Fischer Heidi, Kheifets Leeka, Huss Anke, Peters Tracy L, Vermeulen Roel, Ye Weimin, Fang Fang, Wiebert Pernilla, Vergara Ximena P, Feychting Maria
From the aDepartment of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA; bInstitute for Risk Assessment Sciences, University of Utrecht, Utrecht, The Netherlands; cInstitute for Social and Preventive Medicine, University of Bern, Bern, Switzerland; dDepartment of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; eJulius Centre for Public Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands; fUnit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; gElectric Power Research Institute (EPRI), Palo Alto, CA; and hUnit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Epidemiology. 2015 Nov;26(6):824-30. doi: 10.1097/EDE.0000000000000365.
Amyotrophic lateral sclerosis (ALS) has been consistently related to "electric occupations," but associations with magnetic field levels were generally weaker than those with electrical occupations. Exposure to electric shock has been suggested as a possible explanation. Furthermore, studies were generally based on mortality or prevalence of ALS, and studies often had limited statistical power.
Using two electric shock and three magnetic field job-exposure matrices, we evaluated the relationship of occupational magnetic fields, electric shocks, electric occupations, and incident ALS in a large population-based nested case-control study in Sweden. Subanalyses, specified a priori, were performed for subjects by gender and by age (less than and more than 65 years).
Overall, we did not observe any associations between occupational magnetic field or electric shock exposure and ALS. For individuals less than 65 years old, high electric shock exposure was associated with an odds ratio (OR) of 1.22 (95% confidence interval [CI] = 1.03, 1.43). The corresponding result for the age group 65 years or older was OR = 0.92 (95% CI = 0.81, 1.05). Results were similar regardless which job exposure matrices, exposure definitions, or cutpoints were used. For electric occupations, ORs were close to unity, regardless of age. For welders, no association was observed overall, although for welders <65 years the OR was 1.52 (95% CI = 1.05, 2.21).
In this very large population-based study based on incident ALS case subjects, we did not confirm previous observations of higher risk of ALS in electrical occupations, and provided only weak support for associations between electric shocks and ALS.
肌萎缩侧索硬化症(ALS)一直与“电气职业”相关,但与磁场水平的关联通常比与电气职业的关联弱。电击暴露被认为是一种可能的解释。此外,研究通常基于ALS的死亡率或患病率,且研究的统计效力往往有限。
在瑞典一项基于人群的大型巢式病例对照研究中,我们使用两种电击和三种磁场工作暴露矩阵,评估职业磁场、电击、电气职业与ALS发病之间的关系。对按性别和年龄(小于65岁和大于65岁)划分的受试者进行了预先指定的亚组分析。
总体而言,我们未观察到职业磁场或电击暴露与ALS之间存在任何关联。对于年龄小于65岁的个体,高电击暴露与比值比(OR)为1.22相关(95%置信区间[CI]=1.03,1.43)。65岁及以上年龄组的相应结果为OR = 0.92(95% CI = 0.81,1.05)。无论使用哪种工作暴露矩阵、暴露定义或切点,结果均相似。对于电气职业,无论年龄如何,OR均接近1。对于焊工,总体未观察到关联,尽管对于年龄小于65岁的焊工,OR为1.52(95% CI = 1.05,2.21)。
在这项基于ALS发病病例受试者的大型人群研究中,我们未证实先前关于电气职业中ALS风险较高的观察结果,仅为电击与ALS之间的关联提供了微弱支持。