Abstract
Depression is a risk factor for subsequent Parkinson's disease (PD). Some patients with depression undergo acupuncture treatment because of other diseases in Taiwan. Therefore, the present study used data from Taiwan's National Health Insurance Research Database (NHIRD) to investigate the incidence of PD in patients having depression with and without acupuncture treatment. We conducted a retrospective study of a matched cohort of 48,981 patients with newly diagnosed depression between 2000 and 2012 who were selected from the NHIRD. The 1:1 propensity score method was utilized to match an equal number of patients (N = 9,189) in the acupuncture and non-acupuncture cohorts. We employed Cox proportional hazard models to evaluate the risk of PD. The cumulative incidence of PD in both cohorts was estimated using the Kaplan–Meier method, and the difference was examined through a log-rank test. Patients with depression who received acupuncture treatment demonstrated a lower risk of PD [adjusted hazard ratio (aHR) = 0.39, 95% confidence interval = 0.31–0.49] than those who did not undergo acupuncture treatment, after adjusting for age, sex, insurance amount, geographic region, urbanization levels, comorbidities, and drugs. The cumulative incidence of PD was significantly lower in the acupuncture cohort than in the non-acupuncture cohort (log-rank test, p < 0.001). The database did not indicate the severity of depression and acupoints. The results suggest that acupuncture treatment significantly reduced the development of PD in patients with depression; however, a future study should be conducted to provide more objective evidence.
Highlights
According to the World Health Organization’s (WHO) estimation, depression had the third highest global socioeconomic burden in 2008, and the ranking is estimated to increase to the first in 2030 (Malhi and Mann, 2018)
A retrospective cohort study indicated a strong relationship between depression and Parkinson’s disease (PD), and the hazard ratio (HR) with corresponding 95% confidence interval (CI) was 3.13 (1.95–5.01) for patients with depression compared with patients without depression (Schuurman et al, 2002)
This study examined the risk of PD in patients having depression with or without acupuncture treatment, for which patients with depression were identified according to the following diagnostic codes: ICD-9-CM: 296.2, 296.3, 296.82, 300.4, 309.0, 309.1, 309.28, and 311
Summary
According to the World Health Organization’s (WHO) estimation, depression had the third highest global socioeconomic burden in 2008, and the ranking is estimated to increase to the first in 2030 (Malhi and Mann, 2018). According to an epidemiological study in Canada, in 2002, the prevalence of depression was 5.0% in women and 2.9% in men, and after 10 years, the prevalence had increased to 5.8 and 3.6%, respectively (Albert, 2015). Several reports have indicated that patients with depression undergoing antidepressant treatment demonstrate increased incidence of Parkinson’s disease (PD) (Alonso et al, 2009; Gustafsson et al, 2015). Studies have highlighted that depression is associated with stroke, cardiovascular disease, hypertension, diabetes (Thomas et al, 2004), and PD (Gustafsson et al, 2015). A study found that depression may be an early precursor symptom of PD (Gustafsson et al, 2015). How to reduce the incidence of PD among patients with depression undergoing antidepressant treatment is crucial
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