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Levison LS, Jepsen P, Andersen H. Registration of Amyotrophic Lateral Sclerosis: Validity in the Danish National Patient Registry. Clin Epidemiol 2024; 16:409-415. [PMID: 38860134 PMCID: PMC11164206 DOI: 10.2147/clep.s458661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/06/2024] [Indexed: 06/12/2024] Open
Abstract
Purpose Health care databases are a valuable source for epidemiological research on amyotrophic lateral sclerosis (ALS) if diagnosis codes are valid. We evaluated the validity of the diagnostic codes for ALS in the Danish National Patient Registry (DNPR). Patients and Methods We obtained data from the DNPR for all adult (>17 years) patients registered with ALS in Denmark between 1987 and 2022 (median population of 4.2 million during the study period). We randomly selected adult patients living in the North Denmark Region and Central Denmark Region (median population 1.4 million), with a primary discharge diagnosis code of ALS, diagnosed at three departments of neurology. We retrieved and reviewed medical records and estimated the positive predictive value (PPV) of the ALS diagnosis. Results Over 36 years, we identified 5679 patients. From the validation cohort of 300 patients, we were able to retrieve 240 (80%) medical records, and 215 ALS diagnoses were confirmed. The overall positive predictive value was 89.6% (95% confidence interval (CI): 85.1-92.8). The highest PPV was achieved for diagnoses registered for patients aged ≥70 years (93.8; 95% CI: 86.2-97.3) compared to patients <60 years (83.4; 95% CI: 73.3-90.7). Conclusion We found a high PPV of primary diagnostic codes for ALS from Danish departments of neurology, demonstrating high validity. Thus, the DNPR is a well-suited data source for large-scale epidemiological research on ALS.
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Affiliation(s)
| | - Peter Jepsen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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2
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Rotem RS, Bellavia A, Paganoni S, Weisskopf MG. Medication use and risk of amyotrophic lateral sclerosis: using machine learning for an exposome-wide screen of a large clinical database. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:367-375. [PMID: 38426489 PMCID: PMC11075178 DOI: 10.1080/21678421.2024.2320878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Accumulating evidence suggests that non-genetic factors have important etiologic roles in amyotrophic lateral sclerosis (ALS), yet identification of specific culprit factors has been challenging. Many medications target biological pathways implicated in ALS pathogenesis, and screening large pharmacologic datasets for signals could greatly accelerate the identification of risk-modulating pharmacologic factors for ALS. METHOD We conducted a high-dimensional screening of patients' history of medication use and ALS risk using an advanced machine learning approach based on gradient-boosted decision trees coupled with Bayesian model optimization and repeated data sampling. Clinical and medication dispensing data were obtained from a large Israeli health fund for 501 ALS cases and 4,998 matched controls using a lag period of 3 or 5 years prior to ALS diagnosis for ascertaining medication exposure. RESULTS Of over 1,000 different medication classes, we identified 8 classes that were consistently associated with increased ALS risk across independently trained models, where most are indicated for control of symptoms implicated in ALS. Some suggestive protective effects were also observed, notably for vitamin E. DISCUSSION Our results indicate that use of certain medications well before the typically recognized prodromal period was associated with ALS risk. This could result because these medications increase ALS risk or could indicate that ALS symptoms can manifest well before suggested prodromal periods. The results also provide further evidence that vitamin E may be a protective factor for ALS. Targeted studies should be performed to elucidate the possible pathophysiological mechanisms while providing insights for therapeutics design.
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Affiliation(s)
- Ran S Rotem
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, MA, USA
- KSM Research and Innovation Institute, Maccabi Healthcare Services, Israel
| | - Andrea Bellavia
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, MA, USA
| | - Sabrina Paganoni
- Sean M. Healey and AMG Center for ALS, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, MA, USA
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Mazzucato M, Visonà Dalla Pozza L, Minichiello C, Toto E, Vianello A, Facchin P. Estimating mortality in rare diseases using a population-based registry, 2002 through 2019. Orphanet J Rare Dis 2023; 18:362. [PMID: 37978388 PMCID: PMC10655462 DOI: 10.1186/s13023-023-02944-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/04/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Rare diseases (RD) are a heterogeneous group of diseases, sharing aspects of complexity. Prognosis is variable, even in individuals with the same disease. Real-world data on RD as a whole are scarce. The aim of this study is to provide data on mortality and survival for a substantial group of RD deriving from a population-based registry, which covers the Veneto region in Italy (4.9 million inhabitants). RESULTS During the study period, 3367 deaths occurred, mainly in males (53.9%), elderly patients (63.5%) and patients with diseases having a reported prevalence of 1-9/100000 (65.6%). When standardizing by age, the mortality ratio was higher in RD patients than in the general population, SMR = 1.93 (95% CI 1.84-2.11), with an observed gender difference, 2.01 (95% CI 1.88-2.29) in females and 1.86 (95% CI 1.73-2.10) in males. The lowest survival rates are experienced by patients with rare neurologic diseases, rare skin diseases and rare systemic or rheumatologic diseases, 58%, 68% and 81%, respectively, after a 15-year observation period. It should be noted that only 18% of patients diagnosed with motor neuron diseases were alive after 15 years from diagnosis. CONCLUSIONS Despite progress in diagnosis, treatment and care in recent years, RD patients globally have higher mortality rates and reduced survival compared to the general population, with specific variations according to gender, age and disease group.
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Affiliation(s)
- Monica Mazzucato
- Rare Diseases Coordinating Centre, Veneto Region, Padua University Hospital, Padua, Italy.
- Department of Child and Maternal Health, Padua University Hospital, University of Padova, Padua, Italy.
| | | | - Cinzia Minichiello
- Rare Diseases Coordinating Centre, Veneto Region, Padua University Hospital, Padua, Italy
| | - Ema Toto
- Rare Diseases Coordinating Centre, Veneto Region, Padua University Hospital, Padua, Italy
| | - Andrea Vianello
- Department of Child and Maternal Health, Padua University Hospital, University of Padova, Padua, Italy
| | - Paola Facchin
- Rare Diseases Coordinating Centre, Veneto Region, Padua University Hospital, Padua, Italy.
- Department of Child and Maternal Health, Padua University Hospital, University of Padova, Padua, Italy.
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Nunez Y, Balalian A, Parks RM, He MZ, Hansen J, Raaschou-Nielsen O, Ketzel M, Khan J, Brandt J, Vermeulen R, Peters S, Weisskopf MG, Re DB, Goldsmith J, Kioumourtzoglou MA. Exploring Relevant Time Windows in the Association Between PM2.5 Exposure and Amyotrophic Lateral Sclerosis: A Case-Control Study in Denmark. Am J Epidemiol 2023; 192:1499-1508. [PMID: 37092253 PMCID: PMC10666968 DOI: 10.1093/aje/kwad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 10/08/2022] [Accepted: 04/17/2023] [Indexed: 04/25/2023] Open
Abstract
Studies suggest a link between particulate matter less than or equal to 2.5 μm in diameter (PM2.5) and amyotrophic lateral sclerosis (ALS), but to our knowledge critical exposure windows have not been examined. We performed a case-control study in the Danish population spanning the years 1989-2013. Cases were selected from the Danish National Patient Registry based on International Classification of Diseases codes. Five controls were randomly selected from the Danish Civil Registry and matched to a case on vital status, age, and sex. PM2.5 concentration at residential addresses was assigned using monthly predictions from a dispersion model. We used conditional logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for confounding. We evaluated exposure to averaged PM2.5 concentrations 12-24 months, 2-6 years, and 2-11 years pre-ALS diagnosis; annual lagged exposures up to 11 years prediagnosis; and cumulative associations for exposure in lags 1-5 years and 1-10 years prediagnosis, allowing for varying association estimates by year. We identified 3,983 cases and 19,915 controls. Cumulative exposure to PM2.5 in the period 2-6 years prediagnosis was associated with ALS (OR = 1.06, 95% CI: 0.99, 1.13). Exposures in the second, third, and fourth years prediagnosis were individually associated with higher odds of ALS (e.g., for lag 1, OR = 1.04, 95% CI: 1.00, 1.08). Exposure to PM2.5 within 6 years before diagnosis may represent a critical exposure window for ALS.
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Affiliation(s)
- Yanelli Nunez
- Correspondence to Dr. Yanelli Nunez, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY 10032 (e-mail: )
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Skajaa N, Riahi EB, Szépligeti SK, Horváth‐Puhó E, Sørensen TT, Henderson VW, Sørensen HT. Type 2 diabetes, obesity, and risk of amyotrophic lateral sclerosis: A population-based cohort study. Brain Behav 2023; 13:e3007. [PMID: 37073502 PMCID: PMC10275529 DOI: 10.1002/brb3.3007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Type 2 diabetes and obesity may be inversely associated with amyotrophic lateral sclerosis (ALS), but the evidence is controversial. METHODS Using Danish, nationwide registries (1980-2016), we identified patients with a diagnosis of type 2 diabetes (N = 295,653) and patients with a diagnosis of obesity (N = 312,108). Patients were matched (1:3) to persons from the general population on birth year and sex. We computed incidence rates and Cox regression derived hazard ratios (HRs) of a diagnosis of ALS. In multivariable analyses, HRs were controlled for sex, birth year, calendar year, and comorbidities. RESULTS We observed 168 incident cases of ALS (0.7 [95% confidence interval (CI): 0.6-0.8] per 10,000 person-years) among patients with type 2 diabetes and 859 incident cases of ALS (0.9 [95% CI: 0.9-1.0] per 10,000 person-years) among matched comparators. The adjusted HR was 0.87 (95% CI: 0.72-1.04). The association was present among men (adjusted HR: 0.78 [95% CI: 0.62-0.99]) but not women (adjusted HR: 1.03 [95% CI: 0.78-1.37]), and among those aged ≥60 years (adjusted HR: 0.75 [95% CI: 0.59-0.96]) but not younger. We observed 111 ALS events (0.4 [95% CI: 0.4-0.5] per 10,000 person-years) among obesity patients and 431 ALS events (0.5 [95% CI: 0.5-0.6] per 10,000 person-years) among comparators. The adjusted HR was 0.88 (95% CI: 0.70-1.11). CONCLUSIONS Diagnoses of type 2 diabetes and obesity were associated with a reduced rate of ALS compared with general population comparators, particularly among men and patients aged 60 years or above. However, absolute rate differences were small.
