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Boyle J, Wheeler DC, Naum R, Burke Brockenbrough P, Gebhardt M, Smith L, Harrell T, Stewart D, Gwathmey K. Analysis of the spatial distribution of amyotrophic lateral sclerosis in Virginia. Amyotroph Lateral Scler Frontotemporal Degener 2023:1-9. [PMID: 37452450 DOI: 10.1080/21678421.2023.2236653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
Objective: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder that is usually fatal. Environmental exposures have been posited in the etiology of ALS, but few studies have modeled the spatial risk of ALS over large geographic areas. In this paper, our goal was to analyze the spatial distribution of ALS in Virginia and identify any areas with significantly elevated risk using Virginia ALS Association administrative data. Methods: We used Bayesian hierarchical spatial regression models to estimate the relative risk for ALS in Virginia census tracts, adjusting for several covariates posited to be associated with the disease. We used an intrinsic conditional autoregressive prior to allow for spatial correlation in the risk estimates and stabilize estimates over space. Results: Considerable variation in ALS risk existed across Virginia, with greater relative risk found in the central and western parts of the state. We identified significantly elevated relative risk in a number of census tracts. In particular, Henrico, Albemarle, and Botetourt counties all contained at least four census tracts with significantly elevated risk. Conclusions: We identified several areas with significantly elevated ALS risk across Virginia census tracts. These results can inform future studies of potential environmental triggers for the disease, whose etiology is still being understood.
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Affiliation(s)
- Joseph Boyle
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - David C Wheeler
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Ryan Naum
- Department of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA, and
| | - Paula Burke Brockenbrough
- Department of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA, and
| | - Michelle Gebhardt
- Department of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA, and
| | - LaVon Smith
- Department of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA, and
| | | | | | - Kelly Gwathmey
- Department of Neurology, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA, and
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Andrew A, Zhou J, Gui J, Harrison A, Shi X, Li M, Guetti B, Nathan R, Tischbein M, Pioro E, Stommel E, Bradley W. Airborne lead and polychlorinated biphenyls (PCBs) are associated with amyotrophic lateral sclerosis (ALS) risk in the U.S. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 819:153096. [PMID: 35041949 PMCID: PMC10752436 DOI: 10.1016/j.scitotenv.2022.153096] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/09/2022] [Accepted: 01/09/2022] [Indexed: 06/14/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) risk is linked to environmental exposures. The National Emissions Inventory (NEI) database compiles mandatory reports of levels of airborne contaminants from a variety of stationary and mobile pollution sources across the U.S. The objective of this study was to identify airborne contaminants that may be associated with ALS etiology for future study. We geospatially estimated exposure to airborne contaminants as risk factors for ALS in a nationwide large de-identified medical claims database, the SYMPHONY Integrated Dataverse®. We extracted zip3 of residence at diagnosis of ~26,000 nationally distributed ALS patients and n = 3 non-ALS controls matched per case for age and sex. We individually aggregated the median levels of each of 268 airborne contaminants recorded in the NEI database for 2008 to estimate local residential exposure. We randomly broke the dataset into two independent groups to form independent discovery and validation cohorts. Contaminants associated with increased ALS risk in both the discovery and validation studies included airborne lead (false discovery rate (FDR) = 0.00077), and polychlorinated biphenyls (PCBs), such as heptachlorobiphenyl (FDR = 3.60E-05). Small aircraft were the largest source of airborne lead, while the PCB emissions came from certain power plants burning biomass, and from industrial boilers. Associations with residential history of lead exposure were confirmed in two additional cohorts (10 year top quartile in New Hampshire/Vermont OR 2.46 95% CI 1.46-2.80, and in Ohio OR 1.60 95% CI 1.28-1.98). The results of our geospatial analysis support neurotoxic airborne metals and PCBs as risk factors for ALS.
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Affiliation(s)
- Angeline Andrew
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America.
| | - Jie Zhou
- Dartmouth College, Hanover, NH, United States of America
| | - Jiang Gui
- Dartmouth College, Hanover, NH, United States of America
| | - Antoinette Harrison
- Mitsubishi Tanabe Pharma America, Inc., Jersey City, NJ, United States of America
| | - Xun Shi
- Dartmouth College, Hanover, NH, United States of America
| | - Meifang Li
- Dartmouth College, Hanover, NH, United States of America
| | - Bart Guetti
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America
| | | | - Maeve Tischbein
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America
| | - Erik Pioro
- Cleveland Clinic, Cleveland, OH, United States of America
| | - Elijah Stommel
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States of America
| | - Walter Bradley
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, United States of America
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DeVille NV, Khalili R, Levy JI, Korrick SA, Vieira VM. Prenatal environmental exposures and associations with teen births. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2021; 31:197-210. [PMID: 32913222 PMCID: PMC7943647 DOI: 10.1038/s41370-020-00262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/25/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Children's prenatal exposure to multiple environmental chemicals may contribute to subsequent deficits in impulse control, predisposing them to risk-taking. OBJECTIVE Our goal was to investigate associations between prenatal exposure mixtures and risk of teen birth, a manifestation of high-risk sexual activity, among 5865 girls (1st generation) born in southeast Massachusetts from 1992-1998. METHODS Exposures included prenatal modeled polychlorinated biphenyls (PCBs), ρ,ρ'-dichlorodiphenyl dichloroethylene (DDE), hexachlorobenzene (HCB), lead (Pb), and mercury (Hg). We fit adjusted generalized additive models with multivariable smooths of exposure mixtures, 1st generation infant's birth year, and maternal age at 1st generation birth. Predicted odds ratios (ORs) for teen birth were mapped as a function of joint exposures. We also conducted sensitivity analyses among 1st generation girls with measured exposure biomarkers (n = 371). RESULTS The highest teen birth risk was associated with a mixture of high prenatal HCB, Hg, Pb, and PCB, but low DDE exposure, with similar associations in sensitivity analyses. The highest OR predicted for girls born in 1995 to mothers of median age (26 years) was at the 95th percentile of the HCB and PCB exposure distributions (OR = 3.09; 95% confidence interval: 0.29, 32.4). Additionally, girls born earlier in the study period or to teen mothers were at increased risk of teen birth. SIGNIFICANCE Prenatal environmental chemical exposures and sociodemographic characteristics may interact to substantially increase risk of teen births.
