The aim of this study was to know the top causes of deaths among PD patients and to analyze their long-term patterns of mortality in the United States from 1999 to 2020.

Age-adjusted mortality rates and standard errors of PD (ICD-10 code G20) were extracted from the CDC WONDER database from 1999 to 2020. The top five causes of death in PD were identified to be: atherosclerotic heart disease, Alzheimer's disease, acute myocardial infarction, stroke and pneumonia. Long-term trends over the years were identified by Joinpoint regression software (version 5.4) through determination of joinpoints by permutation test (4499 permutations) at an alpha of p < 0.05. The annual percentage change (APC) and average annual percentage change (AAPC) were computed.

Stroke (AAPC = -4.94%, 95% CI -5.26 to -4.61), pneumonia (AAPC = -7.15%, 95% CI -8.51 to -5.78), acute myocardial infarction (AAPC = -5.75%, 95% CI -6.96 to -4.51)  and atherosclerotic heart disease (AAPC = -3.73%, 95% CI -4.33 to -3.13) showed significant long-term reductions. Alzheimer’s disease showed variable patterns, characterized by an initial rise (1999-2005, APC = +5.19%) followed by a decrease (2005-2014, APC = -3.47%) and subsequent stabilization, resulting in a nonsignificant overall trend (AAPC = -0.05%, 95% CI -0.87 to 0.78).