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

Background: Parkinson's disease (PD) is the second most common neurodegenerative disorder in the United States and a growing driver of late-life disability and death. We characterized U.S. PD-related mortality from 1999 to 2025 and projected it to 2030. Methods: In this serial cross-sectional analysis of CDC WONDER Multiple Cause of Death data, PD-related deaths in adults aged ≥45 years were identified using ICD-10 code G20 recorded anywhere on the death certificate. Age-adjusted mortality rates (AAMRs) per 100,000 were decomposed by joinpoint regression and projected to 2030 using a log-scale ensemble weighted by rolling-origin back-test error, stratified by sex, age, race and ethnicity, census region, and degree of urbanization. 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%. Conclusion: 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.