Abstract：
BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with few risk factors identified and no known cure. Gene-environment interaction is hypothesized especially for sporadic ALS cases (90-95%) which are of unknown etiology. We aimed to investigate risk factors for ALS including exposure to ambient air toxics.
METHODS: This population-based case-control study included 267 ALS cases (from the United States [U.S.] Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry National ALS Registry and Biorepository) and 267 age, sex, and county-matched controls identified via a commercial database. Exposure assessment for 34 ambient air toxicants was performed by assigning census tract-level U.S. Environmental Protection Agency (EPA) 2011 National Air Toxics Assessment (NATA) data to participants\' residential ZIP codes. Conditional logistic regression was used to compute adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for individual compounds, chemical classes, and overall exposure. Sensitivity analyses using both conditional logistic regression and Bayesian grouped weighted quartile sum (GWQS) models were performed to assess the integrity of findings.
RESULTS: Using the 2011 NATA, the highest exposure quartile (Q4) compared to the lowest (Q1) of vinyl chloride (aOR = 6.00, 95% CI: 1.87-19.25), 2,4-dinitrotoluene (aOR = 5.45, 95% CI: 1.53-19.36), cyanide (aOR = 4.34, 95% CI: 1.52-12.43), cadmium (aOR = 3.30, 95% CI: 1.11-9.77), and carbon disulfide (aOR = 2.98, 95% CI: 1.00-8.91) was associated with increased odds of ALS. Residential air selenium showed an inverse association with ALS (second quartile [Q2] vs. Q1: aOR = 0.38, 95% CI: 0.18-0.79). Additionally, residential exposure to organic/chlorinated solvents (Q4 vs Q1: aOR = 2.62, 95% CI: 1.003-6.85) was associated with ALS.
CONCLUSIONS: Our findings using the 2011 NATA linked by census tract to residential area provide evidence of increased ALS risk in cases compared to controls for 2,4-dinitrotoluene, vinyl chloride, cyanide, and the organic/chlorinated solvents class. This underscores the importance of ongoing surveillance of potential exposures for at-risk populations.
METHODS: This population-based case-control study included 267 ALS cases (from the United States [U.S.] Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry National ALS Registry and Biorepository) and 267 age, sex, and county-matched controls identified via a commercial database. Exposure assessment for 34 ambient air toxicants was performed by assigning census tract-level U.S. Environmental Protection Agency (EPA) 2011 National Air Toxics Assessment (NATA) data to participants\' residential ZIP codes. Conditional logistic regression was used to compute adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for individual compounds, chemical classes, and overall exposure. Sensitivity analyses using both conditional logistic regression and Bayesian grouped weighted quartile sum (GWQS) models were performed to assess the integrity of findings.
RESULTS: Using the 2011 NATA, the highest exposure quartile (Q4) compared to the lowest (Q1) of vinyl chloride (aOR = 6.00, 95% CI: 1.87-19.25), 2,4-dinitrotoluene (aOR = 5.45, 95% CI: 1.53-19.36), cyanide (aOR = 4.34, 95% CI: 1.52-12.43), cadmium (aOR = 3.30, 95% CI: 1.11-9.77), and carbon disulfide (aOR = 2.98, 95% CI: 1.00-8.91) was associated with increased odds of ALS. Residential air selenium showed an inverse association with ALS (second quartile [Q2] vs. Q1: aOR = 0.38, 95% CI: 0.18-0.79). Additionally, residential exposure to organic/chlorinated solvents (Q4 vs Q1: aOR = 2.62, 95% CI: 1.003-6.85) was associated with ALS.
CONCLUSIONS: Our findings using the 2011 NATA linked by census tract to residential area provide evidence of increased ALS risk in cases compared to controls for 2,4-dinitrotoluene, vinyl chloride, cyanide, and the organic/chlorinated solvents class. This underscores the importance of ongoing surveillance of potential exposures for at-risk populations.
摘要：
背景：肌萎缩侧索硬化症（ALS）是一种神经退行性疾病，几乎没有确定的危险因素，也没有已知的治愈方法。假设基因-环境相互作用，尤其是对于病因不明的散发性ALS病例（90-95％）。我们旨在调查ALS的危险因素，包括暴露于环境空气中的毒物。
方法：这项基于人群的病例对照研究包括267例ALS病例（来自美国[美国]疾病控制和预防中心/有毒物质和疾病登记机构国家ALS登记和生物库）和267岁，性别,和县匹配的控制通过商业数据库确定。通过将人口普查道级别的美国环境保护署（EPA）2011年国家空气毒物评估（NATA）数据分配给参与者的住宅邮政编码，对34种环境空气毒物进行了暴露评估。条件逻辑回归用于计算单个化合物的调整后比值比（aOR）和95％置信区间（CI）。化学类，和整体曝光。使用条件逻辑回归和贝叶斯分组加权四分位数和（GWQS）模型进行敏感性分析，以评估结果的完整性。
结果：使用2011年NATA，氯乙烯的最高暴露四分位数(Q4)与最低暴露四分位数(Q1)相比(aOR=6.00,95%CI:1.87-19.25),2,4-二硝基甲苯（aOR=5.45，95%CI：1.53-19.36），氰化物（aOR=4.34，95%CI：1.52-12.43），镉（aOR=3.30，95%CI：1.11-9.77），和二硫化碳（aOR=2.98，95％CI：1.00-8.91）与ALS的几率增加有关。住宅空气硒与ALS呈负相关(第二四分位数[Q2]与Q1：aOR=0.38，95%CI：0.18-0.79）。此外,居民暴露于有机/氯化溶剂(Q4vsQ1:aOR=2.62,95%CI:1.003-6.85)与ALS相关.
结论：我们使用2011年NATA与居民区联系的调查结果提供了与2,4-二硝基甲苯对照相比，ALS风险增加的证据。氯乙烯,氰化物,和有机/氯化溶剂类。这强调了持续监测高危人群潜在暴露的重要性。
方法：这项基于人群的病例对照研究包括267例ALS病例（来自美国[美国]疾病控制和预防中心/有毒物质和疾病登记机构国家ALS登记和生物库）和267岁，性别,和县匹配的控制通过商业数据库确定。通过将人口普查道级别的美国环境保护署（EPA）2011年国家空气毒物评估（NATA）数据分配给参与者的住宅邮政编码，对34种环境空气毒物进行了暴露评估。条件逻辑回归用于计算单个化合物的调整后比值比（aOR）和95％置信区间（CI）。化学类，和整体曝光。使用条件逻辑回归和贝叶斯分组加权四分位数和（GWQS）模型进行敏感性分析，以评估结果的完整性。
结果：使用2011年NATA，氯乙烯的最高暴露四分位数(Q4)与最低暴露四分位数(Q1)相比(aOR=6.00,95%CI:1.87-19.25),2,4-二硝基甲苯（aOR=5.45，95%CI：1.53-19.36），氰化物（aOR=4.34，95%CI：1.52-12.43），镉（aOR=3.30，95%CI：1.11-9.77），和二硫化碳（aOR=2.98，95％CI：1.00-8.91）与ALS的几率增加有关。住宅空气硒与ALS呈负相关(第二四分位数[Q2]与Q1：aOR=0.38，95%CI：0.18-0.79）。此外,居民暴露于有机/氯化溶剂(Q4vsQ1:aOR=2.62,95%CI:1.003-6.85)与ALS相关.
结论：我们使用2011年NATA与居民区联系的调查结果提供了与2,4-二硝基甲苯对照相比，ALS风险增加的证据。氯乙烯,氰化物,和有机/氯化溶剂类。这强调了持续监测高危人群潜在暴露的重要性。
