Parkinson’s disease mortality and years of potential life lost in Iran: A 10-year national analysis (2013

Abstract

Background:

Parkinson’s disease (PD) is a leading neurodegenerative disorder associated with increasing global morbidity and premature mortality. Despite its growing burden, national trends in PD-related mortality and years of potential life lost (YPLL) remain understudied in Iran.

Objectives:

To examine temporal trends in PD-related mortality and YPLL in Iran from 2013 to 2023 and to assess demographic and regional disparities.

Methods:

This repeated cross-sectional study used data from the Iranian National Death Registration System. All deaths attributed to PD (ICD-10 codes G20 and G21) between 2013 and 2023 were included. Crude age-specific and cause-specific mortality rates were calculated, and YPLL was estimated using standard methods. Temporal trends were assessed using regression-based analyses. Spatial patterns were evaluated using ArcGIS, and statistical analyses were performed in Stata version 17.

Results:

A total of 9229 PD-related deaths were recorded. Crude mortality rates increased from 0.21 per 100,000 in 2013 to 1.77 in 2023, while YPLL rose from 1.21 to 7.86 per 100,000. Males consistently exhibited higher mortality and YPLL than females. Geospatial analysis identified higher burdens in Tehran, Khorasan Razavi, Isfahan, and Fars. Lower rates in several rural provinces may partly reflect underreporting or disparities in healthcare access.

Conclusion:

The observed increase in crude PD-related mortality and YPLL over the past decade suggests a growing public health challenge in Iran. However, these trends should be interpreted with caution, as they may be influenced by population aging, improvements in diagnosis, and changes in death registration practices. Strengthening early diagnosis, specialized care, and equitable access to neurological services—particularly in underserved regions—remains a public health priority.

Plain language summary

Parkinson’s disease (PD) is a brain disorder that causes problems with movement, balance, and coordination. It mostly affects older adults and can lead to serious health issues and early death. In recent years, PD has been affecting more people worldwide—including in Iran. This study looked at how many people in Iran died from Parkinson’s disease between 2013 and 2023, and how many years of life were lost because of these early deaths. The researchers used official death records from the Iranian Ministry of Health to collect data on all Parkinson’s-related deaths during these 10-years period. They found that more than 9,000 people died from PD in Iran during these years. In 2013, about 0.2 people per 100,000 died from PD, but by 2023, that number had increased to nearly 1.8 per 100,000. The number of “years of life lost” also went up, meaning that people were dying earlier than expected because of PD. Men had higher death rates than women, and more life years were lost among men. The researchers also looked at where in Iran these deaths were happening. Big cities like Tehran, Mashhad (Khorasan Razavi), Isfahan, and Shiraz (Fars) had the most deaths. Poorer and more rural areas had fewer deaths, but this could be because people there are not getting diagnosed properly or don’t have access to good medical care. This study shows that Parkinson’s disease is becoming a bigger problem in Iran. The authors say it’s important for the government to take action—such as improving early diagnosis, giving people better access to neurologists, and helping caregivers. They also recommend improving health records and research to better understand the disease and how to help people affected by it.

Keywords

Parkinson’s disease years of potential life lost neurodegenerative disorders Iran

Introduction

Neurodegenerative disorders encompass a group of progressive and chronic diseases that cause irreversible and gradual damage to the central nervous system, resulting in neuronal loss and functional decline.^1,2 Parkinson’s disease (PD) is the second most common condition in this category, following Alzheimer’s disease, and its incidence is rapidly increasing worldwide.^3,4 The epidemiology of PD varies by geographic region, age, and gender, with men being affected approximately twice as often as women.^5,6 The prevalence of the disease rises with age, impacting 1%–3% of individuals over 60 years old, and significantly diminishing the quality of life for both patients and their caregivers.^5,7 Over the past 25 years, the global prevalence of Parkinson’s disease (PD) has more than doubled, affecting over 8.5 million people worldwide and resulting in approximately 5.8 million disability-adjusted life years (DALYs) and more than 329,000 deaths in 2019.⁸ Neurological disorders, including PD, contribute substantially to the global burden of disease, accounting for a considerable proportion of total DALYs worldwide and in the Eastern Mediterranean region⁹

