Koeman Tom, Slottje Pauline, Schouten Leo J, Peters Susan, Huss Anke, Veldink Jan H, Kromhout Hans, van den Brandt Piet A, Vermeulen Roel
Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands.
Occup Environ Med. 2017 Aug;74(8):578-585. doi: 10.1136/oemed-2016-103780. Epub 2017 Mar 29.
To prospectively study suspected occupational risk factors for amyotrophic lateral sclerosis (ALS).
For this case-cohort analysis within the prospective Netherlands Cohort Study, 58 279 men and 62 573 women aged 55-69 years at enrolment in 1986 were followed up for 17.3 years on ALS mortality. Information on occupational history and potential confounders were collected at baseline through a self-administered questionnaire and entered for a random subcohort (2092 men and 2074 women) and ALS deaths (76 men and 60 women). Occupational exposure to solvents, pesticides, metals, extremely low frequency magnetic fields (ELF-MFs) and electrical shocks was estimated by means of job exposure matrices (JEMs). Associations between ever/never occupationally exposed and cumulative exposure and ALS mortality were analysed by gender using Cox regression.
Occupational exposure to ELF-MF showed a possible association with ALS mortality among men: HR for ever holding a job with high exposure versus background 2.19 (95% (CI): 1.02 to 4.73) and HR for the highest tertile of cumulative exposure versus background 1.93 (95% CI 1.05 to 3.55).
These results strengthen the evidence suggesting a positive association between ELF-MF exposure and ALS. We did not replicate earlier positive findings for other occupational exposures.
前瞻性研究肌萎缩侧索硬化症（ALS）的疑似职业风险因素。
在荷兰前瞻性队列研究中进行该病例队列分析，对1986年入组时年龄在55 - 69岁的58279名男性和62573名女性进行了17.3年的ALS死亡率随访。通过自填问卷在基线时收集职业史和潜在混杂因素信息，并录入一个随机子队列（2092名男性和2074名女性）以及ALS死亡病例（76名男性和60名女性）。通过工作暴露矩阵（JEMs）估计职业性接触溶剂、农药、金属、极低频磁场（ELF - MFs）和电击的情况。使用Cox回归按性别分析曾经/从未职业暴露以及累积暴露与ALS死亡率之间的关联。
职业性接触ELF - MF在男性中显示出与ALS死亡率可能存在关联：曾经从事高暴露工作与背景暴露相比的风险比（HR）为2.19（95%置信区间（CI）：1.02至4.73），累积暴露最高三分位数与背景暴露相比的HR为1.93（95% CI 1.05至3.55）。
这些结果强化了表明ELF - MF暴露与ALS之间存在正相关的证据。我们未重现早期关于其他职业暴露的阳性发现。
