Epidemiological assessment of levodopa use in Spain, 1990-1995. Persistent, low consumption in the south

Parkinson's disease (PD) is considerably underdiagnosed in Spain and its treatment relies mainly on levodopa (LD), a drug enjoying good access country-wide. In order to identify regions with the highest potential for improvement in the quality of life of PD patients, we evaluated total sales of levodopa in Spanish provinces during the period 1990-1995, using a reported method. Total annual crude sales in the country were medium-low and increased with time. When adjusted for age and infant mortality rates (IMRs), taken as an index of socio-sanitary development, annual LD sales become stable and similar to those in the reference population, Sweden 1994. Provincial LD use (LDU) showed a wide variation in annual levels and time trends, with a north-south gradient in evidence. Statistically significant clustering was seen, with the lowest crude age-adjusted and age- and IMR-adjusted LD sales in the south-west and moderately high levels in north-central and north-west provinces. The results show that LDU in Spain is medium-low, and that demographic and social factors may underlie geographical differences in LD sales. The remarkably low LDU in selected provinces in the south-west of the country might reflect deficient PD detection and/or treatment amenable to control.