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Research paper
Parkinson disease male-to-female ratios increase with age: French nationwide study and meta-analysis
  1. Frédéric Moisan1,
  2. Sofiane Kab1,2,3,
  3. Fatima Mohamed2,3,
  4. Marianne Canonico2,3,
  5. Morgane Le Guern1,
  6. Cécile Quintin4,
  7. Laure Carcaillon4,
  8. Javier Nicolau5,
  9. Nicolas Duport4,
  10. Archana Singh-Manoux2,3,
  11. Marjorie Boussac-Zarebska5,
  12. Alexis Elbaz1,2,3
  1. 1Département santé travail, Institut de veille sanitaire (InVS), Saint-Maurice, France
  2. 2Department of Epidemiology of ageing and age related diseases, INSERM, Centre for Research in Epidemiology and Population Health, U1018, Villejuif, France
  3. 3University Paris-Sud, UMRS 1018, Villejuif, France
  4. 4Département des maladies chroniques et des traumatismes, Institut de veille sanitaire (InVS), Saint-Maurice, France
  5. 5Institut de veille sanitaire (InVS), Direction scientifique et de la qualité, Saint-Maurice, France
  1. Correspondence to Dr Alexis Elbaz, INSERM U1018, Hôpital Paul Brousse, Bâtiment 15/16, 16 avenue Paul Vaillant-Couturier, Villejuif cedex 94807, France; alexis.elbaz{at}


Background Parkinson’s disease (PD) is 1.5 times more frequent in men than women. Whether age modifies this ratio is unclear. We examined whether male-to-female (M–F) ratios change with age through a French nationwide prevalence/incidence study (2010) and a meta-analysis of incidence studies.

Methods We used French national drug claims databases to identify PD cases using a validated algorithm. We computed M–F prevalence/incidence ratios overall and by age using Poisson regression. Ratios were regressed on age to estimate their annual change. We identified all PD incidence studies with age/sex-specific data, and performed a meta-analysis of M–F ratios.

Results On the basis of 149 672 prevalent (50% women) and 25 438 incident (49% women) cases, age-standardised rates were higher in men (prevalence=2.865/1000; incidence=0.490/1000 person-years) than women (prevalence=1.934/1000; incidence=0.328/1000 person-years). The overall M–F ratio was 1.48 for prevalence and 1.49 for incidence. Prevalence and incidence M–F ratios increased by 0.05 and 0.14, respectively, per 10 years of age. Incidence was similar in men and women under 50 years (M–F ratio <1.2, p>0.20), and over 1.6 (p<0.001) times higher in men than women above 80 years (p trend <0.001). A meta-analysis of 22 incidence studies (14 126 cases, 46% women) confirmed that M– F ratios increased with age (0.26 per 10 years, p trend=0.005).

Conclusions Age-increasing M–F ratios suggest that PD aetiology changes with age. Sex-related risk/protective factors may play a different role across the continuum of age at onset. This finding may inform aetiological PD research.


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