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Neuroepidemiology Research Program and Neurology Service, Veterans Administration Medical Center, and the Departments of Neurology and Community and Family Medicine, Georgetown University School of Medicine, Washington, DC.
Annual crude death rates due to parkinsonism in Denmark, 1956 to 1985, and the United States, 1950 to 1984, showed a consistent hierarchy, with white male rates greater than white female than black male than black female. Rates rose sharply in both lands and sexes between 1976 and 1984. Age-specific death rate curves for whites in the 1960s and 1980s were very similar between the countries with a regular male excess. Both countries drastically changed the configuration of all the death rate age curves in parallel fashion between the 2 periods: rates were now nearly twice those of the earlier interval for each sex, age, and race, and were then maximal at age 82 or 85 + as opposed to the prior peak at age 77 or 80. Age-adjusted rates did not consistently reflect this change, being markedly lower for US white females despite their age-specific rate increases. This discrepancy appears to be an artifact of changing population distributions which increasingly differ by age between sexes and countries over time. When the recent age-specific death rates were recalculated with the thesis that all deaths had occurred at ages 5 years younger, all the 1980s death rate configurations returned to those of the 1960s, with but modest increases at most ages. This is evidence that age at death, and thus survival, has increased at all ages by about 5 years since the introduction of levodopa, released in the US in 1970 and in Denmark in 1971. The increase in the annual death rates is also taken as an indirect result of therapy, with proportionately more parkinsonians now diagnosed and under continued treatment, and thus now more likely to have the disorder listed on a death certificate.
Address correspondence and reprint requests to Dr. John F. Kurtzke, Neurology Service 127, VA Medical Center, 50 Irving Street NW, Washington, DC 20422.
Received October 20, 1988. Accepted for publication in final form June 13, 1989.
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