报告的职业暴露和环境与 ALS 的关联：一项病例对照研究。

Associations of self-reported occupational exposures and settings to ALS: a case-control study.

机构信息

Department of Neurology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109-5223, USA.

NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI, USA.

出版信息

Int Arch Occup Environ Health. 2022 Sep;95(7):1567-1586. doi: 10.1007/s00420-022-01874-4. Epub 2022 May 20.

DOI:10.1007/s00420-022-01874-4

PMID:35593931

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9424174/

Abstract

BACKGROUND

Environmental exposures contribute to the pathogenesis of amyotrophic lateral sclerosis (ALS), a fatal and progressive neurological disease. Identification of these exposures is important for targeted screening and risk factor modification.

OBJECTIVE

To identify occupational exposures that are associated with a higher risk of ALS using both survey and standard occupational classification (SOC) coding procedures, and to highlight how exposure surveys can complement SOC coding.

METHODS

ALS participants and neurologically healthy controls recruited in Michigan completed a detailed exposure assessment on their four most recent and longest held occupations. Exposure scores were generated from the exposure survey, and occupations were assigned to SOC codes by experienced exposure scientists.

RESULTS

This study included 381 ALS and 272 control participants. ALS participants reported higher duration-adjusted occupational exposure to particulate matter (OR = 1.45, 95% CI 1.19-1.78, p < 0.001), volatile organic compounds (OR = 1.22, 95% CI 1.02-1.45, p = 0.029), metals (OR = 1.48, 95% CI 1.21-1.82, p < 0.001), and combustion and diesel exhaust pollutants (OR = 1.20, 95% CI 1.01-1.43, p = 0.041) prior to ALS diagnosis, when adjusted for sex, age, and military service compared to controls. In multivariable models, only occupational exposure to metals remained significant risk (OR = 1.56, 95% CI 1.11-2.20, p = 0.011), although in an adaptive elastic net model, particulate matter (OR = 1.203), pesticides (OR = 1.015), and metals (1.334) were all selected as risk factors. Work in SOC code "Production Occupations" was associated with a higher ALS risk. SOC codes "Building and Grounds Cleaning and Maintenance Occupations", "Construction and Extraction Occupations", "Installation, Maintenance, and Repair Occupations", and "Production Occupations" were all associated with a higher exposure to metals as determined using survey data.

DISCUSSION

Occupational exposure to particulate matter, volatile organic compounds, metals, pesticides, and combustion and diesel exhaust and employment in "Production Occupations" was associated with an increased ALS risk in this cohort.

摘要

背景

环境暴露是肌萎缩侧索硬化症（ALS）的发病机制之一，ALS 是一种致命且进行性的神经退行性疾病。识别这些暴露因素对于靶向筛查和危险因素的改变很重要。

目的

本研究旨在通过问卷调查和标准职业分类（SOC）编码程序，确定与 ALS 风险增加相关的职业暴露，并强调暴露调查如何补充 SOC 编码。

方法

在密歇根州招募的 ALS 参与者和神经健康对照者完成了他们最近的四个最长时间从事的职业的详细暴露评估。暴露得分是根据暴露调查生成的，由经验丰富的暴露科学家将职业分配到 SOC 代码中。

结果

本研究纳入了 381 名 ALS 患者和 272 名对照者。ALS 患者报告在调整性别、年龄和兵役因素后，其职业暴露于颗粒物（OR=1.45，95%CI 1.19-1.78，p<0.001）、挥发性有机化合物（OR=1.22，95%CI 1.02-1.45，p=0.029）、金属（OR=1.48，95%CI 1.21-1.82，p<0.001）和燃烧及柴油废气污染物（OR=1.20，95%CI 1.01-1.43，p=0.041）的时间明显更长。在多变量模型中，只有职业暴露于金属仍为显著风险（OR=1.56，95%CI 1.11-2.20，p=0.011），尽管在自适应弹性网模型中，颗粒物（OR=1.203）、杀虫剂（OR=1.015）和金属（OR=1.334）均被选为危险因素。SOC 代码为“生产职业”的工作与 ALS 风险增加相关。SOC 代码“建筑和地面清洁与维护职业”、“建筑和提取职业”、“安装、维护和修理职业”和“生产职业”均与使用调查数据确定的更高金属暴露水平相关。