School of Health Sciences, College of New Caledonia, Prince George, BC, Canada.
School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada.
Rev Environ Health. 2021 Nov 18;38(1):65-83. doi: 10.1515/reveh-2021-0111. Print 2023 Mar 28.
Earlier longitudinal reviews on environmental and occupational toxins and Parkinson's disease (PD) risk have limitations. This study aimed to determine the strength of association between three types of toxic occupational exposures and the occurrence of PD by diagnostic methods.
A search was conducted of EMBASE, PubMed/Medline, Toxnet, LILACS, and Cochrane Library databases for longitudinal studies that assessed toxic occupational exposure, Parkinsonian, or related disorders, diagnosed by International Classification of Diseases (ICD) codes, medical records, or confirmation by a neurologist/nurse, and published in the English language from January 1990 to July 2021. Pooled risk ratios (RR) estimates were produced using random-effects models. Systematic review with meta-analysis synthesized the results. Study quality, heterogeneity, and publication bias were examined. High-quality articles that met the inclusion criteria were analyzed.
Twenty-four articles were used in the analyses. The pooled RR for electromagnetic exposure and PD were (RR=1.03, 95% confidence interval [CI] 0.91-1.16) while the pooled RR between PD and metal and pesticide exposure were (RR=1.07, 95% CI 0.92-1.24) and (RR=1.41, 95% CI 1.20-1.65), respectively. Pooled RR for methods of diagnosis and their associations with PD were: confirmation by a neurologist or nurse (RR=2.17, 95% CI 1.32-3.54); ICD codes (RR=1.14, 95% CI 1.03-1.26), and medical records (RR=1.06, 95% CI 0.92-1.21).
Our systematic review provides robust evidence that toxic occupational exposures are significant risk factors for PD especially those diagnosed by neurologists or nurses using standardized methods.
早期关于环境和职业毒素与帕金森病 (PD) 风险的纵向综述存在局限性。本研究旨在通过诊断方法确定三种类型的有毒职业暴露与 PD 发生之间的关联强度。
对 EMBASE、PubMed/Medline、Toxnet、LILACS 和 Cochrane Library 数据库进行了检索，以查找评估有毒职业暴露、帕金森氏症或相关疾病的纵向研究，这些疾病通过国际疾病分类 (ICD) 代码、医疗记录或由神经病学家/护士确认诊断，并于 1990 年 1 月至 2021 年 7 月以英文发表。使用随机效应模型生成汇总风险比 (RR) 估计值。系统综述和荟萃分析综合了结果。检查了研究质量、异质性和发表偏倚。分析了符合纳入标准的高质量文章。
有 24 篇文章用于分析。电磁场暴露与 PD 之间的汇总 RR 为 (RR=1.03，95%置信区间 [CI] 0.91-1.16)，而 PD 与金属和农药暴露之间的汇总 RR 分别为 (RR=1.07，95% CI 0.92-1.24) 和 (RR=1.41，95% CI 1.20-1.65)。用于诊断方法及其与 PD 关联的汇总 RR 为：由神经病学家或护士确认 (RR=2.17，95% CI 1.32-3.54)；ICD 代码 (RR=1.14，95% CI 1.03-1.26) 和医疗记录 (RR=1.06，95% CI 0.92-1.21)。
我们的系统综述提供了有力的证据，表明有毒职业暴露是 PD 的重要危险因素，尤其是那些由使用标准化方法的神经病学家或护士诊断的 PD。
