Cervical dystonia incidence and diagnostic delay in a multiethnic population

Sara C. LaHue, Kathleen Albers, Samuel Goldman, Raymond Y. Lo, Zhuqin Gu, Amethyst Leimpeter, Robin Fross, Kathleen Comyns, Connie Marras, Annelie de Kleijn, Robin Smit, Maya Katz, Laurie J. Ozelius, Susan Bressman, Rachel Saunders-Pullman, Cynthia Comella, Jeffrey Klingman, Lorene M. Nelson, Stephen K. Van Den Eeden, Caroline M. Tanner

Research output: Contribution to journalArticlepeer-review

26 Scopus citations

Abstract

Background: Current cervical dystonia (CD) incidence estimates are based on small numbers in relatively ethnically homogenous populations. The frequency and consequences of delayed CD diagnosis is poorly characterized. Objectives: To determine CD incidence and characterize CD diagnostic delay within a large, multiethnic integrated health maintenance organization. Methods: We identified incident CD cases using electronic medical records and multistage screening of more than 3 million Kaiser Permanente Northern California members from January 1, 2003, to December 31, 2007. A final diagnosis was made by movement disorders specialist consensus. Diagnostic delay was measured by questionnaire and health utilization data. Incidence rates were estimated assuming a Poisson distribution of cases and directly standardized to the 2000 U.S. census. Multivariate logistic regression models were employed to assess diagnoses and behaviors preceding CD compared with matched controls, adjusting for age, sex, and membership duration. Results: CD incidence was 1.18/100,000 person-years (95% confidence interval [CI], 0.35–2.0; women, 1.81; men, 0.52) based on 200 cases over 15.4 million person-years. Incidence increased with age. Half of the CD patients interviewed reported diagnostic delay. Diagnoses more common in CD patients before the index date included essential tremor (odds ratio [OR] 68.1; 95% CI, 28.2–164.5), cervical disc disease (OR 3.83; 95% CI, 2.8–5.2), neck sprain/strain (OR 2.77; 95% CI, 1.99–3.62), anxiety (OR 2.24; 95% CI, 1.63–3.11) and depression (OR 1.94; 95% CI, 1.4–2.68). Conclusions: CD incidence is greater in women and increases with age. Diagnostic delay is common and associated with adverse effects.

Original languageEnglish
Pages (from-to)450-456
Number of pages7
JournalMovement Disorders
Volume35
Issue number3
DOIs
StatePublished - 1 Mar 2020

Keywords

  • cervical dystonia
  • diagnostic delay
  • incidence

Fingerprint

Dive into the research topics of 'Cervical dystonia incidence and diagnostic delay in a multiethnic population'. Together they form a unique fingerprint.

Cite this