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March 01, 2016; 86 (9) Article

Hepatitis C virus infection as a risk factor for Parkinson disease

A nationwide cohort study

Hsin-Hsi Tsai, Horng-Huei Liou, Chih-Hsin Muo, Cha-Ze Lee, Ruoh-Fang Yen, Chia-Hung Kao
First published December 23, 2015, DOI: https://doi.org/10.1212/WNL.0000000000002307
Hsin-Hsi Tsai
From the Departments of Neurology (H.-H.T.), Neurology and Pharmacology (H.-H.L.), Internal Medicine (C.-Z.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; College of Medicine, National Taiwan University (H.-H.L., C.-Z.L.), Taipei; Management Office for Health Data (C.-H.M.) and Department of Nuclear Medicine and PET Center (C.-H.K.), China Medical University Hospital, Taichung; College of Medicine (C.-H.M.), China Medical University, Taichung; Department of Radiology (R.-F.Y.), National Taiwan University College of Medicine, Taipei; Graduate Institute of Clinical Medical Science and School of Medicine (C.-H.K.), College of Medicine, China Medical University, Taichung, Taiwan.
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Horng-Huei Liou
From the Departments of Neurology (H.-H.T.), Neurology and Pharmacology (H.-H.L.), Internal Medicine (C.-Z.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; College of Medicine, National Taiwan University (H.-H.L., C.-Z.L.), Taipei; Management Office for Health Data (C.-H.M.) and Department of Nuclear Medicine and PET Center (C.-H.K.), China Medical University Hospital, Taichung; College of Medicine (C.-H.M.), China Medical University, Taichung; Department of Radiology (R.-F.Y.), National Taiwan University College of Medicine, Taipei; Graduate Institute of Clinical Medical Science and School of Medicine (C.-H.K.), College of Medicine, China Medical University, Taichung, Taiwan.
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Chih-Hsin Muo
From the Departments of Neurology (H.-H.T.), Neurology and Pharmacology (H.-H.L.), Internal Medicine (C.-Z.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; College of Medicine, National Taiwan University (H.-H.L., C.-Z.L.), Taipei; Management Office for Health Data (C.-H.M.) and Department of Nuclear Medicine and PET Center (C.-H.K.), China Medical University Hospital, Taichung; College of Medicine (C.-H.M.), China Medical University, Taichung; Department of Radiology (R.-F.Y.), National Taiwan University College of Medicine, Taipei; Graduate Institute of Clinical Medical Science and School of Medicine (C.-H.K.), College of Medicine, China Medical University, Taichung, Taiwan.
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Cha-Ze Lee
From the Departments of Neurology (H.-H.T.), Neurology and Pharmacology (H.-H.L.), Internal Medicine (C.-Z.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; College of Medicine, National Taiwan University (H.-H.L., C.-Z.L.), Taipei; Management Office for Health Data (C.-H.M.) and Department of Nuclear Medicine and PET Center (C.-H.K.), China Medical University Hospital, Taichung; College of Medicine (C.-H.M.), China Medical University, Taichung; Department of Radiology (R.-F.Y.), National Taiwan University College of Medicine, Taipei; Graduate Institute of Clinical Medical Science and School of Medicine (C.-H.K.), College of Medicine, China Medical University, Taichung, Taiwan.
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Ruoh-Fang Yen
From the Departments of Neurology (H.-H.T.), Neurology and Pharmacology (H.-H.L.), Internal Medicine (C.-Z.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; College of Medicine, National Taiwan University (H.-H.L., C.-Z.L.), Taipei; Management Office for Health Data (C.-H.M.) and Department of Nuclear Medicine and PET Center (C.-H.K.), China Medical University Hospital, Taichung; College of Medicine (C.-H.M.), China Medical University, Taichung; Department of Radiology (R.-F.Y.), National Taiwan University College of Medicine, Taipei; Graduate Institute of Clinical Medical Science and School of Medicine (C.-H.K.), College of Medicine, China Medical University, Taichung, Taiwan.
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Chia-Hung Kao
From the Departments of Neurology (H.-H.T.), Neurology and Pharmacology (H.-H.L.), Internal Medicine (C.-Z.L.), and Nuclear Medicine (R.-F.Y.), National Taiwan University Hospital, Taipei; College of Medicine, National Taiwan University (H.-H.L., C.-Z.L.), Taipei; Management Office for Health Data (C.-H.M.) and Department of Nuclear Medicine and PET Center (C.-H.K.), China Medical University Hospital, Taichung; College of Medicine (C.-H.M.), China Medical University, Taichung; Department of Radiology (R.-F.Y.), National Taiwan University College of Medicine, Taipei; Graduate Institute of Clinical Medical Science and School of Medicine (C.-H.K.), College of Medicine, China Medical University, Taichung, Taiwan.
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Citation
Hepatitis C virus infection as a risk factor for Parkinson disease
A nationwide cohort study
Hsin-Hsi Tsai, Horng-Huei Liou, Chih-Hsin Muo, Cha-Ze Lee, Ruoh-Fang Yen, Chia-Hung Kao
Neurology Mar 2016, 86 (9) 840-846; DOI: 10.1212/WNL.0000000000002307