Despite global increases in PD incidence and burden, national data on premature mortality and YPLL in Iran are scarce. Available estimates suggest that PD affects about 0.05% of the general population and 0.26% of adults over 50 years of age.¹⁰ Mortality figures alone underestimate the true burden of Parkinson’s disease, as they do not account for age at death or premature loss of life. While DALYs provide a broader estimate of both fatal and nonfatal health losses, national data in Iran are insufficient for calculating DALYs.^11,12

This study provides the first comprehensive national assessment of temporal and regional trends in PD-related mortality and YPLL in Iran over a 10-year period (2013–2023). By analyzing both geographic and temporal patterns, this research addresses an important knowledge gap, highlights sex- and region-specific disparities, and informs public health policy for targeted interventions and resource allocation.

Methods

This repeated cross-sectional epidemiological study used data from the Iranian National Death Registration System (NDRS), administered by the Ministry of Health and Medical Education. The study included all officially certified deaths between January 1, 2013, and December 31, 2023, in which Parkinson’s disease was recorded as the underlying cause of death, based on ICD-10 codes G20 and G21. All individuals aged 18 years and older meeting this criterion were included using a census approach. The reporting of this study conforms to the RECORD statement (Reporting of studies Conducted using Observational Routinely-collected Data) for observational studies using routinely collected health data.¹³ The completed RECORD checklist is available as Supplemental File 1. To ensure the accuracy and reliability of the data, a series of quality checks were conducted. These included verifying the completeness of the records and cross-referencing with national census data to identify any discrepancies. Cases with missing or incomplete information, such as age, sex, or province of residence, were excluded from the analysis. In total, approximately 3.5% of records were excluded due to incomplete data, which is consistent with the standards of the National Death Registration System and is unlikely to introduce significant bias into the results.

Variables

For each recorded death attributed to Parkinson’s disease, the following variables were extracted: Age at death (in years), Sex (male or female), Province of residence, Nationality (Iranian or non-Iranian), Place of residence (urban or rural), and Date of death. These variables were selected to facilitate both descriptive and inferential statistical analyses, as well as to enable the assessment of geographic and temporal trends throughout the study period.

Statistical analysis

Qualitative variables were summarized using frequencies and percentages. Quantitative variables were reported as mean and standard deviation (mean ± SD). Additionally, the cause-specific mortality rate (per 100,000 population) was calculated annually, utilizing national census data and the number of deaths attributed to Parkinson’s disease (PD). For the census years (e.g. 2016), official data from the Statistical Center of Iran (SCI) were used. For the years between census data, estimates were derived from the population projections published by the SCI, which are based on the most recent available census data.

Years of potential life lost (YPLL) due to premature mortality were estimated for the total population, as well as separately for male and female participants, for each year of the study period. The following standard formula was applied:

YPLL = \sum (E - I) \times Di

Where:

E represents the life expectancy at birth for each year, I is the actual age at death, D_i is the number of deaths at age I. For this study, life expectancy at birth (E) was used rather than remaining life expectancy at the age of death. This approach aligns with commonly used population-level YPLL methods but may slightly overestimate premature mortality compared with methods using age-specific life expectancy.

All statistical analyses were performed using Stata/17, also for annual crude mortality and YPLL rates, 95% confidence intervals were calculated assuming a Poisson distribution of deaths. Confidence intervals were primarily used to quantify uncertainty around annual rates and trend estimates.

Spatial and temporal trend analysis

Temporal trends in crude cause-specific mortality rates and YPLL per 100,000 population were plotted for the entire study period (2013–2023) to assess annual variations and detect potential upward or downward patterns. Temporal trends in mortality and YPLL were formally assessed using log-linear Poisson regression models, from which the annual percent change (APC) was estimated along with 95% confidence intervals. Spatial distribution of PD mortality was analyzed using ArcGIS software to visualize provincial disparities and detect potential high-burden regions.