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Affiliation(s)
- Nils Skajaa
- Department of Clinical EpidemiologyAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | - Emil Bjerregaard Riahi
- Department of Clinical EpidemiologyAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | | | - Erzsébet Horváth‐Puhó
- Department of Clinical EpidemiologyAarhus University Hospital and Aarhus UniversityAarhusDenmark
| | | | - Victor W. Henderson
- Department of Clinical EpidemiologyAarhus University Hospital and Aarhus UniversityAarhusDenmark
- Department of Epidemiology and Population HealthStanford UniversityStanfordCalifornia
- Department of Neurology and Neurological SciencesStanford UniversityStanfordCalifornia
| | - Henrik Toft Sørensen
- Department of Clinical EpidemiologyAarhus University Hospital and Aarhus UniversityAarhusDenmark
- Clinical Excellence Research CenterStanford UniversityStanfordCalifornia
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Parks RM, Nunez Y, Balalian AA, Gibson EA, Hansen J, Raaschou-Nielsen O, Ketzel M, Khan J, Brandt J, Vermeulen R, Peters S, Goldsmith J, Re DB, Weisskopf MG, Kioumourtzoglou MA. Long-term Traffic-related Air Pollutant Exposure and Amyotrophic Lateral Sclerosis Diagnosis in Denmark: A Bayesian Hierarchical Analysis. Epidemiology 2022; 33:757-766. [PMID: 35944145 PMCID: PMC9560992 DOI: 10.1097/ede.0000000000001536] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. Limited evidence suggests ALS diagnosis may be associated with air pollution exposure and specifically traffic-related pollutants. METHODS In this population-based case-control study, we used 3,937 ALS cases from the Danish National Patient Register diagnosed during 1989-2013 and matched on age, sex, year of birth, and vital status to 19,333 population-based controls free of ALS at index date. We used validated predictions of elemental carbon (EC), nitrogen oxides (NO x ), carbon monoxide (CO), and fine particles (PM 2.5 ) to assign 1-, 5-, and 10-year average exposures pre-ALS diagnosis at study participants' present and historical residential addresses. We used an adjusted Bayesian hierarchical conditional logistic model to estimate individual pollutant associations and joint and average associations for traffic-related pollutants (EC, NO x , CO). RESULTS For a standard deviation (SD) increase in 5-year average concentrations, EC (SD = 0.42 µg/m 3 ) had a high probability of individual association with increased odds of ALS (11.5%; 95% credible interval [CrI] = -1.0%, 25.6%; 96.3% posterior probability of positive association), with negative associations for NO x (SD = 20 µg/m 3 ) (-4.6%; 95% CrI = 18.1%, 8.9%; 27.8% posterior probability of positive association), CO (SD = 106 µg/m 3 ) (-3.2%; 95% CrI = 14.4%, 10.0%; 26.7% posterior probability of positive association), and a null association for nonelemental carbon fine particles (non-EC PM 2.5 ) (SD = 2.37 µg/m 3 ) (0.7%; 95% CrI = 9.2%, 12.4%). We found no association between ALS and joint or average traffic pollution concentrations. CONCLUSIONS This study found high probability of a positive association between ALS diagnosis and EC concentration. Further work is needed to understand the role of traffic-related air pollution in ALS pathogenesis.
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Affiliation(s)
- Robbie M Parks
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
- The Earth Institute, Columbia University, New York, New York, USA
| | - Yanelli Nunez
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Arin A Balalian
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Elizabeth A Gibson
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Johnni Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Matthias Ketzel
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- Global Centre for Clean Air Research (GCARE), University of Surrey, Guildford, United Kingdom
| | - Jibran Khan
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Jørgen Brandt
- Department of Environmental Science, Aarhus University, Roskilde, Denmark
- iClimate – interdisciplinary Center for Climate Change, Aarhus University, Denmark
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Jeff Goldsmith
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Diane B. Re
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Marc G. Weisskopf
- Departments of Environmental Health and Epidemiology, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Marianthi-Anna Kioumourtzoglou
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
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7
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Weisskopf MG, Levy J, Dickerson AS, Paganoni S, Leventer-Roberts M. Statin Medications and Amyotrophic Lateral Sclerosis Incidence and Mortality. Am J Epidemiol 2022; 191:1248-1257. [PMID: 35333291 PMCID: PMC9393061 DOI: 10.1093/aje/kwac054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 01/26/2023] Open
Abstract
Studies of statins and amyotrophic lateral sclerosis (ALS) incidence and survival have had conflicting findings possibly related to difficulties with confounding by indication. We considered potency of statins used and duration of use to explore confounding by indication. Within the Clalit Health Services in Israel, we identified 948 ALS case patients from 2004 through 2017 and matched them with 1,000 control subjects each. Any statin use up to 3 years before ALS onset was not associated with ALS incidence but was associated with a reduced hazard ratio (HR) for death. Odds of ALS did not vary by statin potency, but use of only lower-potency statins was associated with longer survival (HR = 0.82, 95% CI: 0.68, 0.98), whereas the association with higher-potency statins was null compared with those case patients who did not use statins. However, duration of statin use appeared to account for these findings. Those who used statins only up to 3 years had longer survival (HR = 0.77, 95% CI: 0.61, 0.96) than did case patients who did not use statins, but those who used statins for >3 years did not. Although other explanations are possible, these findings could suggest a protective effect of statins on ALS survival that is partially masked by a worse prognosis from underlying reasons for taking statins that deserves further exploration.
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Affiliation(s)
- Marc G Weisskopf
- Correspondence to Marc Weisskopf, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue Building 1, Suite 1402, Boston, MA 02115 (e-mail: )
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PM2.5 composition and disease aggravation in amyotrophic lateral sclerosis. Environ Epidemiol 2022; 6:e204. [PMID: 35434459 PMCID: PMC9005248 DOI: 10.1097/ee9.0000000000000204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/01/2022] [Indexed: 01/18/2023] Open
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Burchardt JM, Mei XW, Ranger T, McDermott CJ, Radunovic A, Coupland C, Hippisley-Cox J. Analysis of incidence of motor neuron disease in England 1998-2019: use of three linked datasets. Amyotroph Lateral Scler Frontotemporal Degener 2022; 23:363-371. [PMID: 35103515 PMCID: PMC9344929 DOI: 10.1080/21678421.2021.2016837] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: This study uses three linked datasets to provide an estimate of incidence of motor neuron disease (MND) in England from 1998 to 2019. Comparison is made to previous British studies. It examines age at diagnosis and ethnicity of those affected. Methods: The literature was searched for studies of MND incidence in Great Britain from 1995 to date. The QResearch and linked Hospital Episode Statistics and Death register databases were searched from 1998 to 2019 for cases of MND, and incidence calculated from 16.8 million adults and 112 million adult years of data. Results: We found 6437 adults with a diagnosis of MND giving an incidence of MND of 5.69/100,000 person years (95% CI 5.51–5.88); 6.57 (6.41–6.99) in men and 4.72 (4.49–4.97) in women when age-standardized to the 2011 UK population. The median age of diagnosis was 72 years. Peak incidence occurred in the 80–84 year age group in men and 75–79 in women. Age-standardized incidence was as high in Bangladeshi, Black Caribbean, Indian, other Asian and Pakistani people as in White people. Black African and Chinese people had a lower incidence. Conclusion: The use of three linked national datasets captured 33% more people than a primary care dataset alone. Patients were older than in previous studies and rates were high in all ethnic groups studied except Black African and Chinese people. We present the highest incidence of MND reported globally in the past 50 years. Methodological differences may in part explain differences with previous reports. The use of national datasets may have captured additional MND patients with serious comorbidities who have not seen a neurologist before death. A limitation of this approach is that unlike population registers, which minimize false positive diagnosis by neurologist review of each patient, we cannot review diagnosis for individuals as data are anonymized.
