Health, social, and economic consequences of idiopathic REM Sleep Behavior Disorder: a controlled national study evaluating societal effects

OBJECTIVE: Idiopathic REM Sleep Behavior Disorder (iRBD) is one of the strongest known risk markers for alpha-synuclein disorder development including Parkinson Disease (prodromal PD). We aimed to determine the socioeconomic and overall health burden for patients with iRBD, and ultimately for society.

METHODS: A nationwide retrospective cohort study, based on anonymized patient data from the Danish National Patient Registry (DNPR) and other Danish registers. Patients hospital-diagnosed (ICD-10) with iRBD without Parkinson Disease (PD) between 1 January 2006 and 31 December 2018 were included. 392 cases were compared with 1568 controls matched by age, sex, marital status, and geographic location (municipality). All patients were eligible for 2 years follow-up after their index date.

RESULTS: The direct total health costs of iRBD patients, from 4 years before until 1 year after the index date, were higher than those of controls in each year. This was also reflected in the results of a comorbidity analysis, in which patients had significantly higher rates of diseases within a wide variety of the ICD-10 classification groups compared with controls. Up until index year +1, there was no difference in income from employment. Cases received higher levels of public transfers from index year -2 to up to year +1.

CONCLUSION: Patients diagnosed with iRBD showed more frequent contact with the healthcare system in the 4 years up to the diagnosis, than their matched controls, indicating that disease onset has occurred years before iRBD diagnosis. However, this was not reflected in patients' levels of educational attainment and employability before the diagnosis, which shows that iRBD is independent of social factors.