Table 1_Parkinson’s disease mortality in the United States, 1999–2025: a national multiple-cause-of-death analysis with projections to 2030.docx

A steep 2014–2021 rise (annual percent change 4.70%; p < 0.001) was followed by a non-significant decline, negative in 13 of the 14 strata observed through 2025. COVID-19 was co-listed on 10.15% of PD-mentioned deaths in 2020 and 0.79% in 2025, accounting for 58% of the 2019–2020 rise and 55% of the 2021–2024 decline; excluding these deaths the series was close to flat (39.88 in 2020; 40.71 in 2025). The projected 2030 AAMR was 41.73 (95% prediction interval 33.97–51.27), essentially unchanged from 2025; however, deaths are projected to rise from 62,162 to 70,825, with approximately 87% of the increase attributable to population aging.

Restricting to PD as the underlying cause gave a steeper increase (+86.2% versus +25.3%), arguing against ascertainment drift. Between 1999–2007 and 2017–2025, nursing home deaths fell from 49.24 to 35.48%, while home deaths rose from 19.37 to 34.93% and hospice deaths from 0.88 to 8.25%.</p>Conclusion<p>Age-adjusted PD-related mortality did not change significantly between 1999 and 2025. Most of the post-2021 decline reflects the unwinding of COVID-19 co-listing rather than an improvement in underlying mortality, a mechanism that is now nearly exhausted.

Projections indicate a plateau in the standardized rate, while absolute deaths rise with population aging, and end-of-life care has shifted from institutions to homes.</p>