Neuropsychopharmacology.

[26]  J. J. Tai,et al.  Different Prevalence Rates of Parkinson’s Disease in Urban and Rural Areas: A Population-Based Study in Taiwan , 2009, Neuroepidemiology.

[27]  C. Mcintosh,et al.  Income disparities in health-adjusted life expectancy for Canadian adults, 1991 to 2001. , 2009, Health reports.

[28]  Peter C. Austin,et al.  The Relative Ability of Different Propensity Score Methods to Balance Measured Covariates Between Treated and Untreated Subjects in Observational Studies , 2009, Medical decision making : an international journal of the Society for Medical Decision Making.

[29]  L. Lix,et al.  Socioeconomic variations in the prevalence and incidence of Parkinson's disease: a population-based analysis , 2009, Journal of Epidemiology & Community Health.

[30]  A. Kopp,et al.  Capitation and enhanced fee-for-service models for primary care reform: a population-based evaluation , 2009, Canadian Medical Association Journal.

[31]  D. Edge,et al.  Canadian Home Care Policy and Practice in Rural and Remote Settings: Challenges and Solutions , 2009, Journal of agromedicine.

[32]  R. Holloway,et al.  Economic burden associated with Parkinson's disease on elderly Medicare beneficiaries , 2006, Movement disorders : official journal of the Movement Disorder Society.

[33]  B. Starfield,et al.  Contribution of primary care to health systems and health. , 2005, The Milbank quarterly.

[34]  J. Gallacher,et al.  Cross‐sectional survey of Parkinson's disease and parkinsonism in a rural area of the United Kingdom , 2005, Movement disorders : official journal of the Movement Disorder Society.

[35]  J. Hux,et al.  Time trends and geographic disparities in acute complications of diabetes in Ontario, Canada. , 2005, Diabetes care.

[36]  Lorene M Nelson,et al.  Incidence of Parkinson's disease: variation by age, gender, and race/ethnicity. , 2003, American journal of epidemiology.

[37]  Ulf Persson,et al.  Resource use and costs in a Swedish cohort of patients with Parkinson's disease , 2002, Movement disorders : official journal of the Movement Disorder Society.

[38]  M. Yen,et al.  Prevalence, incidence, and mortality of PD: A door-to-door survey in Ilan County, Taiwan , 2001 .

[39]  T. Chen,et al.  Prevalence, incidence, and mortality of PD , 2001, Neurology.

[40]  Ross Upshur,et al.  A population based time series analysis of asthma hospitalisations in Ontario, Canada: 1988 to 2000 , 2001, BMC health services research.

[41]  Y Ben-Shlomo,et al.  Cross sectional prevalence survey of idiopathic Parkinson's disease and parkinsonism in London , 2000, BMJ : British Medical Journal.

[42]  B. Robottom.  Neurologist care in Parkinson disease: A utilization, outcomes, and survival study , 2012 .

[43]  J. Sundquist,et al.  Socioeconomic and occupational groups and Parkinson’s disease: a nationwide study based on hospitalizations in Sweden , 2009, International archives of occupational and environmental health.

[44]  E. Teng,et al.  A door-to-door survey of Parkinson's disease in a Chinese population in Kinmen. , 1996, Archives of neurology.