{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T16:25:55Z","timestamp":1781108755179,"version":"3.54.1"},"reference-count":40,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T00:00:00Z","timestamp":1748476800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009307","name":"Parkinson Canada","doi-asserted-by":"publisher","award":["CRF\u20102022\u20100000000013"],"award-info":[{"award-number":["CRF\u20102022\u20100000000013"]}],"id":[{"id":"10.13039\/501100009307","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["202311FBD\u2010514464\u201086128"],"award-info":[{"award-number":["202311FBD\u2010514464\u201086128"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disorders"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Parkinson disease (PD) disease\u2010modifying therapy (DMT) trials generally recruit individuals from teaching hospitals. Whether these participants represent the broader PD population is unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective was to compare individuals with PD seen by neurologists in teaching hospitals early in their disease\u2014a proxy for DMT trial\u2010eligible cohorts\u2014with individuals seen in other settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study using population\u2010based data from Ontario (Canada) included individuals with PD from 1995 to 2017. Individuals with \u22651 PD visit with a teaching hospital neurologist within 3\u2009years served as a proxy for DMT trial\u2010eligible participants. Comparators were individuals with PD seen in other settings. We compared age, sex, income, rurality, marginalization, and comorbidities. We measured time to milestones, including drug escalation, surgical\/infusion therapies, home care, dementia, long\u2010term care admission, and death.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 19,948 individuals with PD, of whom 4386 (22.0%) were seen by a teaching hospital neurologist and 15,562 (78.0%) in other settings. Compared to other settings, individuals with teaching hospital neurology visits were younger, belonged to socioeconomically advantaged neighborhoods, and had fewer comorbidities. They had more drug escalation (unadjusted hazard ratio\u2009=\u20091.30; 95% confidence interval [CI]\u2009=\u2009(1.21, 1.38), surgical or infusion therapies (2.35 [2.09, 2.64]), and home care (1.06 [1.02, 1.10]). They had less dementia (0.813 [0.77, 0.86]), long\u2010term care admission (0.62 [0.58, 0.67]), and death (0.68 [0.64, 0.72]).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Individuals with PD seen early by teaching hospital neurologists exhibited differences from the PD population. DMT trials in PD may exclude individuals with faster PD progression and from marginalized groups, impacting generalizability. Our study highlights health equity issues. \u00a9 2025 The Author(s). <jats:italic>Movement Disorders<\/jats:italic> published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mds.30239","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T02:58:50Z","timestamp":1748573930000},"page":"1965-1976","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Differences in Parkinson's Disease Populations: Teaching Hospitals Versus Other Settings and Implications for Clinical Trials"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8250-5915","authenticated-orcid":false,"given":"Priti","family":"Gros","sequence":"first","affiliation":[{"name":"Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital University Health Network Toronto  Toronto Ontario Canada"},{"name":"Department of Medicine, Division of Neurology University of Toronto  Toronto Ontario Canada"},{"name":"Institute of Health Policy, Management &amp; Evaluation University of Toronto  Toronto Ontario Canada"},{"name":"ICES  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connie","family":"Marras","sequence":"additional","affiliation":[{"name":"Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital University Health Network Toronto  Toronto Ontario Canada"},{"name":"Department of Medicine, Division of Neurology University of Toronto  Toronto Ontario Canada"},{"name":"Institute of Health Policy, Management &amp; Evaluation University of Toronto  Toronto Ontario Canada"},{"name":"ICES  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuesong","family":"Wang","sequence":"additional","affiliation":[{"name":"ICES  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Chiu","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management &amp; Evaluation University of Toronto  Toronto Ontario Canada"},{"name":"Pediatric Oncology Group of Ontario  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Farkouh","sequence":"additional","affiliation":[{"name":"Academic Affairs, Cedars\u2010Sinai Health System  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abby","family":"Emdin","sequence":"additional","affiliation":[{"name":"ICES  Toronto Ontario Canada"},{"name":"Dalla Lana School of Public Health University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan E.","family":"Bronskill","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management &amp; 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