Santé publique France, 12 Rue du Val d'Osne, 94410, Saint-Maurice, France.
Université Paris-Sud, UVSQ, CESP, INSERM, Université Paris-Saclay, Villejuif, France.
Eur J Epidemiol. 2018 Nov;33(11):1101-1111. doi: 10.1007/s10654-018-0399-3. Epub 2018 May 5.
In order to identify working environments at risk for Parkinson's disease (PD), we investigated the relation between the importance of industry sectors, used as a surrogate for occupational exposures, and PD incidence in French cantons. The number of incident PD cases (2010-2014) in 3689 cantons of metropolitan France was determined using drug claims from French National Health Insurance databases. The proportions of workers in 38 industry sectors in 2006 were calculated for each canton. Associations between the proportions of workers in industry sectors and PD age/sex-standardized incidence ratios were examined using incidence rate ratios (IRR) and 95% confidence intervals (CI) estimated with multilevel negative binomial regressions with a random intercept at the canton-level and adjusted for smoking, deprivation index, and density of neurologists. We then used two-step semi-Bayes hierarchical regression (HR) to include prior information about exposure to pesticides, metals, and solvents in each industry sector. We identified 112,625 incident cases. PD incidence was higher in areas characterized by high proportions of workers in "Agriculture, forestry and fishing" (IRR = 1.042; CI 95% = 1.014-1.070; p-Trend = 0.004), "Manufacture of textiles, wearing apparel, leather and related products" (IRR = 1.024; CI 95% = 1.005-1.044; p-Trend = 0.010), and "Manufacture of basic metals and fabricated metal products, except machinery and equipment" (IRR = 1.024; CI 95% = 1.003-1.046; p-Trend = 0.071). This nationwide study, based on a comprehensive analysis of industry sectors, shows significant associations between high proportions of workers in specific industry sectors (agriculture, metallurgy, textile) and PD incidence that may be targeted in further epidemiological studies to replicate and better understand these associations.
为了确定帕金森病(PD)的工作环境风险,我们研究了作为职业暴露替代物的行业部门的重要性与法国各省 PD 发病率之间的关系。使用法国国家健康保险数据库中的药物索赔,确定了法国大都市 3689 个省份的 2010-2014 年新发 PD 病例数。计算了每个省份 2006 年 38 个行业部门中工人的比例。使用多水平负二项式回归,以 canton 级别为随机截距,调整了吸烟、剥夺指数和神经科医生密度,用发病率比(IRR)和 95%置信区间(CI)来检验行业部门工人比例与 PD 年龄/性别标准化发病率比值之间的关系。然后,我们使用两步半贝叶斯分层回归(HR)来包括每个行业部门中接触农药、金属和溶剂的先验信息。我们确定了 112625 例新发病例。在“农业、林业和渔业”(IRR=1.042;95%CI=1.014-1.070;p-Trend=0.004)、“纺织、服装、皮革及相关产品制造”(IRR=1.024;95%CI=1.005-1.044;p-Trend=0.010)和“基本金属和金属制品制造,机械和设备除外”(IRR=1.024;95%CI=1.003-1.046;p-Trend=0.071)比例高的地区,PD 发病率较高。这项基于对行业部门全面分析的全国性研究表明,特定行业部门(农业、冶金、纺织)中工人比例高与 PD 发病率之间存在显著关联,这些关联可能成为进一步流行病学研究的目标,以复制和更好地理解这些关联。
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