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Affiliation(s)
- Judith M Burchardt
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, England
| | - Xue W Mei
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, England
| | - Tom Ranger
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, England
| | | | | | - Carol Coupland
- School of Medicine, University of Nottingham, Nottingham, England
| | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, England
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10
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Bjornevik K, O'Reilly EJ, Molsberry S, Kolonel LN, Le Marchand L, Paganoni S, Schwarzschild MA, Benkert P, Kuhle J, Ascherio A. Prediagnostic Neurofilament Light Chain Levels in Amyotrophic Lateral Sclerosis. Neurology 2021; 97:e1466-e1474. [PMID: 34380747 PMCID: PMC8575132 DOI: 10.1212/wnl.0000000000012632] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 07/19/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To assess whether plasma neurofilament light chain (NfL) levels are elevated before amyotrophic lateral sclerosis (ALS) diagnosis and to evaluate whether prediagnostic NfL levels are associated with metabolic alterations. METHODS We conducted a matched case-control study nested in 3 large prospective US cohorts (the Nurses' Health Study, the Health Professionals Follow-up Study, and the Multiethnic Cohort Study) and identified 84 individuals who developed ALS during follow-up and had available plasma samples prior to disease diagnosis. For each ALS case, we randomly selected controls from those who were alive at the time of the case diagnosis and matched on birth year, sex, race/ethnicity, fasting status, cohort, and time of blood draw. We measured NfL in the plasma samples and used conditional logistic regression to estimate rate ratios (RRs) and 95% confidence intervals (CIs) for ALS, adjusting for body mass index, smoking, physical activity, and urate levels. RESULTS Higher NfL levels were associated with a higher ALS risk in plasma samples collected within 5 years of the ALS diagnosis (RR per 1 SD increase 2.68, 95% CI 1.18-6.08), but not in samples collected further away from the diagnosis (RR per 1 SD increase 1.16, 95% CI 0.78-1.73). A total of 21 metabolites were correlated with prediagnostic NfL levels in ALS cases (p < 0.05), but none of these remained significant after multiple comparison adjustments. DISCUSSION Plasma NfL levels were elevated in prediagnostic ALS cases, indicating that NfL may be a useful biomarker already in the earliest stages of the disease. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that plasma NfL levels are elevated in prediagnostic ALS.
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Affiliation(s)
- Kjetil Bjornevik
- From the Departments of Nutrition (K.B., E.J.O., S.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health, College of Medicine (E.J.O.), University College Cork, Ireland; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Healey Center for ALS (S.P.), and Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Harvard Medical School (S.P., M.A.S.), Boston, MA; Clinical Trial Unit, Department of Clinical Research (P.B.), and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Biomedicine and Clinical Research (J.K.), University Hospital Basel, University of Basel, Switzerland; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Eilis J O'Reilly
- From the Departments of Nutrition (K.B., E.J.O., S.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health, College of Medicine (E.J.O.), University College Cork, Ireland; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Healey Center for ALS (S.P.), and Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Harvard Medical School (S.P., M.A.S.), Boston, MA; Clinical Trial Unit, Department of Clinical Research (P.B.), and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Biomedicine and Clinical Research (J.K.), University Hospital Basel, University of Basel, Switzerland; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Samantha Molsberry
- From the Departments of Nutrition (K.B., E.J.O., S.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health, College of Medicine (E.J.O.), University College Cork, Ireland; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Healey Center for ALS (S.P.), and Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Harvard Medical School (S.P., M.A.S.), Boston, MA; Clinical Trial Unit, Department of Clinical Research (P.B.), and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Biomedicine and Clinical Research (J.K.), University Hospital Basel, University of Basel, Switzerland; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Laurence N Kolonel
- From the Departments of Nutrition (K.B., E.J.O., S.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health, College of Medicine (E.J.O.), University College Cork, Ireland; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Healey Center for ALS (S.P.), and Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Harvard Medical School (S.P., M.A.S.), Boston, MA; Clinical Trial Unit, Department of Clinical Research (P.B.), and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Biomedicine and Clinical Research (J.K.), University Hospital Basel, University of Basel, Switzerland; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Loic Le Marchand
- From the Departments of Nutrition (K.B., E.J.O., S.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health, College of Medicine (E.J.O.), University College Cork, Ireland; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Healey Center for ALS (S.P.), and Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Harvard Medical School (S.P., M.A.S.), Boston, MA; Clinical Trial Unit, Department of Clinical Research (P.B.), and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Biomedicine and Clinical Research (J.K.), University Hospital Basel, University of Basel, Switzerland; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Sabrina Paganoni
- From the Departments of Nutrition (K.B., E.J.O., S.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health, College of Medicine (E.J.O.), University College Cork, Ireland; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Healey Center for ALS (S.P.), and Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Harvard Medical School (S.P., M.A.S.), Boston, MA; Clinical Trial Unit, Department of Clinical Research (P.B.), and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Biomedicine and Clinical Research (J.K.), University Hospital Basel, University of Basel, Switzerland; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Michael A Schwarzschild
- From the Departments of Nutrition (K.B., E.J.O., S.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health, College of Medicine (E.J.O.), University College Cork, Ireland; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Healey Center for ALS (S.P.), and Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Harvard Medical School (S.P., M.A.S.), Boston, MA; Clinical Trial Unit, Department of Clinical Research (P.B.), and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Biomedicine and Clinical Research (J.K.), University Hospital Basel, University of Basel, Switzerland; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Pascal Benkert
- From the Departments of Nutrition (K.B., E.J.O., S.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health, College of Medicine (E.J.O.), University College Cork, Ireland; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Healey Center for ALS (S.P.), and Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Harvard Medical School (S.P., M.A.S.), Boston, MA; Clinical Trial Unit, Department of Clinical Research (P.B.), and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Biomedicine and Clinical Research (J.K.), University Hospital Basel, University of Basel, Switzerland; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Jens Kuhle
- From the Departments of Nutrition (K.B., E.J.O., S.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health, College of Medicine (E.J.O.), University College Cork, Ireland; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Healey Center for ALS (S.P.), and Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Harvard Medical School (S.P., M.A.S.), Boston, MA; Clinical Trial Unit, Department of Clinical Research (P.B.), and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Biomedicine and Clinical Research (J.K.), University Hospital Basel, University of Basel, Switzerland; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Alberto Ascherio
- From the Departments of Nutrition (K.B., E.J.O., S.M., A.A.) and Epidemiology (A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health, College of Medicine (E.J.O.), University College Cork, Ireland; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Healey Center for ALS (S.P.), and Department of Neurology (M.A.S.), Massachusetts General Hospital, Boston; Harvard Medical School (S.P., M.A.S.), Boston, MA; Clinical Trial Unit, Department of Clinical Research (P.B.), and Neurologic Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Departments of Biomedicine and Clinical Research (J.K.), University Hospital Basel, University of Basel, Switzerland; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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11
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Skajaa N, Bakos I, Horváth-Puhó E, Henderson VW, Lash TL, Sørensen HT. Statin Initiation and Risk of Amyotrophic Lateral Sclerosis: A Danish Population-based Cohort Study. Epidemiology 2021; 32:756-762. [PMID: 34183532 DOI: 10.1097/ede.0000000000001384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The evidence of an association between statins and amyotrophic lateral sclerosis (ALS) is heterogeneous and inconclusive. METHODS We performed a population-based cohort study consisting of 974,304 statin initiators ≥40 years of age and 1,948,606 matched general population comparators identified from Danish, nationwide registries (1996-2016). We computed incidence rates and hazard ratios (HRs) of a first-time hospital-based diagnosis of ALS. HRs were controlled for sex, birth year, calendar year, medically diagnosed comorbidities, and concomitant medications. RESULTS During a median follow-up of 7.7 years, 852 ALS events occurred among statin initiators (11.3 [95% confidence interval (CI) = 10.6, 12.1] events per 100,000 person-years) and 1,679 among noninitiators (11.4 [95% CI = 10.9, 12.0] events per 100,000 person years). The overall adjusted HR indicated a slight association between statin initiation and ALS (1.11 [95% CI = 1.00, 1.23]. In the first year after initiation, the HR was 1.40 (95% CI = 1.09, 1.79) for both sexes combined, 1.00 (95% CI = 0.70, 1.42) for men, and 1.92 (95% CI = 1.30, 2.82) for women. The associations diminished to approximately null after the first year of follow-up for both sexes combined and for men, but point estimates were above 1 for women until 10 years after initiation. CONCLUSIONS Statin initiation was largely unassociated with ALS diagnosis but was associated with an elevated risk of ALS in women, especially in the first year after initiation. The association could be explained by reverse causation, detection bias, early neurotoxic effects of statins that affect women more than men, or a combination thereof.
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Affiliation(s)
- Nils Skajaa
- From the Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Istvan Bakos
- From the Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Erzsébet Horváth-Puhó
- From the Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Victor W Henderson
- From the Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA
| | - Timothy L Lash
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Department of Epidemiology, Rollins School of Public Health, Emory University, GA
| | - Henrik Toft Sørensen
- From the Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA
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12
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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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13
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Garton FC, Trabjerg BB, Wray NR, Agerbo E. Cardiovascular disease, psychiatric diagnosis and sex differences in the multistep hypothesis of amyotrophic lateral sclerosis. Eur J Neurol 2020; 28:421-429. [PMID: 32978838 DOI: 10.1111/ene.14554] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/10/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Amyotrophic lateral sclerosis (ALS) risk increases with age, and a linear log-incidence and log-age relationship is interpreted to suggest that five to six factors are involved in disease onset. The factors remain unidentified, except that fewer steps are predicted for those carrying a known ALS-causing mutation. METHODS Men with a psychiatric disorder or cardiovascular disease (CVD) diagnosis have an increased relative risk of ALS. Using the Danish population registries and ALS diagnosis years 1980 to 2017, we tested whether these factors would decrease the predicted steps to disease. RESULTS Consistent with previous reports, we find a linear log-incidence and log-age ALS-onset relationship (n = 4385, regression coefficient b = 4.6, 95% confidence interval [CI]: 4.3-4.9, R2 = 0.99). This did not differ when considering ALS cases with a prior psychiatric diagnosis (n = 391, b = 4.6, 95% CI: 4.0-5.1) Surprisingly, it was higher (+1.5 steps, P = 2.3 × 10-5 ) for those with a prior CVD diagnosis (n = 901, b = 6.1, 95% CI: 5.4-6.8). To control for competing risk of death, a test to investigate if this effect was maintained in those with CVD in the population demonstrated an increased baseline risk and fewer steps to disease (b = 1.8, 95% CI: 1.2-2.3, P = 4.6 × 10-21 ), which consistent with a positive association of CVD and ALS. Assessing sex differences, our data and meta-analyses (n = 22 495) support half a step fewer for men (-0.4, 95% CI: ±0.24, P = 0.00031) without support for contributing differences explained by menopause. CONCLUSIONS Any factor associated with ALS disease onset may be relevant for understanding disease pathogenesis and/or counselling. Modelling disease incidence with age demonstrates some insight into relevant risk factors; however, the outcome can differ if competing risks are considered.
