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Amyotrophic Lateral Sclerosis and Occupational Exposures: A Systematic Literature Review and Meta-Analyses

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  • Lars-Gunnar Gunnarsson

    (School of Medical Sciences, Örebro University, SE 701 82 Örebro, Sweden
    Department of Occupational and Environmental Medicine, Örebro University, SE 701 82 Örebro, Sweden)

  • Lennart Bodin

    (Department of Statistics, Örebro University, SE 701 82 Örebro, Sweden
    Institute of Environmental Medicine, Karolinska Institute, SE 177 77 Stockholm, Sweden)

Abstract

Objectives: We conducted a systematic literature review to identify studies fulfilling good scientific epidemiological standards for use in meta-analyses of occupational risk factors for amyotrophic lateral sclerosis (ALS). Methods : We identified 79 original publications on associations between work and ALS. The MOOSE (Meta-analysis Of Observational Studies in Epidemiology) and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) guidelines were used to ensure high scientific quality, and reliable protocols were applied to classify the articles. Thirty-seven articles fulfilled good scientific standards, while 42 were methodologically deficient and thus were excluded from our meta-analyses. Results : The weighted relative risks for the various occupational exposures were respectively; 1.29 (95% confidence interval (CI): 0.97–1.72; six articles) for heavy physical work, 3.98 (95% CI: 2.04–7.77; three articles) for professional sports, 1.45 (95% CI: 1.07–1.96; six articles) for metals, 1.19 (95% CI: 1.07–1.33; 10 articles) for chemicals, 1.18 (95% CI: 1.07–1.31; 16 articles) for electromagnetic fields or working with electricity, and 1.18 (95% CI: 1.05–1.34; four articles) for working as a nurse or physician. Conclusions : Meta-analyses based only on epidemiologic publications of good scientific quality show that the risk of ALS is statistically significantly elevated for occupational exposures to excessive physical work, chemicals (especially pesticides), metals (especially lead), and possibly also to electromagnetic fields and health care work. These results are not explained by publication bias.

Suggested Citation

  • Lars-Gunnar Gunnarsson & Lennart Bodin, 2018. "Amyotrophic Lateral Sclerosis and Occupational Exposures: A Systematic Literature Review and Meta-Analyses," IJERPH, MDPI, vol. 15(11), pages 1-21, October.
    • Handle: RePEc:gam:jijerp:v:15:y:2018:i:11:p:2371-:d:178552
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    References listed on IDEAS

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    1. Hongjie Zhou & Guangdi Chen & Chunjing Chen & Yunxian Yu & Zhengping Xu, 2012. "Association between Extremely Low-Frequency Electromagnetic Fields Occupations and Amyotrophic Lateral Sclerosis: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 7(11), pages 1-7, November.
    2. Schulte, P.A. & Bumett, C.A. & Boeniger, M. & Johnson, J., 1996. "Neurodegenerative diseases: Occupational occurrence and potential risk factors, 1982 through 1991," American Journal of Public Health, American Public Health Association, vol. 86(9), pages 1281-1288.
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    Cited by:

    1. Lars-Gunnar Gunnarsson & Lennart Bodin, 2019. "Occupational Exposures and Neurodegenerative Diseases—A Systematic Literature Review and Meta-Analyses," IJERPH, MDPI, vol. 16(3), pages 1-17, January.
    2. Jane A. Parkin Kullmann & Roger Pamphlett, 2018. "A Comparison of Mercury Exposure from Seafood Consumption and Dental Amalgam Fillings in People with and without Amyotrophic Lateral Sclerosis (ALS): An International Online Case-Control Study," IJERPH, MDPI, vol. 15(12), pages 1-14, December.

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