IMPORTANCE Early features of Parkinson disease (PD) have been described through population-based studies that overrepresent White, affluent groups and may not be generalizable. OBJECTIVE To investigate the association between risk factors and prediagnostic presentations of PD in an ethnically diverse UK population with high socioeconomic deprivation but universal access to health care. DESIGN, SETTING, AND PARTICIPANTS A nested case-control study was conducted using electronic health care records on 1 016 277 individuals from primary care practices in East London to extract clinical information recorded between 1990 and February 6, 2018. The data were analyzed between September 3, 2020, and September 3, 2021. Individuals with a diagnosis of PD were compared with controls without PD or other major neurological conditions. MAIN OUTCOMES AND MEASURES A matched analysis (10 controls matched for each patient with PD according to age and sex) and an unmatched analysis (adjusted for age and sex) were undertaken using multivariable logistic regression to determine associations between risk factors and prediagnostic presentations to primary care with subsequent diagnosis of PD. Three time periods (<2, 2-<5, and 5-10 years before diagnosis) were analyzed separately and together. RESULTS Of 1 016 277 individuals included in the data set, 5699 were excluded and 1055 patients with PD and 1 009 523 controls were included in the analysis. Patients with PD were older than controls (mean [SD], 72.9 [11.3] vs 40.3 [15.2] years), and more were male (632 [59.9%] vs 516 862 [51.2%]). In the matched analysis (1055 individuals with PD and 10 550 controls), associations were found for tremor (odds ratio [OR], 145.96; 95% CI, 90.55-235.28) and memory symptoms (OR, 8.60; 95% CI, 5.91-12.49) less than 2 years before the PD diagnosis. The associations were also found up to 10 years before PD diagnosis for tremor and 5 years for memory symptoms. Among midlife risk factors, hypertension (OR, 1.36; 95% CI, 1.19-1.55) and type 2 diabetes (OR, 1.39; 95% CI, 1.19-1.62) were associated with subsequent diagnosis of PD. Associations with early nonmotor features, including hypotension (OR, 6.84; 95% CI, 3.38-13.85), constipation (OR, 3.29; 95% CI, 2.32-4.66), and depression (OR, 4.69; 95% CI, 2.88-7.63), were also noted. Associations were found for epilepsy (OR, 2.5; 95% CI, 1.63-3.83) and hearing loss (OR, 1.66; 95% CI, 1.06-2.58), which have not previously been well reported. These findings were replicated using data from the UK Biobank. No association with future PD diagnosis was found for ethnicity or deprivation index level. CONCLUSIONS AND RELEVANCE This study provides data suggesting that a range of comorbidities and symptoms are encountered in primary care settings before PD diagnosis in an ethnically diverse and deprived population. Novel temporal associations were observed for epilepsy and hearing loss with subsequent development of PD. The prominence of memory symptoms suggests an excess of cognitive dysfunction in early PD in this population or difficulty in correctly ascertaining symptoms in traditionally underrepresented groups.

中文翻译：

---

在英国不同人群的初级保健中评估帕金森病的危险因素和早期表现。


重要性 帕金森病 (PD) 的早期特征已通过基于人群的研究进行了描述，这些研究过多地代表了白人、富裕群体，并且可能无法推广。目的 调查社会经济贫困程度较高但普遍获得医疗保健的英国多种族人群中 PD 危险因素与诊断前表现之间的关联。设计、设置和参与者使用来自东伦敦初级保健实践的 1 016 277 名个人的电子医疗记录进行了一项巢式病例对照研究，以提取 1990 年至 2018 年 2 月 6 日期间记录的临床信息。数据在 2018 年 9 月期间进行了分析。 2020年9月3日和2021年9月3日。将诊断为帕金森病的个体与没有帕金森病或其他主要神经系统疾病的对照者进行比较。主要结果和措施 使用多变量逻辑回归进行匹配分析（根据年龄和性别为每位 PD 患者匹配 10 名对照）和不匹配分析（根据年龄和性别调整），以确定危险因素和诊断前表现之间的关联。护理与随后的 PD 诊断。分别和一起分析三个时间段（诊断前<2年、2-<5年和5-10年）。结果 数据集中包含 1 016 277 名个体，其中 5 699 名被排除，1 055 名 PD 患者和 1 009 523 名对照者被纳入分析。 PD 患者比对照组年龄更大（平均 [SD]，72.9 [11.3] vs 40.3 [15.2] 岁），男性较多（632 [59.9%] vs 516 862 [51.2%]）。在匹配分析（1055 名 PD 患者和 10 550 名对照者）中，发现震颤（比值比 [OR]，145.96；95% CI，90.55-235.28）和记忆症状（OR，8.60；95% CI，5.91）之间存在关联。 -12。49) PD 诊断前不到 2 年。震颤和记忆症状在帕金森病诊断前 10 年和帕金森病诊断前 5 年也发现了这种关联。在中年危险因素中，高血压（OR，1.36；95% CI，1.19-1.55）和2型糖尿病（OR，1.39；95% CI，1.19-1.62）与随后的PD诊断相关。与早期非运动特征的关联，包括低血压（OR，6.84；95% CI，3.38-13.85）、便秘（OR，3.29；95% CI，2.32-4.66）和抑郁（OR，4.69；95% CI，2.88- 7.63），也被注意到。发现与癫痫（OR，2.5；95% CI，1.63-3.83）和听力损失（OR，1.66；95% CI，1.06-2.58）之间存在关联，此前尚未有过充分报道。使用英国生物银行的数据重复了这些发现。未发现种族或剥夺指数水平与未来 PD 诊断存在关联。结论和相关性 本研究提供的数据表明，在种族多样化和贫困人群中，在 PD 诊断之前，初级保健机构会遇到一系列合并症和症状。观察到癫痫和听力损失与随后的帕金森病发展之间存在新的时间关联。记忆症状的突出表明该人群在早期帕金森病中存在过多的认知功能障碍，或者在传统上代表性不足的群体中难以正确确定症状。