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Affiliation(s)
- F C Garton
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia
| | - B B Trabjerg
- National Centre for Register-Based Research NCRR, Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-Based Research CIRRAU, Aarhus University, Aarhus, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - N R Wray
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Queensland, Australia.,Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - E Agerbo
- National Centre for Register-Based Research NCRR, Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-Based Research CIRRAU, Aarhus University, Aarhus, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
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14
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Bjornevik K, O'Reilly ÉJ, Cortese M, Furtado JD, Kolonel LN, Le Marchand L, Mccullough ML, Paganoni S, Schwarzschild MA, Shadyab AH, Manson JE, Ascherio A. Pre-diagnostic plasma lipid levels and the risk of amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2020; 22:133-143. [PMID: 32985910 DOI: 10.1080/21678421.2020.1822411] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess whether pre-diagnostic lipid levels are associated with Amyotrophic lateral sclerosis (ALS) risk. Methods: We conducted a matched case-control study nested in five large prospective US cohorts (the Nurses' Health Study, the Health Professionals Follow-up Study, the Cancer Prevention Study II Nutrition Cohort, the Multiethnic Cohort Study, and the Women's Health Initiative), and identified 275 individuals who developed ALS during follow-up and had provided blood samples before disease diagnosis. For each ALS case, we randomly selected two controls who were alive at the time of the case diagnosis and matched on cohort, birth year (±1 year), sex, race/ethnicity, fasting status, and time of blood draw. We measured total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) levels in the plasma samples, and used conditional logistic regression to estimate associations between lipid levels and ALS risk. Results: Higher levels of HDL-C were associated with higher ALS risk in an analysis adjusted for the matching factors (risk ratio [RR] Q4 vs. Q1: 1.78, 95% confidence interval [CI]: 1.18-2.69, p trend: 0.007). The estimate remained similar in a multivariable analysis additionally adjusted for body mass index, physical activity, smoking, alcohol intake, plasma urate levels, and use of cholesterol-lowering drugs (RR Q4 vs. Q1: 1.71, 95% CI: 1.07-2.73, p trend: 0.02). Plasma levels of TC, LDL-C, and TG were not associated with ALS risk. Conclusions: Higher pre-diagnostic HDL-C levels, but not levels of other lipids, were associated with a higher risk of ALS.
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Affiliation(s)
- Kjetil Bjornevik
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Éilis J O'Reilly
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,School of Public Health, College of Medicine, University College Cork, Cork, Ireland
| | - Marianna Cortese
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jeremy D Furtado
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Laurence N Kolonel
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Loic Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | | | - Sabrina Paganoni
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael A Schwarzschild
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Aladdin H Shadyab
- Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Joann E Manson
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alberto Ascherio
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, 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 and Harvard Medical School, Boston, MA, USA
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15
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Lacasse A, Cauvier Charest E, Dault R, Cloutier AM, Choinière M, Blais L, Vanasse A. Validity of Algorithms for Identification of Individuals Suffering from Chronic Noncancer Pain in Administrative Databases: A Systematic Review. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:1825-1839. [PMID: 32142130 PMCID: PMC7553015 DOI: 10.1093/pm/pnaa004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Secondary analysis of health administrative databases is indispensable to enriching our understanding of health trajectories, health care utilization, and real-world risks and benefits of drugs among large populations. OBJECTIVES This systematic review aimed at assessing evidence about the validity of algorithms for the identification of individuals suffering from nonarthritic chronic noncancer pain (CNCP) in administrative databases. METHODS Studies reporting measures of diagnostic accuracy of such algorithms and published in English or French were searched in the Medline, Embase, CINAHL, AgeLine, PsycINFO, and Abstracts in Social Gerontology electronic databases without any dates of coverage restrictions up to March 1, 2018. Reference lists of included studies were also screened for additional publications. RESULTS Only six studies focused on commonly studied CNCP conditions and were included in the review. Some algorithms showed a ≥60% combination of sensitivity and specificity values (back pain disorders in general, fibromyalgia, low back pain, migraine, neck/back problems studied together). Only algorithms designed to identify fibromyalgia cases reached a ≥80% combination (without replication of findings in other studies/databases). CONCLUSIONS In summary, the present investigation informs us about the limited amount of literature available to guide and support the use of administrative databases as valid sources of data for research on CNCP. Considering the added value of such data sources, the important research gaps identified in this innovative review provide important directions for future research. The review protocol was registered with PROSPERO (CRD42018086402).
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Affiliation(s)
- Anaïs Lacasse
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, Québec, Canada
| | - Elizabeth Cauvier Charest
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Roxanne Dault
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Anne-Marie Cloutier
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Manon Choinière
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, Québec, Canada
- Département d'Anesthésiologie et de Médecine de la Douleur, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Lucie Blais
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada
| | - Alain Vanasse
- Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Québec, Canada
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16
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Palese F, Pisa FE. Validation of discharge diagnosis coding for amyotrophic lateral sclerosis in an Italian regional healthcare database. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:428-434. [PMID: 32321310 DOI: 10.1080/21678421.2020.1752245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: (a) to estimate the accuracy of International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code for amyotrophic lateral sclerosis (ALS) in the Hospital Discharge Database (HDD) of the Italian region Friuli-Venezia Giulia; (b) to identify the predictors of a true positive ALS code; (c) to compare incident and prevalent cases obtained from HDD with those identified in a retrospective population-based study. Methods: Records of all patients discharged 2010-2014 with an ICD-9-CM code for ALS and other motor neuron diseases were extracted from the HDD. For each record, all the available clinical documentation was evaluated to confirm or reject the diagnosis of ALS. ALS incident and prevalent cases were identified. Validity measures were calculated both overall and stratified by patient and hospitalization characteristics. Adjusted odds ratio (aOR), with 95% confidence interval (95%CI), of a true positive code was estimated using unconditional logistic regression. Results: ALS code had sensitivity 92.9%, specificity 75.3%, positive predictive value (PPV) 92.3%, and negative predictive value (NPV) 76.8%. A true positive ALS code was predicted by concurrent codes for respiratory interventions (aOR: 3.82; 95%CI: 2.09-6.99), primary position code (2.78; 1.68-4.62), non-programed hospitalization (2.06; 1.18-3.61), male patient (1.56; 1.06-2.29), and hospitalization length <14 days (1.42; 1.07-2.84). Two hundred and thirty-six prevalent and 187 incident cases were identified, 84% of those detected in the population-based study. Conclusion: ALS code shows very good accuracy and identifies a high percentage of true positive, incident and prevalent cases, but additional sources and an algorithm based on selected variables may further improve case identification.
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Affiliation(s)
| | - Federica Edith Pisa
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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17
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Baldin E, Preux PM, Couratier P, Pugliatti M, Marin B. Validity of death certificates in the identification of cases of amyotrophic lateral sclerosis (ALS) in the Limousin region, France. A population-based study. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:228-234. [PMID: 32276555 DOI: 10.1080/21678421.2020.1746811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: Mortality data have been used as a proxy for amyotrophic lateral sclerosis (ALS) incidence. However, the accuracy of death certificates (DCs) needs to be validated. This study aims to assess the accuracy of DCs in the identification of ALS cases. Methods: This is a retrospective population-based validation study. DC information, provided by the "Centre d'épidémiologie sur les causes médicales de décès", including ICD10 codes for specific cause of death for patients recorded in the French register of ALS cases in the Limousin region (FRALim) and deceased between 2000 and 2011, was assessed. The FRALim register was used as gold standard. Results: In the study period, DCs were available for 197 patients diagnosed with ALS, of whom 185 (93.9%) were correctly identified with an ICD10 code (G12.2) corresponding to ALS. The overall sensitivity was 93.9% (95% CI 89.6-96.8) and the positive predictive value (PPV) was 64.9 (59.1-70.4), with higher values in the period 2004-2011 (75.0-78.9). Stratification for sex, age, and year at death did not show difference in accuracy, except a lower PPV during the first years of observation. Conclusions: DCs identifying subjects with a diagnosis of ALS in the Limousin region, France showed an overall good sensitivity and moderate PPV. The absence of ALS diagnosis as the main and underlying cause of death on DCs highlights the need to use DC in combination with other administrative data to create algorithms with higher accuracy performances.
