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      Cancers Preceding Parkinson’s Disease after Adjustment for Bias in a Danish Population-Based Case-Control Study

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          Abstract

          Cancer patients are at lower risk of developing Parkinson’s disease (PD) compared with the general population. One explanation is the negative association between smoking and PD, but PD risk is also lower for cancers not related to smoking. Another explanation is survival bias where death from cancer may act as a competing risk. We conducted a large population-based case-control study in Denmark and investigated whether cancer diagnosis reduced the risk of developing PD even after adjusting for important risk factors including smoking, physical activity, and lifetime oestrogen status. Using probabilistic bias analysis we quantified the influence of survival bias. We estimated negative point estimates (ORs) between cancers and PD for all cancers except skin, female breast, and ill-defined and unspecified 0.85 (95% CI 0.59–1.21); smoking-related cancers 0.75 (95% CI 0.45–1.23); and cancers not related to smoking 0.82 (95% CI 0.49–1.38) that are very similar to those previously reported for a much larger Danish register only based study, even though our confidence intervals include the null. These effect estimates shifted towards the null after accounting for survival bias but most bias-adjusted ORs remained below 1 within the range of priors considered in simulations. Overall, cancer patients have a lower risk of developing PD even after controlling for cancer-related lifestyles factors and correcting for survival bias.

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          Author and article information

          Journal
          NED
          Neuroepidemiology
          10.1159/issn.0251-5350
          Neuroepidemiology
          S. Karger AG
          0251-5350
          1423-0208
          2019
          April 2019
          18 January 2019
          : 52
          : 3-4
          : 136-143
          Affiliations
          [_a] aDepartment of Epidemiology, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California, USA
          [_b] bDanish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
          [_c] cDepartment of Health Care Management, College of Healthcare Administration and Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
          [_d] dAcademic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
          [_e] eCenter for Health Policy Research, UCLA, Los Angeles, California, USA
          [_f] fDepartment of Neurology, Geffen School of Medicine, UCLA, Los Angeles, California, USA
          Author notes
          *Beate Ritz, MD, PhD, Department of Epidemiology, Fielding School of Public Health, UCLA, 650 Charles E. Young Drive, Los Angeles, CA 90095-1772 (USA), E-Mail britz@ucla.edu
          Author information
          https://orcid.org/0000-0002-4277-7972
          Article
          494292 PMC6482096 Neuroepidemiology 2019;52:136–143
          10.1159/000494292
          PMC6482096
          30661072
          6677982c-bad8-4b14-b63a-5c76b9547e0a
          © 2019 S. Karger AG, Basel

          Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

          History
          : 26 May 2018
          : 04 October 2018
          Page count
          Figures: 2, Tables: 3, Pages: 8
          Categories
          Original Paper

          Geriatric medicine,Neurology,Cardiovascular Medicine,Neurosciences,Clinical Psychology & Psychiatry,Public health
          Parkinson’s disease,Survival,Cancer,Bias analysis

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