Ethical considerations

This study was approved by the Ethics Committee of Mashhad University of Medical Sciences (Approval code: IR.MUMS.FHMPM.REC.1403.196). The study utilized anonymized and aggregated secondary data, ensuring full compliance with national data protection regulations and international ethical standards for research involving human subjects.

Results

Between 2013 and 2023, a total of 9229 deaths attributed to Parkinson’s disease (PD) were recorded in Iran (Table 1). Over this 11-year period, the mean age at death was 75.71 ± 10.41 years, with the highest average age observed in 2016 (76.69 ± 9.69 years) and the lowest in 2013 (73.63 ± 11.69 years; Table 1). Males accounted for the majority of PD-related deaths each year, comprising approximately 63% of total cases (Tables 1 and 2). The highest proportion of PD-related deaths in rural areas was observed in 2014 (16.49%; Table 1).

Table 1.

Descriptive characteristics of Parkinson’s disease mortality cases by year (2013–2023).

Variable	2023 (n = 1366)	2022 (n = 1313)	2021 (n = 1114)	2020 (n = 1036)	2019 (n = 976)	2018 (n = 865)	2017 (n = 755)	2016 (n = 659)	2015 (n = 584)	2014 (n = 382)	2013 (n = 183)
Age	75.78 + 10.16	75.82 + 10.17	75.82 + 10.35	75.82 + 10.23	75.68 + 10.85	75.84 ± 10.35	76.06 ± 10.85	76.69 ± 9.69	74.69 ± 10.76	74.42 ± 10.61	73.63 ± 11.69
Sex
Female	508 (37.19%)	457 (34.81%)	429 (38.51%)	352 (33.98%)	335 (34.47%)	292 (33.76%)	235 (31.13%)	239 (36.27%)	186 (31.85%)	123 (32.20%)	63 (34.43%)
Male	858 (62.81%)	856 (65.19%)	685 (61.49%)	684 (66.02%)	637 (65.53%)	573 (66.24%)	520 (68.87%)	420 (63.37%)	398 (68.15%)	259 (67.80%)	120 (65.57%)
Nationality
Iranian	1362 (99.71%)	1306 (99.47%)	1108 (99.46%)	1031 (99.52%)	969 (99.69%)	864 (99.88%)	751 (99.47%)	657 (99.70%)	853 (99.83%)	381 (99.74%)	183 (100%)
Non-Iranian	4 (0.29%)	7 (0.53%)	6 (0.54%)	5 (0.48%)	3 (0.31%)	1 (0.12%)	4 (0.53%)	2 (0.30%)	1 (0.17%)	1 (0.26%)	0
Residency
Rural	174 (12.78%)	141 (10.81%)	163 (14.75%)	161 (15.59%)	137 (14.23%)	118 (13.79%)	107 (14.32%)	81 (12.44%)	69 (12.17%)	63 (16.49%)	29 (15.85%)
Urban	1188 (87.22%)	1163 (89.19%)	942 (85.25%)	872 (84.41%)	826 (85.77%)	738 (86.21%)	640 (85.68%)	570 (87.56%)	498 (87.83%)	319 (83.51%)	154 (84.15%)

Table 2.

Overall demographic distribution of PD-related deaths in Iran, 2013–2023.

Variable	Total (n = 9229)
Age	75.71 ± 10.41
Sex
Female	3400 (36.84%)
Male	5829 (63.16%)
Nationality
Iranian	9195 (99.63%)
Non-Iranian	34 (0.37%)
Residency
Rural	1243 (13.58%)
Urban	7910 (86.42%)

The crude cause-specific mortality rate increased substantially over the study period, from 0.24 (95% CI: 0.21–0.27) per 100,000 population in 2013 to 1.62 (95% CI: 1.53–1.71) per 100,000 in 2023 (Table 3, Figure 1). Similarly, the years of potential life lost (YPLL) per 100,000 population rose from 0.98 (95% CI: 0.83–1.13) in 2013 to 7.38 (95% CI: 6.22–8.54) in 2023 (Table 3, Figure 2). Males and females showed varying rate differences across years, with males generally exhibiting higher rates in earlier years (Table 3).