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Affiliation(s)
- Elisa Baldin
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.,INSERM, University of Limoges, CHU Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France, and
| | - Pierre-Marie Preux
- INSERM, University of Limoges, CHU Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France, and
| | - Philippe Couratier
- INSERM, University of Limoges, CHU Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France, and.,CHU Limoges, Service de Neurologie, Centre de Reférence Maladies Rares SLA et autres maladies du neurone moteur, CHU Limoges, Limoges, France
| | - Maura Pugliatti
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Benoit Marin
- INSERM, University of Limoges, CHU Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France, and
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18
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Dickerson AS, Hansen J, Thompson S, Gredal O, Weisskopf MG. A mixtures approach to solvent exposures and amyotrophic lateral sclerosis: a population-based study in Denmark. Eur J Epidemiol 2020; 35:241-249. [PMID: 32193761 PMCID: PMC7176306 DOI: 10.1007/s10654-020-00624-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 03/13/2020] [Indexed: 12/14/2022]
Abstract
Studies of occupational solvent exposures and amyotrophic lateral sclerosis (ALS) have been conflicting. We conducted a population-based case-control study of mixed occupational solvent exposures and ALS. Using the Danish National Patient Registry, we identified ALS cases in Denmark from 1982 to 2013, and matched them to 100 controls based on sex and birth year. We estimated cumulative exposures to solvents (benzene, methylene chloride, toluene, trichloroethylene, perchloroethylene, and 1,1,1-trichloroethane) via job exposure matrices and applied them to occupational history from the Danish Pension Fund. Sex-stratified conditional logistic regression analyses revealed higher adjusted odds of ALS for men with exposure to benzene (aOR = 1.20; 95% CI 1.02, 1.41) and methylene chloride (aOR = 1.23; 95% CI 1.07, 1.42). We used weighted quantile sum regression to explore combined solvent exposures and risk of ALS in exposed subjects and found increased odds of 26 to 28% in all exposure lag periods for every one-unit increase in the mixture index in men. Weights of methylene chloride predominated the mixture index in all lag periods. Our study suggests an increased risk of ALS in men exposed to multiple solvents, with the greatest influence being from methylene chloride. These findings highlight the need to utilize mixtures analysis when considering co-occurring exposures.
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Affiliation(s)
- Aisha S Dickerson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
- Environmental and Occupation Medicine and Epidemiology Division of the Department of Environmental Health, Harvard T.H. Chan School of Public Health, 667 Huntington Ave, Boston, MA, 1402-176, USA.
| | - Johnni Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Shiraya Thompson
- Department of Comparative Human Development, University of Chicago, Chicago, IL, USA
| | - Ole Gredal
- National Rehabilitation Center for Neuromuscular Disorders, Copenhagen, Denmark
| | - Marc G Weisskopf
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Environmental and Occupation Medicine and Epidemiology Division of the Department of Environmental Health, Harvard T.H. Chan School of Public Health, 667 Huntington Ave, Boston, MA, 1402-176, USA
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19
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Bellavia A, Rotem RS, Dickerson AS, Hansen J, Gredal O, Weisskopf MG. The use of Logic regression in epidemiologic studies to investigate multiple binary exposures: an example of occupation history and amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2020; 9. [PMID: 33224709 DOI: 10.1515/em-2019-0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Investigating the joint exposure to several risk factors is becoming a key component of epidemiologic studies. Individuals are exposed to multiple factors, often simultaneously, and evaluating patterns of exposures and high-dimension interactions may allow for a better understanding of health risks at the individual level. When jointly evaluating high-dimensional exposures, common statistical methods should be integrated with machine learning techniques that may better account for complex settings. Among these, Logic regression was developed to investigate a large number of binary exposures as they relate to a given outcome. This method may be of interest in several public health settings, yet has never been presented to an epidemiologic audience. In this paper, we review and discuss Logic regression as a potential tool for epidemiological studies, using an example of occupation history (68 binary exposures of primary occupations) and amyotrophic lateral sclerosis in a population-based Danish cohort. Logic regression identifies predictors that are Boolean combinations of the original (binary) exposures, fully operating within the regression framework of interest (e.g. linear, logistic). Combinations of exposures are graphically presented as Logic trees, and techniques for selecting the best Logic model are available and of high importance. While highlighting several advantages of the method, we also discuss specific drawbacks and practical issues that should be considered when using Logic regression in population-based studies. With this paper, we encourage researchers to explore the use of machine learning techniques when evaluating large-dimensional epidemiologic data, as well as advocate the need of further methodological work in the area.
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Affiliation(s)
- Andrea Bellavia
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115
| | - Ran S Rotem
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115
| | - Aisha S Dickerson
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115
| | - Johnni Hansen
- Danish Cancer Society, Institute of Cancer Epidemiology, DK-2100 Copenhagen, Denmark
| | - Ole Gredal
- Danish Cancer Society, Institute of Cancer Epidemiology, DK-2100 Copenhagen, Denmark
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115
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20
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Trabjerg BB, Garton FC, van Rheenen W, Fang F, Henderson RD, Mortensen PB, Agerbo E, Wray NR. ALS in Danish Registries: Heritability and links to psychiatric and cardiovascular disorders. NEUROLOGY-GENETICS 2020; 6:e398. [PMID: 32211514 PMCID: PMC7073454 DOI: 10.1212/nxg.0000000000000398] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/13/2020] [Indexed: 12/13/2022]
Abstract
Objective To investigate the genetic contribution to amyotrophic lateral sclerosis (ALS) and the phenotypic and genetic associations between ALS and psychiatric and cardiovascular disorders (CVD) we used the national registry data from Denmark linked to first-degree relatives to estimate heritability and cross-trait parameters. Methods ALS cases and 100 sex and birth-matched controls per case from the Danish Civil Registration System were linked to their records in the Danish National Patient Registry. Cases and controls were compared for (1) risk of ALS in first-degree relatives, used to estimate heritability, (2) comorbidity with psychiatric disorders and CVD, and (3) risk of psychiatric disorders and CVD in first-degree relatives. Results 5,808 ALS cases and 580,800 controls were identified. Fifteen percent of cases and controls could be linked to both parents and full siblings, whereas 70% could be linked to children. (1) We estimated the heritability of ALS to be 0.43 (95% CI, 0.34–0.53). (2) We found increased rates of diagnosis of mental disorders (risk ratio = 1.18; 95% CI, 1.09–1.29) and CVD in those later diagnosed with ALS. (3) In first-degree relatives of those with ALS, we found increased rate of schizophrenia (1.17; 95% CI, 0.96–1.42), but no evidence for increased risk CVD. Conclusions Heritability of ALS is lower than commonly reported. There is likely a genetic relationship between ALS and schizophrenia, and a nongenetic relationship between ALS and CVD.
