Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM-U1018, Hôpital Paul Brousse, 16 avenue Paul Vaillant-Couturier, Villejuif, France.
Santé publique France, Direction santé travail, 94415, Saint-Maurice, France.
Eur J Epidemiol. 2017 Mar;32(3):203-216. doi: 10.1007/s10654-017-0229-z. Epub 2017 Feb 9.
Most studies on pesticides and Parkinson's disease (PD) focused on occupational exposure in farmers. Whether non-occupational exposure is associated with PD has been little explored. We investigated the association between agricultural characteristics and PD incidence in a French nationwide ecologic study. We hypothesized that persons living in regions with agricultural activities involving more intensive pesticide use would be at higher risk. We identified incident PD cases from French National Health Insurance databases (2010-2012). The proportion of land dedicated to 18 types of agricultural activities was defined at the canton of residence level. We examined the association between agricultural activities and PD age/sex-standardized incidence ratios using multivariable multilevel Poisson regression adjusted for smoking, deprivation index, density of neurologists, and rurality (proportion of agricultural land); we used a false discovery rate approach to correct for multiple comparisons and compute q-values. We also compared incidence in clusters of cantons with similar agricultural characteristics (k-means algorithm). We identified 69,010 incident PD cases. Rurality was associated with higher PD incidence (p < 0.001). Cantons with higher density of vineyards displayed the strongest association (RR = 1.102, 95% CI = 1.049-1.158; q-trend = 0.040). This association was similar in men, women, and non-farmers, stronger in older than younger persons, and present in all French regions. Persons living in the cluster with greatest vineyards density had 8.5% (4.4-12.6%) higher PD incidence (p < 0.001). In France, vineyards rank among the crops that require most intense pesticide use. Regions with greater presence of vineyards are characterized by higher PD risk; non-professional pesticides exposure is a possible explanation.
大多数关于农药和帕金森病 (PD) 的研究都集中在农民的职业暴露上。非职业暴露是否与 PD 有关尚未得到充分探讨。我们在一项法国全国范围的生态学研究中调查了农业特征与 PD 发病率之间的关系。我们假设，生活在农业活动涉及更多农药使用的地区的人患 PD 的风险更高。我们从法国国家健康保险数据库（2010-2012 年）中确定了 PD 新发病例。居住地层面的州内，用于 18 种农业活动的土地比例被定义为农业活动的比例。我们使用多变量多层泊松回归模型，根据吸烟、贫困指数、神经科医生密度和农村化（农业用地比例）调整后，检查了农业活动与 PD 年龄/性别标准化发病率比值之间的关系；我们使用虚假发现率方法来纠正多次比较并计算 q 值。我们还比较了具有相似农业特征的州集群的发病率（k-均值算法）。我们确定了 69,010 例新发病例。农村化与 PD 发病率较高相关（p<0.001）。葡萄园密度较高的州与最强的关联（RR=1.102，95%CI=1.049-1.158；q 趋势=0.040）。这种关联在男性、女性和非农民中相似，在老年人中比年轻人更强，并且存在于法国所有地区。生活在葡萄园密度最大的集群中的人 PD 发病率高出 8.5%（4.4-12.6%）（p<0.001）。在法国，葡萄园是需要最密集使用农药的作物之一。葡萄园存在较多的地区 PD 风险较高；非职业性农药暴露可能是一个解释。