Table 3.

Trends in Parkinson’s disease mortality and years of potential life lost (YPLL) in Iran, 2013–2023.

Year	Total deaths (n)	Crude mortality rate per 100,000 (95% CI)	YPLL rate per 100,000 (95% CI)	Mortality rate males (per 100,000)	Mortality rate females (per 100,000)	YPLL rate males (per 100,000)	YPLL rate females (per 100,000)
2013	183	0.24 (0.21–0.27)	0.98 (0.83–1.13)	0.08	0.16	0.35	0.63
2014	381	0.49 (0.44–0.54)	1.63 (1.37–1.87)	0.16	0.33	0.46	1.17
2015	583	0.74 (0.68–0.80)	2.73 (2.30–3.16)	0.23	0.51	1.12	1.61
2016	659	0.83 (0.77–0.89)	2.42 (2.04–2.80)	0.53	0.30	1.39	1.03
2017	754	0.94 (0.87–1.01)	3.30 (2.78–3.82)	0.29	0.65	1.14	2.16
2018	865	1.07 (1.00–1.14)	4.15 (3.50–4.80)	0.36	0.71	1.57	2.58
2019	969	1.18 (1.11–1.25)	4.71 (3.98–5.46)	0.40	0.78	1.88	2.83
2020	1036	1.25 (1.17–1.33)	5.03 (4.25–5.83)	0.43	0.82	1.89	3.14
2021	1113	1.33 (1.25–1.41)	5.66 (4.77–6.55)	0.51	0.82	2.32	3.34
2022	1313	1.56 (1.48–1.64)	6.94 (5.85–8.03)	0.54	1.02	2.43	4.51
2023	1366	1.62 (1.53–1.71)	7.38 (6.22–8.54)	0.60	1.02	2.79	4.59

Rates are crude per 100,000 population. A log-linear regression showed an annual percent change (APC) of 16.7% in mortality rate and 19.9% in YPLL rate (both P < 0.001).

Figure 1.

Annual cause-specific mortality rate due to Parkinson’s disease per 100,000 population in Iran (2013–2023).

Figure 2.

Trend in years of potential life lost (YPLL) per 100,000 population in Iran (2013–2023).

Formal time-trend analysis using log-linear regression confirmed statistically significant upward trends, with an estimated annual percent change (APC) of 16.7% (95% CI: 11.4–22.2%) for the mortality rate and 19.9% (95% CI: 15.1–24.7%) for the YPLL rate over the 11-year period.

In terms of geographical distribution, spatial mapping using ArcGIS software revealed considerable variation in PD-related mortality and YPLL across Iranian provinces (as illustrated in Figures 3 –5).

Figure 3.

Provincial distribution of Parkinson’s disease mortality rate in Iran (2013).

Figure 4.

Provincial distribution of Parkinson’s disease mortality rate in Iran (2018).

Figure 5.

Provincial distribution of Parkinson’s disease mortality rate in Iran (2023).

The highest cause-specific mortality rates and YPLL per 100,000 were recorded in Tehran, Khorasan Razavi, Isfahan, and Fars provinces (Figures 3 –5). In contrast, the lowest values were observed in provinces such as Sistan and Baluchestan, Ilam, Kohgiluyeh and Boyer-Ahmad, and South Khorasan (Figures 3 –5). Several other provinces, including East Azerbaijan, Gilan, Mazandaran, Kerman, and Alborz, reported intermediate levels of PD burden (Figures 3 –5).