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Affiliation(s)
- Betina B Trabjerg
- National Centre for Register-Based Research NCRR (B.B.T., P.B.M., E.A.), Aarhus University; Centre for Integrated Register-Based Research CIRRAU (B.B.T., P.B.M., E.A.), Aarhus University; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (B.B.T., P.B.M., E.A.), iPSYCH, Denmark; Institute for Molecular Bioscience (F.C.G., N.R.W.), University of Queensland, Brisbane, Australia; Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands; Department of Medical Epidemiology and Biostatistics (F.F.), Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research (R.D.H.), The University of Queensland, Brisbane; Queensland Brain Institute (R.D.H., N.R.W.), University of Queensland, Brisbane; Department of Neurology (R.D.H.), Royal Brisbane and Women's Hospital, Australia
| | - Fleur C Garton
- National Centre for Register-Based Research NCRR (B.B.T., P.B.M., E.A.), Aarhus University; Centre for Integrated Register-Based Research CIRRAU (B.B.T., P.B.M., E.A.), Aarhus University; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (B.B.T., P.B.M., E.A.), iPSYCH, Denmark; Institute for Molecular Bioscience (F.C.G., N.R.W.), University of Queensland, Brisbane, Australia; Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands; Department of Medical Epidemiology and Biostatistics (F.F.), Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research (R.D.H.), The University of Queensland, Brisbane; Queensland Brain Institute (R.D.H., N.R.W.), University of Queensland, Brisbane; Department of Neurology (R.D.H.), Royal Brisbane and Women's Hospital, Australia
| | - Wouter van Rheenen
- National Centre for Register-Based Research NCRR (B.B.T., P.B.M., E.A.), Aarhus University; Centre for Integrated Register-Based Research CIRRAU (B.B.T., P.B.M., E.A.), Aarhus University; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (B.B.T., P.B.M., E.A.), iPSYCH, Denmark; Institute for Molecular Bioscience (F.C.G., N.R.W.), University of Queensland, Brisbane, Australia; Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands; Department of Medical Epidemiology and Biostatistics (F.F.), Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research (R.D.H.), The University of Queensland, Brisbane; Queensland Brain Institute (R.D.H., N.R.W.), University of Queensland, Brisbane; Department of Neurology (R.D.H.), Royal Brisbane and Women's Hospital, Australia
| | - Fang Fang
- National Centre for Register-Based Research NCRR (B.B.T., P.B.M., E.A.), Aarhus University; Centre for Integrated Register-Based Research CIRRAU (B.B.T., P.B.M., E.A.), Aarhus University; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (B.B.T., P.B.M., E.A.), iPSYCH, Denmark; Institute for Molecular Bioscience (F.C.G., N.R.W.), University of Queensland, Brisbane, Australia; Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands; Department of Medical Epidemiology and Biostatistics (F.F.), Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research (R.D.H.), The University of Queensland, Brisbane; Queensland Brain Institute (R.D.H., N.R.W.), University of Queensland, Brisbane; Department of Neurology (R.D.H.), Royal Brisbane and Women's Hospital, Australia
| | - Robert D Henderson
- National Centre for Register-Based Research NCRR (B.B.T., P.B.M., E.A.), Aarhus University; Centre for Integrated Register-Based Research CIRRAU (B.B.T., P.B.M., E.A.), Aarhus University; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (B.B.T., P.B.M., E.A.), iPSYCH, Denmark; Institute for Molecular Bioscience (F.C.G., N.R.W.), University of Queensland, Brisbane, Australia; Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands; Department of Medical Epidemiology and Biostatistics (F.F.), Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research (R.D.H.), The University of Queensland, Brisbane; Queensland Brain Institute (R.D.H., N.R.W.), University of Queensland, Brisbane; Department of Neurology (R.D.H.), Royal Brisbane and Women's Hospital, Australia
| | - Preben Bo Mortensen
- National Centre for Register-Based Research NCRR (B.B.T., P.B.M., E.A.), Aarhus University; Centre for Integrated Register-Based Research CIRRAU (B.B.T., P.B.M., E.A.), Aarhus University; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (B.B.T., P.B.M., E.A.), iPSYCH, Denmark; Institute for Molecular Bioscience (F.C.G., N.R.W.), University of Queensland, Brisbane, Australia; Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands; Department of Medical Epidemiology and Biostatistics (F.F.), Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research (R.D.H.), The University of Queensland, Brisbane; Queensland Brain Institute (R.D.H., N.R.W.), University of Queensland, Brisbane; Department of Neurology (R.D.H.), Royal Brisbane and Women's Hospital, Australia
| | - Esben Agerbo
- National Centre for Register-Based Research NCRR (B.B.T., P.B.M., E.A.), Aarhus University; Centre for Integrated Register-Based Research CIRRAU (B.B.T., P.B.M., E.A.), Aarhus University; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (B.B.T., P.B.M., E.A.), iPSYCH, Denmark; Institute for Molecular Bioscience (F.C.G., N.R.W.), University of Queensland, Brisbane, Australia; Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands; Department of Medical Epidemiology and Biostatistics (F.F.), Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research (R.D.H.), The University of Queensland, Brisbane; Queensland Brain Institute (R.D.H., N.R.W.), University of Queensland, Brisbane; Department of Neurology (R.D.H.), Royal Brisbane and Women's Hospital, Australia
| | - Naomi R Wray
- National Centre for Register-Based Research NCRR (B.B.T., P.B.M., E.A.), Aarhus University; Centre for Integrated Register-Based Research CIRRAU (B.B.T., P.B.M., E.A.), Aarhus University; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (B.B.T., P.B.M., E.A.), iPSYCH, Denmark; Institute for Molecular Bioscience (F.C.G., N.R.W.), University of Queensland, Brisbane, Australia; Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands; Department of Medical Epidemiology and Biostatistics (F.F.), Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research (R.D.H.), The University of Queensland, Brisbane; Queensland Brain Institute (R.D.H., N.R.W.), University of Queensland, Brisbane; Department of Neurology (R.D.H.), Royal Brisbane and Women's Hospital, Australia
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21
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Dickerson AS, Hansen J, Specht AJ, Gredal O, Weisskopf MG. Population-based study of amyotrophic lateral sclerosis and occupational lead exposure in Denmark. Occup Environ Med 2019; 76:208-214. [PMID: 30705111 DOI: 10.1136/oemed-2018-105469] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/16/2018] [Accepted: 11/28/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Previous research has indicated links between lead (Pb) exposure and increased risk of neurodegenerative disorders, including amyotrophic lateral sclerosis (ALS). In this study, we evaluated the association between occupational Pb exposures and ALS. METHODS ALS cases were ascertained through the Danish National Patient Registry from 1982 to 2013 and age and sex-matched to 100 controls. Using complete employment history since 1964 from the Danish Pension Fund, cumulative Pb exposure was estimated for each subject via a Danish job exposure matrix. Associations were evaluated using conditional logistic regression analyses and stratified by sex. RESULTS For men with >50% probability of exposure, there was an increase in odds of ALS for exposures in the 60th percentile or higher during any time 5 years prior to diagnosis (aOR: 1.35; 95% CI 1.04 to 1.76) and 10 years prior to diagnosis (aOR: 1.33; 95% CI 1.03 to 1.72). No significant associations were observed in women, and there were no linear trends seen for Pb exposures for either sex. CONCLUSIONS Our study indicates an association between consistently higher occupational Pb exposures and ALS. These findings support those of previously reported associations between ALS and specific occupations that commonly experience Pb exposure.
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Affiliation(s)
- Aisha S Dickerson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Johnni Hansen
- Occupation Research Unit, Institute of Cancer Epidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Aaron J Specht
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ole Gredal
- Occupation Research Unit, Institute of Cancer Epidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Marc G Weisskopf
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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22
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Bjornevik K, O'Reilly ÉJ, Berry JD, Clish CB, Jeanfavre S, Kato I, Kolonel LN, Le Marchand L, McCullough ML, Paganoni S, Schwarzschild MA, Talbott EO, Wallace RB, Zhang Z, Manson JE, Ascherio A. Prediagnostic plasma branched-chain amino acids and the risk of amyotrophic lateral sclerosis. Neurology 2018; 92:e2081-e2088. [PMID: 30429276 DOI: 10.1212/wnl.0000000000006669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 09/17/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To assess whether prediagnostic levels of plasma branched-chain amino acids (BCAAs) are associated with amyotrophic lateral sclerosis (ALS) risk. METHODS We included participants from 5 large cohort studies-The Nurses' Health Study, the Health Professionals Follow-up Study, the Cancer Prevention Study II Nutrition, the Multiethnic Cohort Study, and the Women's Health Initiative-and identified 275 individuals who developed ALS during follow-up. Two controls were randomly selected for each case, matched on cohort, age, sex, fasting status, and time of blood draw. We measured metabolites using liquid chromatography-mass spectrometry and used conditional logistic regression to estimate rate ratios (RRs) and 95% confidence intervals (CIs) for the association of individual BCAAs with ALS risk. RESULTS None of the 3 BCAAs was associated with a higher ALS risk. The risk estimates were similar for leucine (RR top vs bottom quartile: 0.87, 95% CI 0.57-1.33), isoleucine (RR top vs bottom quartile: 0.81, 95% CI 0.52-1.24), and valine (RR top vs bottom quartile: 0.80, 95% CI 0.52-1.23) in a multivariable analysis adjusted for body mass index, smoking, level of education, and physical activity. The estimates did not vary significantly by sex, fasting status, or time interval between blood draw and disease onset. CONCLUSION The results from this study do not support the hypothesis that BCAAs are risk factors for ALS.
