Income, employment, and clinical outcomes in Parkinson’s disease

• Employment status is associated with motor and non-motor outcomes in Parkinson’s disease. • Lower income predicts worse depression, health-related quality of life, and motor severity in Parkinson’s disease. • Unemployment and retirement show consistent risk across multiple clinical domains. • Longitudinal FoxInsight data reveal socioeconomic disparities in Parkinson’s disease outcomes. Socioeconomic factors such as employment status and household income may influence clinical outcomes in Parkinson’s disease, yet their associations with both motor and non-motor symptoms are not well characterized. This study examined whether employment status and income are associated with cognitive complaints, depressive symptoms, health-related quality of life, and motor severity among individuals with Parkinson’s disease. Data were obtained from FoxInsight, and online longitudinal cohort study. Participants aged 40 years and older with Parkinson’s disease who completed self-report questionnaires were included (n = 29,826). Multilevel models examined associations between employment status and household income with cognitive complaints, depressive symptoms, health-related quality of life, and motor severity across up to three annual assessments. Employment status was significantly associated with all outcomes. Compared with full-time employment, unemployment and retirement were associated with more cognitive complaints, greater depressive symptoms, poorer health-related quality of life, and greater motor severity (all p < 0.05). Part-time employment was generally associated with fewer depressive symptoms and did not significantly differ from full-time employment on several outcomes. Lower household income was significantly associated with greater depressive symptoms, poorer health-related quality of life, and greater motor severity (all p < 0.05), but was not associated with cognitive complaints. Employment status and household income are important social determinants of both motor and non-motor outcomes in Parkinson’s disease. These findings highlight the potential clinical relevance of socioeconomic factors shaping disease experience and emphasize the need for interventions that address economic and occupational vulnerability.