Discussion

This nationwide analysis demonstrates a substantial increase in crude Parkinson’s disease (PD)–related mortality and years of potential life lost (YPLL) in Iran between 2013 and 2023. Formal time-trend analyses confirmed statistically significant upward trends in both indicators over the study period. However, these increases should be interpreted with caution and should not be construed as evidence of a causal rise in the underlying risk of Parkinson’s disease. A considerable proportion of the observed increase is likely attributable to population aging, improvements in diagnostic recognition, and enhanced completeness of the national death registration system rather than a true escalation in disease incidence or lethality.^3,14

The observed sex disparity, with males accounting for approximately 63% of PD-related deaths and exhibiting higher YPLL than females, is consistent with existing epidemiological evidence indicating a higher prevalence and mortality burden of Parkinson’s disease among men.^15
–17 Biological susceptibility, hormonal factors, and sex-specific differences in health-seeking behavior have been proposed as potential explanations for this pattern. In the Iranian context, male-dominant occupational exposures and gender-related disparities in healthcare utilization may further contribute to the higher observed mortality and premature mortality burden among men.^18,19

Marked geographic variation in PD-related mortality and YPLL was observed across Iranian provinces. Provinces with higher levels of urbanization and population density, including Tehran, Isfahan, Khorasan Razavi, and Fars, consistently exhibited higher crude mortality and YPLL rates. These patterns may partially reflect better access to neurologic services, greater availability of specialists, and more complete death certification practices in urban and economically developed regions, leading to improved ascertainment of Parkinson’s disease as an underlying cause of death.^20
–22 Conversely, lower reported rates in provinces such as Sistan and Baluchestan, Ilam, Kohgiluyeh and Boyer-Ahmad, and South Khorasan are unlikely to indicate a genuinely lower disease burden. Instead, these findings may reflect underdiagnosis, limited access to neurologic care, and incomplete mortality reporting in underserved or rural areas.^19
–22

Similar regional disparities in Parkinson’s disease mortality have been reported in other low- and middle-income countries, including China and Brazil, where variations in socioeconomic development, healthcare infrastructure, and registry quality substantially influence reported mortality patterns.^19,20 These international comparisons suggest that geographic differences in PD mortality are shaped by both epidemiologic factors and health system performance, underscoring the importance of cautious interpretation of crude regional comparisons.

At the global level, Parkinson’s disease has been increasingly recognized as a rapidly growing contributor to neurological morbidity and mortality. The World Health Organization has reported a marked rise in the burden of Parkinson’s disease since 2000, and Global Burden of Disease analyses have documented increasing years of life lost attributable to PD, particularly in middle-income countries.^16,20,21 Although direct comparisons are constrained by methodological differences, the upward crude trends observed in Iran are broadly consistent with these global patterns.

The COVID-19 pandemic during 2020–2021 may have further influenced observed mortality trends. Disruptions in healthcare access, delays in diagnosis and follow-up, and potential misclassification or displacement of causes of death during the pandemic may have affected the accuracy of Parkinson’s disease mortality reporting.²³ Due to limitations in available data, formal pre–post or interaction analyses could not be conducted; nevertheless, the potential impact of the pandemic should be considered when interpreting temporal fluctuations during this period.

Several important methodological limitations warrant consideration. First, this study relied exclusively on ICD-10–coded death certificates (G20–G21), with Parkinson’s disease identified only when recorded as the underlying cause of death. Parkinson’s disease is frequently listed as a contributing rather than underlying cause, particularly when immediate causes such as pneumonia or cardiovascular events are present. This practice likely leads to systematic underestimation of PD-related mortality.^19
–22 The absence of consistently available contributing-cause or “any-mention” PD data in the national mortality registry precluded a comprehensive sensitivity analysis incorporating these cases.

Second, although a sensitivity approach was undertaken to address incomplete registry coverage in Tehran prior to 2015 by excluding Tehran’s population from the denominator for those years, this exclusion did not materially alter the direction or magnitude of national mortality and YPLL trends (data not shown). A full sensitivity analysis across all provinces and years was not feasible due to data limitations. Nonetheless, the persistence of national trends after this adjustment suggests that the overall findings are robust to incomplete early registry coverage.