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Affiliation(s)
- Kjetil Bjornevik
- From the Departments of Nutrition (K.B., É.J.O., Z.Z., A.A.) and Epidemiology (J.E.M., A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health (É.J.O.), College of Medicine, University College Cork, Ireland; Department of Neurology (J.D.B., M.A.S.), Massachusetts General Hospital (S.P.), Boston; Metabolomics Platform (C.B.C., S.J.), Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge; Department of Oncology (I.K.), Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Epidemiology Research Program (M.L.M.), American Cancer Society, Atlanta, GA; Department of Physical Medicine and Rehabilitation (S.P.), Spaulding Rehabilitation Hospital, Charlestown; Harvard Medical School (S.P., M.A.S.), Boston, MA; Department of Epidemiology (E.O.T.), Graduate School of Public Health, University of Pittsburgh, PA; Department of Epidemiology (R.B.W.), College of Public Health, University of Iowa, Iowa City; and Department of Medicine (J.E.M.) and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Éilis J O'Reilly
- From the Departments of Nutrition (K.B., É.J.O., Z.Z., A.A.) and Epidemiology (J.E.M., A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health (É.J.O.), College of Medicine, University College Cork, Ireland; Department of Neurology (J.D.B., M.A.S.), Massachusetts General Hospital (S.P.), Boston; Metabolomics Platform (C.B.C., S.J.), Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge; Department of Oncology (I.K.), Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Epidemiology Research Program (M.L.M.), American Cancer Society, Atlanta, GA; Department of Physical Medicine and Rehabilitation (S.P.), Spaulding Rehabilitation Hospital, Charlestown; Harvard Medical School (S.P., M.A.S.), Boston, MA; Department of Epidemiology (E.O.T.), Graduate School of Public Health, University of Pittsburgh, PA; Department of Epidemiology (R.B.W.), College of Public Health, University of Iowa, Iowa City; and Department of Medicine (J.E.M.) and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - James D Berry
- From the Departments of Nutrition (K.B., É.J.O., Z.Z., A.A.) and Epidemiology (J.E.M., A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health (É.J.O.), College of Medicine, University College Cork, Ireland; Department of Neurology (J.D.B., M.A.S.), Massachusetts General Hospital (S.P.), Boston; Metabolomics Platform (C.B.C., S.J.), Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge; Department of Oncology (I.K.), Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Epidemiology Research Program (M.L.M.), American Cancer Society, Atlanta, GA; Department of Physical Medicine and Rehabilitation (S.P.), Spaulding Rehabilitation Hospital, Charlestown; Harvard Medical School (S.P., M.A.S.), Boston, MA; Department of Epidemiology (E.O.T.), Graduate School of Public Health, University of Pittsburgh, PA; Department of Epidemiology (R.B.W.), College of Public Health, University of Iowa, Iowa City; and Department of Medicine (J.E.M.) and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Clary B Clish
- From the Departments of Nutrition (K.B., É.J.O., Z.Z., A.A.) and Epidemiology (J.E.M., A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health (É.J.O.), College of Medicine, University College Cork, Ireland; Department of Neurology (J.D.B., M.A.S.), Massachusetts General Hospital (S.P.), Boston; Metabolomics Platform (C.B.C., S.J.), Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge; Department of Oncology (I.K.), Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Epidemiology Research Program (M.L.M.), American Cancer Society, Atlanta, GA; Department of Physical Medicine and Rehabilitation (S.P.), Spaulding Rehabilitation Hospital, Charlestown; Harvard Medical School (S.P., M.A.S.), Boston, MA; Department of Epidemiology (E.O.T.), Graduate School of Public Health, University of Pittsburgh, PA; Department of Epidemiology (R.B.W.), College of Public Health, University of Iowa, Iowa City; and Department of Medicine (J.E.M.) and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sarah Jeanfavre
- From the Departments of Nutrition (K.B., É.J.O., Z.Z., A.A.) and Epidemiology (J.E.M., A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health (É.J.O.), College of Medicine, University College Cork, Ireland; Department of Neurology (J.D.B., M.A.S.), Massachusetts General Hospital (S.P.), Boston; Metabolomics Platform (C.B.C., S.J.), Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge; Department of Oncology (I.K.), Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Epidemiology Research Program (M.L.M.), American Cancer Society, Atlanta, GA; Department of Physical Medicine and Rehabilitation (S.P.), Spaulding Rehabilitation Hospital, Charlestown; Harvard Medical School (S.P., M.A.S.), Boston, MA; Department of Epidemiology (E.O.T.), Graduate School of Public Health, University of Pittsburgh, PA; Department of Epidemiology (R.B.W.), College of Public Health, University of Iowa, Iowa City; and Department of Medicine (J.E.M.) and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ikuko Kato
- From the Departments of Nutrition (K.B., É.J.O., Z.Z., A.A.) and Epidemiology (J.E.M., A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health (É.J.O.), College of Medicine, University College Cork, Ireland; Department of Neurology (J.D.B., M.A.S.), Massachusetts General Hospital (S.P.), Boston; Metabolomics Platform (C.B.C., S.J.), Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge; Department of Oncology (I.K.), Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Epidemiology Research Program (M.L.M.), American Cancer Society, Atlanta, GA; Department of Physical Medicine and Rehabilitation (S.P.), Spaulding Rehabilitation Hospital, Charlestown; Harvard Medical School (S.P., M.A.S.), Boston, MA; Department of Epidemiology (E.O.T.), Graduate School of Public Health, University of Pittsburgh, PA; Department of Epidemiology (R.B.W.), College of Public Health, University of Iowa, Iowa City; and Department of Medicine (J.E.M.) and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Laurence N Kolonel
- From the Departments of Nutrition (K.B., É.J.O., Z.Z., A.A.) and Epidemiology (J.E.M., A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health (É.J.O.), College of Medicine, University College Cork, Ireland; Department of Neurology (J.D.B., M.A.S.), Massachusetts General Hospital (S.P.), Boston; Metabolomics Platform (C.B.C., S.J.), Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge; Department of Oncology (I.K.), Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Epidemiology Research Program (M.L.M.), American Cancer Society, Atlanta, GA; Department of Physical Medicine and Rehabilitation (S.P.), Spaulding Rehabilitation Hospital, Charlestown; Harvard Medical School (S.P., M.A.S.), Boston, MA; Department of Epidemiology (E.O.T.), Graduate School of Public Health, University of Pittsburgh, PA; Department of Epidemiology (R.B.W.), College of Public Health, University of Iowa, Iowa City; and Department of Medicine (J.E.M.) and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Loic Le Marchand
- From the Departments of Nutrition (K.B., É.J.O., Z.Z., A.A.) and Epidemiology (J.E.M., A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health (É.J.O.), College of Medicine, University College Cork, Ireland; Department of Neurology (J.D.B., M.A.S.), Massachusetts General Hospital (S.P.), Boston; Metabolomics Platform (C.B.C., S.J.), Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge; Department of Oncology (I.K.), Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Epidemiology Research Program (M.L.M.), American Cancer Society, Atlanta, GA; Department of Physical Medicine and Rehabilitation (S.P.), Spaulding Rehabilitation Hospital, Charlestown; Harvard Medical School (S.P., M.A.S.), Boston, MA; Department of Epidemiology (E.O.T.), Graduate School of Public Health, University of Pittsburgh, PA; Department of Epidemiology (R.B.W.), College of Public Health, University of Iowa, Iowa City; and Department of Medicine (J.E.M.) and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Marjorie L McCullough
- From the Departments of Nutrition (K.B., É.J.O., Z.Z., A.A.) and Epidemiology (J.E.M., A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health (É.J.O.), College of Medicine, University College Cork, Ireland; Department of Neurology (J.D.B., M.A.S.), Massachusetts General Hospital (S.P.), Boston; Metabolomics Platform (C.B.C., S.J.), Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge; Department of Oncology (I.K.), Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Epidemiology Research Program (M.L.M.), American Cancer Society, Atlanta, GA; Department of Physical Medicine and Rehabilitation (S.P.), Spaulding Rehabilitation Hospital, Charlestown; Harvard Medical School (S.P., M.A.S.), Boston, MA; Department of Epidemiology (E.O.T.), Graduate School of Public Health, University of Pittsburgh, PA; Department of Epidemiology (R.B.W.), College of Public Health, University of Iowa, Iowa City; and Department of Medicine (J.E.M.) and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sabrina Paganoni
- From the Departments of Nutrition (K.B., É.J.O., Z.Z., A.A.) and Epidemiology (J.E.M., A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health (É.J.O.), College of Medicine, University College Cork, Ireland; Department of Neurology (J.D.B., M.A.S.), Massachusetts General Hospital (S.P.), Boston; Metabolomics Platform (C.B.C., S.J.), Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge; Department of Oncology (I.K.), Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Epidemiology Research Program (M.L.M.), American Cancer Society, Atlanta, GA; Department of Physical Medicine and Rehabilitation (S.P.), Spaulding Rehabilitation Hospital, Charlestown; Harvard Medical School (S.P., M.A.S.), Boston, MA; Department of Epidemiology (E.O.T.), Graduate School of Public Health, University of Pittsburgh, PA; Department of Epidemiology (R.B.W.), College of Public Health, University of Iowa, Iowa City; and Department of Medicine (J.E.M.) and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michael A Schwarzschild
- From the Departments of Nutrition (K.B., É.J.O., Z.Z., A.A.) and Epidemiology (J.E.M., A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health (É.J.O.), College of Medicine, University College Cork, Ireland; Department of Neurology (J.D.B., M.A.S.), Massachusetts General Hospital (S.P.), Boston; Metabolomics Platform (C.B.C., S.J.), Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge; Department of Oncology (I.K.), Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Epidemiology Research Program (M.L.M.), American Cancer Society, Atlanta, GA; Department of Physical Medicine and Rehabilitation (S.P.), Spaulding Rehabilitation Hospital, Charlestown; Harvard Medical School (S.P., M.A.S.), Boston, MA; Department of Epidemiology (E.O.T.), Graduate School of Public Health, University of Pittsburgh, PA; Department of Epidemiology (R.B.W.), College of Public Health, University of Iowa, Iowa City; and Department of Medicine (J.E.M.) and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Evelyn O Talbott
- From the Departments of Nutrition (K.B., É.J.O., Z.Z., A.A.) and Epidemiology (J.E.M., A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health (É.J.O.), College of Medicine, University College Cork, Ireland; Department of Neurology (J.D.B., M.A.S.), Massachusetts General Hospital (S.P.), Boston; Metabolomics Platform (C.B.C., S.J.), Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge; Department of Oncology (I.K.), Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Epidemiology Research Program (M.L.M.), American Cancer Society, Atlanta, GA; Department of Physical Medicine and Rehabilitation (S.P.), Spaulding Rehabilitation Hospital, Charlestown; Harvard Medical School (S.P., M.A.S.), Boston, MA; Department of Epidemiology (E.O.T.), Graduate School of Public Health, University of Pittsburgh, PA; Department of Epidemiology (R.B.W.), College of Public Health, University of Iowa, Iowa City; and Department of Medicine (J.E.M.) and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Robert B Wallace