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Abstract

Objective: To determine whether hepatitis C virus (HCV) infection is a risk factor for developing Parkinson disease (PD).

Methods: This nationwide population-based cohort study was based on data obtained from a dataset of the Taiwan National Health Insurance Research Database for the period 2000 to 2010. A total of 49,967 patients with viral hepatitis were included for analysis. Furthermore, 199,868 people without viral hepatitis were included for comparisons. Patients with viral hepatitis were further grouped into 3 cohorts: hepatitis B virus (HBV) infection, HCV infection, and HBV-HCV coinfection. In each cohort, we calculated the incidence of developing PD. A Cox proportional hazards model was applied to estimate the risk of developing PD in terms of hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: The crude HRs for developing PD was 0.66 (95% CI = 0.55–0.80) for HBV infection, 2.50 (95% CI = 2.07–3.02) for HCV infection, and 1.28 (95% CI = 0.88–1.85) for HBV-HCV coinfection. The association between HCV and PD remained statistically significant after adjustments for age, sex, and comorbidities (adjusted HR = 1.29, 95% CI = 1.06–1.56).

Conclusions: We conducted a large nationwide population-based study and found that patients with HCV exhibit a significantly increased risk of developing PD.

GLOSSARY

BBB=
blood–brain barrier;
CI=
confidence interval;
HBV=
hepatitis B virus;
HCV=
hepatitis C virus;
HR=
hazard ratio;
ICD-9-CM=
International Classification of Diseases, Ninth Revision, Clinical Modification;
LHID=
Longitudinal Health Insurance Database;
NHI=
National Health Insurance;
NHIP=
National Health Insurance Program;
NHIRD=
National Health Insurance Research Database;
PD=
Parkinson disease;
PS=
propensity score

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • ↵* These authors contributed equally to this work.

  • Supplemental data at Neurology.org

  • Received September 3, 2015.
  • Accepted in final form November 4, 2015.
  • © 2015 American Academy of Neurology
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Disputes & Debates: Rapid online correspondence

  • Author Response to Boyd et al.
    • Chia-Hung Kao, Professor, National Taiwan University HospitalD10040@mail.cmuh.org.tw
    • Hsin-Hsi Tsai
    Submitted April 01, 2016
  • Hepatitis C virus infection and Parkinson disease: Possible role for interferon
    • Jame T. Boyd, Department of Neurological Sciences, University of Vermont College of Medicinejames.boyd@uvmhealth.org
    • Kirk J. Wangensteen, Philadelphia, PA; Edward L. Krawitt, Burlington, VT; Robert W. Hamill, Burlington, VT
    Submitted March 24, 2016
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