A Cycle of Social Violence: a novel theoretical framework for explaining how structural, slow, and symbolic violence interact to produce and maintain health inequalities in England.

In the 2016 Global Burden of Disease Study, the age-standardized prevalence of Parkinson's disease (PD) was 1.4 times higher in men than in women. This male preponderance might be explained by a protective effect of female sex hormones, a different genetic mechanism or different exposures to environmental risk factors in men and women. Consequently, sex-specific factors in PD merit further study. However, most research has focused on biological differences between men and women, neglecting to place these in the psychosocial context that impacts clinical care and quality of life of men and women with PD. Therefore, the effect of sex and/or gender should be considered in designing future studies in PD. Moreover, previous longitudinal studies addressed the sex-specific progression of some symptoms. Thus, the association of sex with patient-reported and clinician-assessed motor symptoms, the phenotype, activities of daily living and medication with progression was investigated. Another study explored the role of sex in the progression of patient-reported motor symptoms, cognition, dyskinesia, wearing off, depression, rapid eye movement (REM) sleep behavior disorder and some non-motor symptoms. However, most often single studies have mainly reported cross-sectional sex differences of selected symptoms in men and women with PD while a comprehensive empirical description and illustration of the motor- and non-motor symptoms associated with PD progression has not been reported in the literature. Aiming to provide an overview of symptom and general disease progression of PD in men and women that can be easily interpreted by health professionals, we describe the progression of motor- and non-motor symptoms in men and women and quantify the effect moderation by sex in people with typical PD participating in a large monocentric longitudinal cohort. This retrospective analysis is part of the Luxembourg Parkinson's study, a nationwide, monocentric, observational, longitudinal-prospective and dynamic cohort. The completed STROBE reporting guideline checklist is included in Supplemental Table 3.