Division of Occupational and Environmental Medicine, University of California, San Francisco.
San Francisco Veterans Affairs Health Care System, San Francisco, California.
JAMA Neurol. 2023 Jul 1;80(7):673-681. doi: 10.1001/jamaneurol.2023.1168.
An increased risk of Parkinson disease (PD) has been associated with exposure to the solvent trichloroethylene (TCE), but data are limited. Millions of people in the US and worldwide are exposed to TCE in air, food, and water.
To test whether the risk of PD is higher in veterans who served at Marine Corps Base Camp Lejeune, whose water supply was contaminated with TCE and other volatile organic compounds (VOCs), compared with veterans who did not serve on that base.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study examined the risk for PD among all Marines and Navy personnel who resided at Camp Lejeune, North Carolina (contaminated water) (n = 172 128), or Camp Pendleton, California (uncontaminated water) (n = 168 361), for at least 3 months between 1975 and 1985, with follow-up from January 1, 1997, until February 17, 2021. Veterans Health Administration and Medicare databases were searched for International Classification of Diseases diagnostic codes for PD or other forms of parkinsonism and related medications and for diagnostic codes indicative of prodromal disease. Parkinson disease diagnoses were confirmed by medical record review.
Water supplies at Camp Lejeune were contaminated with several VOCs. Levels were highest for TCE, with monthly median values greater than 70-fold the permissible amount.
Risk of PD in former residents of Camp Lejeune relative to residents of Camp Pendleton. In those without PD or another form of parkinsonism, the risk of being diagnosed with features of prodromal PD were assessed individually and cumulatively using likelihood ratio tests.
Health data were available for 158 122 veterans (46.4%). Demographic characteristics were similar between Camp Lejeune (5.3% women, 94.7% men; mean [SD] attained age of 59.64 [4.43] years; 29.7% Black, 6.0% Hispanic, 67.6% White; and 2.7% other race and ethnicity) and Camp Pendleton (3.8% women, 96.2% men; mean [SD] age, 59.80 [4.62] years; 23.4% Black, 9.4% Hispanic, 71.1% White, and 5.5% other race and ethnicity). A total of 430 veterans had PD, with 279 from Camp Lejeune (prevalence, 0.33%) and 151 from Camp Pendleton (prevalence, 0.21%). In multivariable models, Camp Lejeune veterans had a 70% higher risk of PD (odds ratio, 1.70; 95% CI, 1.39-2.07; P < .001). No excess risk was found for other forms of neurodegenerative parkinsonism. Camp Lejeune veterans also had a significantly increased risk of prodromal PD diagnoses, including tremor, anxiety, and erectile dysfunction, and higher cumulative prodromal risk scores.
The study's findings suggest that the risk of PD is higher in persons exposed to TCE and other VOCs in water 4 decades ago. Millions worldwide have been and continue to be exposed to this ubiquitous environmental contaminant.
接触溶剂三氯乙烯（TCE）与帕金森病（PD）风险增加有关，但数据有限。在美国和世界各地，数以百万计的人在空气、食物和水中接触 TCE。
检测曾在海军陆战队营地勒琼（其供水受到 TCE 和其他挥发性有机化合物（VOCs）污染）服役的退伍军人与未在该基地服役的退伍军人相比，患 PD 的风险是否更高。
设计、地点和参与者：这项基于人群的队列研究调查了居住在北卡罗来纳州勒琼营地（污染水）（n=172128）或加利福尼亚州彭德尔顿营地（未污染水）（n=168361）的所有海军陆战队员和海军人员中 PD 的风险，他们在 1975 年至 1985 年期间至少有 3 个月的时间居住在那里，随访时间从 1997 年 1 月 1 日开始，到 2021 年 2 月 17 日结束。退伍军人健康管理局和医疗保险数据库被搜索用于 PD 或其他形式的帕金森病的国际疾病分类诊断代码或相关药物，以及用于提示前驱疾病的诊断代码。帕金森病的诊断通过病历审查得到确认。
勒琼营地的供水受到多种 VOC 的污染。TCE 的含量最高，每月的中位数值超过允许量的 70 倍。
与彭德尔顿营地的居民相比，曾居住在勒琼营地的退伍军人患 PD 的风险。在那些没有 PD 或其他形式的帕金森病的退伍军人中，使用似然比检验单独和累积评估前驱 PD 特征的诊断风险。
有 158122 名退伍军人（46.4%）可提供健康数据。营地勒琼（5.3%的女性，94.7%的男性；平均[SD]获得的年龄为 59.64[4.43]岁；29.7%的黑人，6.0%的西班牙裔，67.6%的白人；和 2.7%的其他种族和民族）和彭德尔顿营地（3.8%的女性，96.2%的男性；平均[SD]年龄，59.80[4.62]岁；23.4%的黑人，9.4%的西班牙裔，71.1%的白人，和 5.5%的其他种族和民族）的人口统计学特征相似。共有 430 名退伍军人患有 PD，其中 279 名来自勒琼营地（患病率为 0.33%），151 名来自彭德尔顿营地（患病率为 0.21%）。在多变量模型中，勒琼营地的退伍军人患 PD 的风险增加了 70%（优势比，1.70；95%置信区间，1.39-2.07；P<0.001）。未发现其他形式的神经退行性帕金森病的风险增加。勒琼营地的退伍军人也有明显更高的前驱 PD 诊断风险，包括震颤、焦虑和勃起功能障碍，以及更高的累积前驱风险评分。
研究结果表明，40 年前暴露于 TCE 和水中其他 VOC 的人患 PD 的风险更高。全世界数以百万计的人已经并且继续接触这种无处不在的环境污染物。
