Association Between Viral Hepatitis Infection and Parkinson's Disease

A Population-based Prospective Study

Hwa-Young Choi; Thi Ha Mai; Kyung-Ah Kim; Hyunsoon Cho; Moran Ki

Disclosures

J Viral Hepat. 2020;27(11):1171-1178. 

In This Article

Results

The study cohort included 1 010 317 participants (358 052, participants with noninfections; 488 990, participants with HBV infections; 144 459, participants with HCV infections; and 18 680 participants with HCV/HBV infections) (Figure 1). Among total 1 010 317 participants, 4032 (0.4%) developed PD. The number of participants who developed PD was 1791 (0.5%) participants with noninfection; 1487 (0.3%) participants with HBV infections; 685 (0.5%) participants with HCV infections; and 69 (0.4%) participants with HBV/HCV infections. Mean ages at baseline at the time of viral infection diagnoses were 53.1, 57.1 and 55.7 years in the HBV, HCV and HBV/HCV groups, respectively. Average follow-up durations were 10.3, 6.1, 5.9 and 5.4 years in the noninfection, HBV, HCV and HBV/HCV groups, respectively. Overall, participants in the HCV group were older and everything had a higher prevalence of most of the selected comorbidities except the liver cancer, head injury and alcoholic liver disease than those in the other groups. All differences were statistically significant. Noticeable differences were also seen in the number of deaths during the follow-up period between the 4 groups: 44 579 (12.5%), participants with noninfections; 46 641 (9.5%), participants with HBV infections; 17 046 (11.8%), participants with HCV infections; and 2248 (12.0%), participants with HCV/HBV infections (Table 1).

The cumulative incidence rate of PD during the 11-year follow-up was 0.30% in the noninfection, 0.32% in the HBV and 0.53% in the HCV groups (Figure 2). The incidence density of PD per 10 000 person-years was the highest, at 8.0, in the HCV group, followed by 6.8 in the HBV/HCV group, 5.0 in the HBV group and 4.9 in the noninfection group. The incidence density of PD per 10 000 person-years increased with increasing age and highest in the 70–79 years with the exception of the HBV/HCV group. Especially, among HBV/HCV group, the incidence density of PD per 10 000 person-years was approximately 3 times higher in participants aged ≥80 years than in those aged 70–79 years. Moreover, the incidence density of PD per 10 000 person-years increased with the presence of comorbidities, including hypertension, ischaemic heart disease, epilepsy, type 2 diabetes mellitus, stroke and depressive disorder (Table S1).

Figure 2.

Adjusted (Age, sex, comorbidity and death) cumulative incidence of Parkinson's disease (PD) by viral hepatitis infection using Fine and Gray model, South Korea, 2005–2015

Based on male patient in the noninfection group, the female patient had higher in HRs of PD than male patient in all 4 groups. In addition, based on the not diagnosed with comorbidities in noninfection group, the HRs of PD for those diagnosed with hypertension, ischaemic heart disease, epilepsy, stroke and depressive disorder were higher than those not diagnosed in the all groups. Patients with alcoholic liver diseases in the noninfection, HBV and HCV groups showed lower HRs than those without alcoholic liver diseases in the same groups (Table 2).

The adjusted HRs of PD for age, sex, comorbidities and death were calculated using multivariate competing risk analysis. HRs for PD in the nonadjusted model (model 1) were 1.06 (95% CI: 0.99–1.14), 1.71 (95% CI: 1.56–1.87) and 1.46 (95% CI: 1.15–1.86) in the HBV, HCV and HBV/HCV groups, respectively. When age and sex were included in the model, the HRs of PD went up to 1.40 (95% CI: 1.30–1.50) and 1.61 (95% CI: 1.26–2.04) in the HBV and HBV/HCV groups. However, after including age and sex in the model, HR of PD in the HCV group showed a slight decrease to 1.62 (95% CI: 1.48–1.77). When comorbidities were added to the model (model 3), only the HRs of HBV/HCV group increased to 1.66 (95% CI: 1.30–2.11). The final model (model 4) was adjusted for age, sex, comorbidities and death; the HRs were 1.25 (95% CI: 1.17–1.35), 1.39 (95% CI: 1.27–1.52) and 1.46 (95% CI: 1.14–1.85) in the HBV, HCV and HBV/HCV groups, respectively (Table 3).

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