McGuire V, Longstreth W T, Nelson L M, Koepsell T D, Checkoway H, Morgan M S, van Belle G
Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle 98195-9775, USA.
Am J Epidemiol. 1997 Jun 15;145(12):1076-88. doi: 10.1093/oxfordjournals.aje.a009070.
This population-based case-control study was conducted in three countries in western Washington State to evaluate associations between workplace exposures and the risk of amyotrophic lateral sclerosis (ALS). Cases (n = 174) were all newly diagnosed with ALS by neurologists during 1990-1994, and controls (n = 348), who were matched according to age (+/-5 years) and sex, were identified via random-digit dialing or Medicare enrollment files. Four industrial hygienists blindly assessed detailed lifetime job histories for exposures to metals, solvents, and agricultural chemicals. Case-control comparisons were made for jobs held between 15 years of age and 10 years prior to the cases' dates of diagnosis. After adjustment for age and education, ever exposure to agricultural chemicals was associated with ALS (odds ratio (OR) = 2.0, 95% confidence interval (CI) 1.1-3.5); this association was observed separately in men (OR = 2.4, 95% CI 1.2-4.8) but not in women (OR = 0.9, 95% CI 0.2-3.8). Among men, the odds ratio for low exposure to agricultural chemicals (below the median level for exposed controls) relative to no exposure was 1.5 (95% CI 0.4-5.3), and for high exposure, it was 2.8 (95% CI 1.3-6.1) (p for trend = 0.03). Similar analyses based on the panel's assessment of exposures to metals and solvents showed no associations. These findings suggest an association between ALS and agricultural chemicals in men.
这项基于人群的病例对照研究在华盛顿州西部的三个国家开展，旨在评估工作场所暴露与肌萎缩侧索硬化症（ALS）风险之间的关联。病例组（n = 174）为1990年至1994年期间由神经科医生新诊断出患有ALS的患者，对照组（n = 348）通过随机数字拨号或医疗保险参保档案确定，根据年龄（±5岁）和性别进行匹配。四名工业卫生学家对接触金属、溶剂和农用化学品的详细终生工作经历进行了盲法评估。对病例诊断日期前10年至15岁期间从事的工作进行病例对照比较。在对年龄和教育程度进行调整后，曾接触农用化学品与ALS有关联（优势比（OR）= 2.0，95%置信区间（CI）1.1 - 3.5）；这种关联在男性中单独观察到（OR = 2.4，95% CI 1.2 - 4.8），但在女性中未观察到（OR = 0.9，95% CI 0.2 - 3.8）。在男性中，相对于未接触，低水平接触农用化学品（低于接触对照组的中位数水平）的优势比为1.5（95% CI 0.4 - 5.3），高水平接触的优势比为2.8（95% CI 1.3 - 6.1）（趋势p值 = 0.03）。基于该小组对金属和溶剂暴露评估的类似分析未显示出关联。这些发现表明男性ALS与农用化学品之间存在关联。