Third, the use of crude mortality and YPLL rates represents an important limitation. Because age-standardized population denominators were not available for all provinces and years, age-standardized mortality rates could not be calculated. Consequently, part of the observed increase in crude PD mortality and YPLL likely reflects Iran’s demographic aging rather than a true increase in disease risk. Improvements in diagnostic accuracy and death registration completeness may have further contributed to the observed upward trends. These factors underscore the need to avoid causal interpretation of crude temporal changes.

Despite these limitations, this study provides the first comprehensive national assessment of temporal and geographic patterns in Parkinson’s disease mortality and YPLL in Iran over a 10-year period. The findings highlight the growing public health importance of Parkinson’s disease and underscore the need to strengthen neurologic care capacity, improve early diagnosis, and reduce regional inequities in access to specialized services. Enhancing the quality and completeness of mortality surveillance systems, particularly through the inclusion of age-stratified population data and contributing-cause information, will be essential for future studies aimed at producing more precise and policy-relevant estimates of the Parkinson’s disease burden in Iran.

Conclusion

This nationwide study shows a clear increase in crude Parkinson’s disease (PD)–related mortality and years of potential life lost (YPLL) in Iran between 2013 and 2023, underscoring the growing public health importance of PD. These trends should be interpreted cautiously, as they are likely influenced by population aging, improved diagnostic recognition, enhanced death registration, and potential disruptions during the COVID-19 pandemic, rather than reflecting a true causal increase in disease risk.

Higher mortality and YPLL among males and in more urbanized provinces highlight important demographic and regional disparities in the burden of Parkinson’s disease. Future studies incorporating age-standardized mortality rates, contributing-cause data, and disability-adjusted life years (DALYs) are needed to better quantify the true disease burden. Strengthening neurologic services and mortality surveillance systems will be essential for informed policy planning in Iran.

Supplemental Material

sj-docx-1-phj-10.1177_22799036261433155 – Supplemental material for Parkinson’s disease mortality and years of potential life lost in Iran: A 10-year national analysis (2013–2023)

Supplemental material, sj-docx-1-phj-10.1177_22799036261433155 for Parkinson’s disease mortality and years of potential life lost in Iran: A 10-year national analysis (2013–2023) by Faezeh Sadeghzadeh, Mahdieh Sahebi, Mahin Ghavami, Elaheh Kazemi, Hamed Etemadi, Fatemeh Zahra Nezamdoust and Ehsan Mosa Farkhani in Journal of Public Health Research

Footnotes

ORCID iD

Faezeh Sadeghzadeh

Ethical Considerations

The study protocol was approved by the Mashhad University of Medical Sciences Ethics Committee (Approval ID: IR.MUMS.FHMPM.REC.1403.196).

Consent to Participate

Not applicable. This study used anonymized secondary data with no direct involvement of human participants.

Author Contributions

“Conceptualization, F.S., M.S., E.F., H.E., and F.N.; methodology, M.S., F.S. and E.K.; software, M.S. and E.F.; validation, M.S. and E.F.; formal analysis, M.S. and E.K.; investigation, M.S., F.S. and E.F.; resources, E.F.; data curation, E.F.; writing—original draft preparation, M.S., F.S. and E.F; writing—review and editing, M.S.,F.S., E.F., M.Gh., F.N., E.K.; supervision, E.F.; project administration, E.F.; funding acquisition, E.F. All authors have read and agreed to the published version of the manuscript.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by Mashhad University of Medical Sciences, Mashhad, Iran.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The data are available upon reasonable request to the corresponding author (Ehsan Mosa Farkhani, farkhanie@mums.ac.ir). The data that support the findings of this study are not publicly available due to privacy or ethical restrictions.*

Supplemental Material

Supplemental material for this article is available online.

References

Lamptey

RNL

Chaulagain

Trivedi

, et al. A review of the common neurodegenerative disorders: current therapeutic approaches and the potential role of nanotherapeutics. Int J Mol Sci 2022; 23(3): 1851.

