The incidence of iPD is twice as high in men, but women have a higher mortality rate and faster progression. Yet, most research samples in iPD have been skewed towards educated white men. Progression of iPD is associated with decreased effectiveness of dopaminergic therapies and complications of these therapies such as dyskinesia. Here, we leverage RWD from the AAN Axon Registry, a neurology-specific patient registry of electronic health record data, to evaluate dyskinesia-related gender disparity among iPD patients.

15,000 iPD patients were identified from a collection of 2.6 million patients and 41 million visits between 1 January 2015 to 15 February 2023, using ICD codes and iPD-related keywords. CS-dyskinesia and cardinal symptoms (tremor, bradykinesia, rigidity) severity were curated from clinical notes using deep-learning approaches. Three logistic regression models were used to assess the association between documentation of CS-dyskinesia during the study period and gender: 1) unadjusted; 2) adjusted for race, ethnicity, and age at first documentation of dyskinesia or most recent non-dyskinesia encounter for non-dyskinesia patients; and 3) adjusted for demographics plus the most severe cardinal symptoms.

1,195 (7.96%) iPD patients had documented CS-dyskinesia. Females had greater odds of dyskinesia (unadjusted - 1.59, 95% CI: 1.41 - 1.79; adjusted for demographics - 1.68, 95% CI: 1.49 - 1.89; adjusted for demographics and symptom severity - 1.80, 95% CI: 1.59 - 2.03).

In the Axon Registry, females with iPD have 1.59 to 1.80 greater odds of having dyskinesia than males during their patient journey, suggesting a gender disparity in disease progression, clinical assessments, or documentation that could prompt new management approaches.