A Meta-Analysis of Observational Studies of the Association Between Chronic Occupational Exposure to Lead and Amyotrophic Lateral Sclerosis

Wang, Mingdong; Gomes, James; Cashman, Neil R.; Little, Julian; Krewski, Daniel

doi:10.1097/jom.0000000000000323

Cited by 55 publications

(40 citation statements)

References 80 publications

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“…Finally, only one of the 16 meta-analyses (exposure to lead [33] ) presented convincing evidence for an association with ALS, supported by more than 1,000 cases, p < 0.001 under the random-effects model, small or moderate heterogeneity (I 2 <50%), a 95% PI excluding the null value, absence of evidence for small-study effects and excess statistical significance. This association had a summary OR of 1.81 (95% CI 1.39-2.35; p = 2.13 × 10 -6 ) with small heterogeneity (I 2 = 12.7%).…”

Section: Resultsmentioning

confidence: 99%

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Environmental Risk Factors and Amyotrophic Lateral Sclerosis: An Umbrella Review and Critical Assessment of Current Evidence from Systematic Reviews and Meta-Analyses of Observational Studies

2016

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Background: The pathogenesis of amyotrophic lateral sclerosis (ALS) involves both environmental and genetic factors. Our study aimed at summarising the environmental risk factors for ALS, assessing the evidence for diverse biases, and pinpointing risk factors with high epidemiological credibility. Methods: We searched PubMed from inception to August 20, 2015, to identify systematic reviews and meta-analyses of observational studies examining associations between environmental factors and ALS. For each meta-analysis, we estimated the summary effect size by the use of random-effects and fixed-effects models, the 95% CI, the 95% prediction interval (PI), and the between-study heterogeneity. We assessed the evidence of small-study effects and excess significance bias. Results: Sixteen unique meta-analyses of different risk factors and ALS were considered. Of them, 5 were statistically significant at p < 0.001 under the random-effects model. Only one factor presented robust evidence for a convincing association. This association pertained to chronic occupational exposure to lead (random-effects OR 1.81, 95% CI 1.39-2.35). Conclusions: A small number of published meta-analyses on environmental factors and risk of ALS was identified, a phenomenon that could be attributed to the challenges in studying a rare neurological disease. More observational studies with adequate sample size and study design are needed to clarify the environmental component of ALS pathogenesis.

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Section: Resultsmentioning

confidence: 99%

“…Five were significant at p < 0.001 under the randomeffects model ( table 1 ): farming [32] , lead [33] , n-3 fatty acids [34] , pesticides [32] and serum uric acid [35] . The heterogeneity was large (I 2 ≥ 50 and ≤ 75%) in 5 metaanalyses and very large (I 2 >75%) in 3 meta-analyses.…”

Section: Resultsmentioning

confidence: 99%

Environmental Risk Factors and Amyotrophic Lateral Sclerosis: An Umbrella Review and Critical Assessment of Current Evidence from Systematic Reviews and Meta-Analyses of Observational Studies

2016

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“…Whites, males, non-Hispanics, those aged >60 years, and those with a family history of the disease are more likely to develop ALS (1,6). Previous exposure to heavy metals (e.g., lead and chromium), pesticides, and ß-N-methylamino-L-alanine (BMAA) produced by cyanobacteria also have been associated with an increased risk for ALS (7)(8)(9)(10)(11). Military service continues to be a possible risk factor for ALS; however, no strong evidence has been found linking etiology with service (12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Amyotrophic Lateral Sclerosis — United States, 2012–2013

Mehta

Kaye

Bryan

et al. 2016

MMWR Surveill. Summ.

120

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“…Occupational exposure to lead has been found to be associated with the occurrence of ALS. According to Wang et al [40], the risk of developing ALS almost doubled among individuals with a history of exposure to lead, with a pooled odds ratio of 1.81 (95% CI 1.39–2.36). Santurtún et al [11] found higher mortality ratios for people older than 65 years in the provinces of northern Spain.…”

Section: Introductionmentioning

confidence: 99%

“…With regard to the exposure to metals, systematic evidence includes mostly lead [22, 23, 40, 41], but also iron, selenium, manganese [22, 41], mercury [41] and aluminium [26]. Occupational exposure to lead has been found to be associated with the occurrence of ALS.…”

Section: Introductionmentioning

confidence: 99%

Spatial Assessment of the Association between Long-Term Exposure to Environmental Factors and the Occurrence of Amyotrophic Lateral Sclerosis in Catalonia, Spain: A Population-Based Nested Case-Control Study

et al. 2018

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Background: It is believed that an interaction between genetic and non-genetic factors may be involved in the development of amyotrophic lateral sclerosis (ALS). With the exception of exposure to agricultural chemicals like pesticides, evidence of an association between environmental risk factors and ALS is inconsistent. Our objective here was to investigate the association between long-term exposure to environmental factors and the occurrence of ALS in Catalonia, Spain, and to provide evidence that spatial clusters of ALS related to these environmental factors exist. Methods: We carried out a nested case-control study constructed from a retrospective population-based cohort, covering the entire region. Environmental variables were the explanatory variables of interest. We controlled for both observed and unobserved confounders. Results: We have found some spatial clusters of ALS. The results from the multivariate model suggest that these clusters could be related to some of the environmental variables, in particular agricultural chemicals. In addition, in high-risk clusters, besides corresponding to agricultural areas, key road infrastructures with a high density of traffic are also located. Conclusion: Our results indicate that some environmental factors, in particular those associated with exposure to pesticides and air pollutants as a result of urban traffic, could be associated with the occurrence of ALS.

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A Meta-Analysis of Observational Studies of the Association Between Chronic Occupational Exposure to Lead and Amyotrophic Lateral Sclerosis

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 55 publications

References 80 publications

Environmental Risk Factors and Amyotrophic Lateral Sclerosis: An Umbrella Review and Critical Assessment of Current Evidence from Systematic Reviews and Meta-Analyses of Observational Studies

Environmental Risk Factors and Amyotrophic Lateral Sclerosis: An Umbrella Review and Critical Assessment of Current Evidence from Systematic Reviews and Meta-Analyses of Observational Studies

Prevalence of Amyotrophic Lateral Sclerosis — United States, 2012–2013

Spatial Assessment of the Association between Long-Term Exposure to Environmental Factors and the Occurrence of Amyotrophic Lateral Sclerosis in Catalonia, Spain: A Population-Based Nested Case-Control Study

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