Rekatsina

Paladini

Piroli

, et al. Pathophysiology and therapeutic perspectives of oxidative stress and neurodegenerative diseases: a narrative review. Adv Ther 2020; 37(1): 113–139.

Lang

Siderowf

Macklin

, et al. Trial of cinpanemab in early Parkinson’s disease. N Engl J Med 2022; 387(5): 408–420.

Wirdefeldt

Adami

Cole

, et al. Epidemiology and etiology of Parkinson’s disease: a review of the evidence. Eur J Epidemiol 2011; 26: S1–58.

Ben-Shlomo

Darweesh

Llibre-Guerra

, et al. The epidemiology of Parkinson’s disease. Lancet 2024; 403(10423): 283–292.

Simon

Tanner

Brundin

Parkinson disease epidemiology, pathology, genetics, and pathophysiology. Clin Geriatr Med 2020; 36(1): 1–12.

Zhao

Yang

Zhang

, et al. Quality of life in Parkinson’s disease: a systematic review and meta-analysis of comparative studies. CNS Neurosci Ther 2021; 27(3): 270–279.

World Health Organization. Parkinson disease [Internet]. WHO, https://www.who.int/news-room/fact-sheets/detail/parkinson-disease (2023, accessed 10 June 2025).

GBD 2019 Parkinson’s Disease Collaborators. Global, regional, and national burden of Parkinson’s disease, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2022; 21(10): 913–934. https://doi.org/10.1016/S1474-4422(22)00201-8

10.

Hosseinzadeh

Baneshi

Sedighi

, et al. Estimation of Parkinson’s disease prevalence and its geographical variation in Iran. J Mazandaran Univ Med Sci 2021; 31(200): 113–124.

11.

Sarmadi

Rezaei

Poursadeghiyan

, et al. Burden of Parkinson’s disease in Iran: disparities, trends, and the impact of social development indicators. Neurol Sci 2025; 46(8): 3651–3662.

12.

Roldós

Orazem

Fortunato-Tavares

Longitudinal trends (2011-2020) of premature mortality and years of potential life loss (YPLL) and associated covariates of the 62 New York State counties. Int J Equity Health 2023; 22(1): 89.

13.

Benchimol

Smeeth

Guttmann

, et al. The REporting of studies conducted using observational routinely-collected health data (RECORD) statement. PLoS Med 2015; 12(10): e1001885.

14.

Okobi

Ezeamii

, et al. A comprehensive 16-year analysis of National Center for Health Statistics data on the top three causes of death before age 75 by sex, race, and Hispanic origin. Cureus 2023; 15(11): e49765.

15.

Steenland

MacNeil

Seals

, et al. Factors affecting survival of patients with neurodegenerative disease. Neuroepidemiology 2010; 35(1): 28–35.

16.

Dorsey

Sherer

Okun

, et al. The emerging evidence of the Parkinson pandemic. J Parkinsons Dis 2018; 8(Suppl 1): S3–S8.

17.

Shulman

LM.

Gender differences in Parkinson’s disease. Gend Med 2007; 4(1): 8–18.

18.

Van Den Eeden

Tanner

Bernstein

, et al. Incidence of Parkinson’s disease: variation by age, gender, and race/ethnicity. Am J Epidemiol 2003; 157(11): 1015–1022.

19.

Feigin

Nichols

Alam

, et al. Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019; 18(5): 459–480.

20.

World Health Organization. Neurological disorders: public health challenges. WHO, 2006.

21.

Pringsheim

Jette

Frolkis

, et al. The prevalence of Parkinson’s disease: a systematic review and meta-analysis. Mov Disord 2014; 29(13): 1583–1590.

22.

Espay

Lang

AE.

Common myths in the use of levodopa in Parkinson disease. JAMA Neurol 2017; 74(6): 633.

23.

Ioannidis

JPA

. Global perspective of COVID-19 epidemiology for a full-cycle pandemic. Eur J Clin Invest 2020; 50(12): e13423.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.03 MB

0.00 MB