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Affiliation(s)
- Nicole V DeVille
- Program in Public Health, College of Health Sciences, University of California, Irvine, Irvine, CA, USA.
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Roxana Khalili
- Program in Environmental Health Sciences, College of Health Sciences, University of California, Irvine, Irvine, CA, USA
| | - Jonathan I Levy
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Susan A Korrick
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Verónica M Vieira
- Program in Public Health, College of Health Sciences, University of California, Irvine, Irvine, CA, USA
- Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA
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de Jongh AD, van Eijk RPA, Peters SM, van Es MA, Horemans AMC, van der Kooi AJ, Voermans NC, Vermeulen RCH, Veldink JH, van den Berg LH. Incidence, Prevalence, and Geographical Clustering of Motor Neuron Disease in the Netherlands. Neurology 2021; 96:e1227-e1236. [PMID: 33472922 PMCID: PMC8055340 DOI: 10.1212/wnl.0000000000011467] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/26/2020] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To assess time trends in motor neuron disease (MND) incidence, prevalence, and mortality and to investigate geographic clustering of MND cases in the Netherlands from 1998 to 2017, we analyzed data from the Netherlands Personal Records database, the Netherlands MND Center, and the Netherlands Patient Association of Neuromuscular Diseases. METHODS In this prospective cohort study, Poisson regression was used to assess time trends in MND risk. We calculated age- and sex-standardized, observed, and expected cases for 1,694 areas. Bayesian smoothed risk mapping was used to investigate geographic MND risk. RESULTS We identified 7,992 MND cases, reflecting an incidence of 2.64 (95% confidence interval [CI] 2.62-2.67) per 100,000 person-years and a prevalence of 9.5 (95% CI 9.1-10.0) per 100,000 persons. Highest age-standardized prevalence and mortality rates occurred at a later age in men than in women (p < 0.001). Unadjusted mortality rates increased by 53.2% from 2.57 per 100,000 person-years in 1998 to 3.86 per 100,000 person-years in 2017. After adjustment for age and sex, an increase in MND mortality rate of 14.1% (95% CI 5.7%-23.2%, p < 0.001) remained. MND relative risk ranged from 0.78 to 1.43 between geographic areas; multiple urban and rural high-risk areas were identified. CONCLUSIONS We found a significant national increase in MND mortality from 1998 through 2017, explained only partly by an aging Dutch population, and a geographic variability in MND risk, suggesting a role for environmental or demographic risk factors.
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Affiliation(s)
- Adriaan D de Jongh
- From the Department of Neurology (A.D.d.J., R.P.A.v.E., M.A.v.E., J.H.V., LH.v.d.B.), Brain Center Rudolf Magnus, Biostatistics & Research Support (R.P.A.v.E.), and Julius Center for Health Sciences and Primary Care (R.C.H.V.), University Medical Center Utrecht; Institute for Risk Assessment Sciences (S.M.P., R.C.H.V.), Utrecht University, the Netherlands; National Patient Organization for Neuromuscular Diseases (A.M.C.H.), Baarn; Department of Neurology (A.J.v.d.K.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience; and Department of Neurology (N.C.V.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ruben P A van Eijk
- From the Department of Neurology (A.D.d.J., R.P.A.v.E., M.A.v.E., J.H.V., LH.v.d.B.), Brain Center Rudolf Magnus, Biostatistics & Research Support (R.P.A.v.E.), and Julius Center for Health Sciences and Primary Care (R.C.H.V.), University Medical Center Utrecht; Institute for Risk Assessment Sciences (S.M.P., R.C.H.V.), Utrecht University, the Netherlands; National Patient Organization for Neuromuscular Diseases (A.M.C.H.), Baarn; Department of Neurology (A.J.v.d.K.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience; and Department of Neurology (N.C.V.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Susan M Peters
- From the Department of Neurology (A.D.d.J., R.P.A.v.E., M.A.v.E., J.H.V., LH.v.d.B.), Brain Center Rudolf Magnus, Biostatistics & Research Support (R.P.A.v.E.), and Julius Center for Health Sciences and Primary Care (R.C.H.V.), University Medical Center Utrecht; Institute for Risk Assessment Sciences (S.M.P., R.C.H.V.), Utrecht University, the Netherlands; National Patient Organization for Neuromuscular Diseases (A.M.C.H.), Baarn; Department of Neurology (A.J.v.d.K.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience; and Department of Neurology (N.C.V.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michael A van Es
- From the Department of Neurology (A.D.d.J., R.P.A.v.E., M.A.v.E., J.H.V., LH.v.d.B.), Brain Center Rudolf Magnus, Biostatistics & Research Support (R.P.A.v.E.), and Julius Center for Health Sciences and Primary Care (R.C.H.V.), University Medical Center Utrecht; Institute for Risk Assessment Sciences (S.M.P., R.C.H.V.), Utrecht University, the Netherlands; National Patient Organization for Neuromuscular Diseases (A.M.C.H.), Baarn; Department of Neurology (A.J.v.d.K.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience; and Department of Neurology (N.C.V.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anja M C Horemans
- From the Department of Neurology (A.D.d.J., R.P.A.v.E., M.A.v.E., J.H.V., LH.v.d.B.), Brain Center Rudolf Magnus, Biostatistics & Research Support (R.P.A.v.E.), and Julius Center for Health Sciences and Primary Care (R.C.H.V.), University Medical Center Utrecht; Institute for Risk Assessment Sciences (S.M.P., R.C.H.V.), Utrecht University, the Netherlands; National Patient Organization for Neuromuscular Diseases (A.M.C.H.), Baarn; Department of Neurology (A.J.v.d.K.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience; and Department of Neurology (N.C.V.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anneke J van der Kooi
- From the Department of Neurology (A.D.d.J., R.P.A.v.E., M.A.v.E., J.H.V., LH.v.d.B.), Brain Center Rudolf Magnus, Biostatistics & Research Support (R.P.A.v.E.), and Julius Center for Health Sciences and Primary Care (R.C.H.V.), University Medical Center Utrecht; Institute for Risk Assessment Sciences (S.M.P., R.C.H.V.), Utrecht University, the Netherlands; National Patient Organization for Neuromuscular Diseases (A.M.C.H.), Baarn; Department of Neurology (A.J.v.d.K.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience; and Department of Neurology (N.C.V.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nicol C Voermans
- From the Department of Neurology (A.D.d.J., R.P.A.v.E., M.A.v.E., J.H.V., LH.v.d.B.), Brain Center Rudolf Magnus, Biostatistics & Research Support (R.P.A.v.E.), and Julius Center for Health Sciences and Primary Care (R.C.H.V.), University Medical Center Utrecht; Institute for Risk Assessment Sciences (S.M.P., R.C.H.V.), Utrecht University, the Netherlands; National Patient Organization for Neuromuscular Diseases (A.M.C.H.), Baarn; Department of Neurology (A.J.v.d.K.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience; and Department of Neurology (N.C.V.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Roel C H Vermeulen
- From the Department of Neurology (A.D.d.J., R.P.A.v.E., M.A.v.E., J.H.V., LH.v.d.B.), Brain Center Rudolf Magnus, Biostatistics & Research Support (R.P.A.v.E.), and Julius Center for Health Sciences and Primary Care (R.C.H.V.), University Medical Center Utrecht; Institute for Risk Assessment Sciences (S.M.P., R.C.H.V.), Utrecht University, the Netherlands; National Patient Organization for Neuromuscular Diseases (A.M.C.H.), Baarn; Department of Neurology (A.J.v.d.K.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience; and Department of Neurology (N.C.V.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jan H Veldink
- From the Department of Neurology (A.D.d.J., R.P.A.v.E., M.A.v.E., J.H.V., LH.v.d.B.), Brain Center Rudolf Magnus, Biostatistics & Research Support (R.P.A.v.E.), and Julius Center for Health Sciences and Primary Care (R.C.H.V.), University Medical Center Utrecht; Institute for Risk Assessment Sciences (S.M.P., R.C.H.V.), Utrecht University, the Netherlands; National Patient Organization for Neuromuscular Diseases (A.M.C.H.), Baarn; Department of Neurology (A.J.v.d.K.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience; and Department of Neurology (N.C.V.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Leonard H van den Berg
- From the Department of Neurology (A.D.d.J., R.P.A.v.E., M.A.v.E., J.H.V., LH.v.d.B.), Brain Center Rudolf Magnus, Biostatistics & Research Support (R.P.A.v.E.), and Julius Center for Health Sciences and Primary Care (R.C.H.V.), University Medical Center Utrecht; Institute for Risk Assessment Sciences (S.M.P., R.C.H.V.), Utrecht University, the Netherlands; National Patient Organization for Neuromuscular Diseases (A.M.C.H.), Baarn; Department of Neurology (A.J.v.d.K.), Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience; and Department of Neurology (N.C.V.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands.
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