- From the Departments of Nutrition (K.B., É.J.O., Z.Z., A.A.) and Epidemiology (J.E.M., A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health (É.J.O.), College of Medicine, University College Cork, Ireland; Department of Neurology (J.D.B., M.A.S.), Massachusetts General Hospital (S.P.), Boston; Metabolomics Platform (C.B.C., S.J.), Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge; Department of Oncology (I.K.), Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Epidemiology Research Program (M.L.M.), American Cancer Society, Atlanta, GA; Department of Physical Medicine and Rehabilitation (S.P.), Spaulding Rehabilitation Hospital, Charlestown; Harvard Medical School (S.P., M.A.S.), Boston, MA; Department of Epidemiology (E.O.T.), Graduate School of Public Health, University of Pittsburgh, PA; Department of Epidemiology (R.B.W.), College of Public Health, University of Iowa, Iowa City; and Department of Medicine (J.E.M.) and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Zhongli Zhang
- From the Departments of Nutrition (K.B., É.J.O., Z.Z., A.A.) and Epidemiology (J.E.M., A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health (É.J.O.), College of Medicine, University College Cork, Ireland; Department of Neurology (J.D.B., M.A.S.), Massachusetts General Hospital (S.P.), Boston; Metabolomics Platform (C.B.C., S.J.), Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge; Department of Oncology (I.K.), Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Epidemiology Research Program (M.L.M.), American Cancer Society, Atlanta, GA; Department of Physical Medicine and Rehabilitation (S.P.), Spaulding Rehabilitation Hospital, Charlestown; Harvard Medical School (S.P., M.A.S.), Boston, MA; Department of Epidemiology (E.O.T.), Graduate School of Public Health, University of Pittsburgh, PA; Department of Epidemiology (R.B.W.), College of Public Health, University of Iowa, Iowa City; and Department of Medicine (J.E.M.) and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - JoAnn E Manson
- From the Departments of Nutrition (K.B., É.J.O., Z.Z., A.A.) and Epidemiology (J.E.M., A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health (É.J.O.), College of Medicine, University College Cork, Ireland; Department of Neurology (J.D.B., M.A.S.), Massachusetts General Hospital (S.P.), Boston; Metabolomics Platform (C.B.C., S.J.), Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge; Department of Oncology (I.K.), Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Epidemiology Research Program (M.L.M.), American Cancer Society, Atlanta, GA; Department of Physical Medicine and Rehabilitation (S.P.), Spaulding Rehabilitation Hospital, Charlestown; Harvard Medical School (S.P., M.A.S.), Boston, MA; Department of Epidemiology (E.O.T.), Graduate School of Public Health, University of Pittsburgh, PA; Department of Epidemiology (R.B.W.), College of Public Health, University of Iowa, Iowa City; and Department of Medicine (J.E.M.) and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alberto Ascherio
- From the Departments of Nutrition (K.B., É.J.O., Z.Z., A.A.) and Epidemiology (J.E.M., A.A.), Harvard T.H. Chan School of Public Health, Boston, MA; School of Public Health (É.J.O.), College of Medicine, University College Cork, Ireland; Department of Neurology (J.D.B., M.A.S.), Massachusetts General Hospital (S.P.), Boston; Metabolomics Platform (C.B.C., S.J.), Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge; Department of Oncology (I.K.), Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI; Epidemiology Program (L.N.K., L.L.M.), University of Hawaii Cancer Center, Honolulu; Epidemiology Research Program (M.L.M.), American Cancer Society, Atlanta, GA; Department of Physical Medicine and Rehabilitation (S.P.), Spaulding Rehabilitation Hospital, Charlestown; Harvard Medical School (S.P., M.A.S.), Boston, MA; Department of Epidemiology (E.O.T.), Graduate School of Public Health, University of Pittsburgh, PA; Department of Epidemiology (R.B.W.), College of Public Health, University of Iowa, Iowa City; and Department of Medicine (J.E.M.) and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Dickerson AS, Hansen J, Gredal O, Weisskopf MG. Amyotrophic Lateral Sclerosis and Exposure to Diesel Exhaust in a Danish Cohort. Am J Epidemiol 2018; 187:1613-1622. [PMID: 29590300 DOI: 10.1093/aje/kwy069] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/20/2018] [Indexed: 12/12/2022] Open
Abstract
Previous studies have suggested an increased risk of amyotrophic lateral sclerosis (ALS) and other motor neuron diseases for persons in occupations commonly involving exposure to diesel exhaust (DE). In this study, we investigated the association between occupational exposure to DE and odds of ALS. ALS cases were identified from the Danish National Patient Registry (1982-2013) and individually matched to 100 controls per case on the basis of birth year and sex. Using information on occupational history from 1964 onward obtained from the Danish Pension Fund, we estimated cumulative DE exposures using a job exposure matrix. We evaluated associations using conditional logistic regression analyses and stratified the analyses by sex. Using a 10-year lag period, DE exposure was positively associated with ALS among men who had ever been exposed (adjusted odds ratio (aOR) = 1.20, 95% confidence interval (CI): 1.05, 1.38). For men with greater than 50% probability of DE exposure, we observed a positive association between ALS and highest-quartile exposure during the 5-year (aOR = 1.35, 95% CI: 1.07, 1.70) and 10-year (aOR = 1.41, 95% CI: 1.11, 1.79) lag periods. Our study suggests an association between consistently higher exposures to DE and ALS in men, but not in women. These findings support previous reports of associations between ALS and occupations commonly involving DE exposure.
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Affiliation(s)
- Aisha S Dickerson
- Departments of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Johnni Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Ole Gredal
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Marc G Weisskopf
- Departments of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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24
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Dickerson AS, Hansen J, Kioumourtzoglou MA, Specht AJ, Gredal O, Weisskopf MG. Study of occupation and amyotrophic lateral sclerosis in a Danish cohort. Occup Environ Med 2018; 75:630-638. [PMID: 29941657 DOI: 10.1136/oemed-2018-105110] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/24/2018] [Accepted: 05/28/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Several manuscripts have proposed associations between amyotrophic lateral sclerosis (ALS) and occupational toxicant exposures-not to mention physical activity and trauma/injury. Some have also reported associations in investigations of specific occupations. Using data from a prospective Danish cohort study, we investigated the association between employment in certain industries and ALS diagnosis. METHODS We identified 1826 ALS cases who were 25 years old or less in 1964 and diagnosed from 1982 to 2013 from the Danish National Patient Registry then matched 100 population controls to each case based on birth year and sex. Demographic data were linked to the Danish Pension Fund to determine occupation history. Conditional logistic regression models were adjusted for socioeconomic status, marital status and residential location at the index date. RESULTS There was an increase in odds of ALS among men who worked in agriculture, hunting, forestry or fishing (adjusted OR (aOR)=1.21; 95% CI 1.02 to 1.45). There was also a positive association for men employed in construction (aOR=1.21; 95% CI 1.05 to 1.39). In women, a protective association was seen with employment in the cleaning industry (aOR=0.69; 95% CI 0.52 to 0.93). CONCLUSIONS Our study shows various occupations with exposure to toxicants, such as diesel exhaust and lead, and strenuous physical activity associated with increased odds of ALS in men. Future studies should have a particular focus on gathering detailed information on physical exertion and toxicant exposures specific to certain job tasks.
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Affiliation(s)
- Aisha S Dickerson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Johnni Hansen
- Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark
| | | | - Aaron J Specht
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ole Gredal
- Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark
| | - Marc G Weisskopf
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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25
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Vieira VM, Hansen J, Gredal O, Weisskopf MG. Spatial analyses of ALS incidence in Denmark over three decades. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:275-284. [PMID: 29383960 DOI: 10.1080/21678421.2018.1432658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease of the motor neuron with very few known risk factors. We conducted a spatial epidemiologic analysis of ALS incidence in Denmark to assess the contribution of sociodemographic determinants to geographic variation. METHODS We analyzed 4249 ALS cases (1982-2013), each with 100 controls matched on sex and birth year. Odds ratio and 95% confidence bands at birth and diagnosis/index locations were calculated using generalized additive models. We included a bivariate spatial smooth for location in our conditional logistic regression adjusted for socioeconomic status and marital status. We also conducted analyses adjusted for both birth and diagnosis addresses to separate location effects. RESULTS We observed significantly elevated ALS odds near Copenhagen for both the birth and diagnosis period analyses. Sociodemographic factors did not explain the observed patterns. When we further adjusted our spatial analyses by including both birth and diagnosis addresses, the significant area of elevated male ALS odds by birth address shifted to northwest Denmark away from Copenhagen, and there was little evidence of variation among women. Geographic variation at diagnosis differed between male and females, suggesting that patterns are not just due to regional variation in case ascertainment. CONCLUSION ALS incidence in Denmark is associated with both location at birth and diagnosis, suggesting that geographic variation may be due to exposures occurring at birth or closer to diagnosis, although the latter could relate to case ascertainment issues.
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Affiliation(s)
- Verónica M Vieira
- a Program in Public Health, Susan and Henry Samueli College of Health Sciences , University of California , Irvine , CA , USA
| | - Johnni Hansen
- b Danish Cancer Society Research Center , Copenhagen , Denmark
| | - Ole Gredal
- c National Rehabilitation Center for Neuromuscular Disorders , Copenhagen , Denmark , and
| | - Marc G Weisskopf
- d Departments of Environmental Health and Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA
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26
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Gunton A, Hansen G, Schellenberg KL. Hospital utilization for patients with amyotrophic lateral sclerosis in saskatoon, Canada. Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:201-205. [PMID: 29160128 DOI: 10.1080/21678421.2017.1400071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This retrospective study reviewed hospital and intensive care unit (ICU) admissions for patients with amyotrophic lateral sclerosis (ALS) in Saskatoon, Canada, between 2005 and 2017. The purpose was to understand hospital utilization and admission patterns for patients with ALS in the absence of coordinated multidisciplinary care. METHODS Hospital/ICU admissions were detected at two hospitals in Saskatoon using the International Classification of Diseases (ICD-10) coding for ALS. Patient demographic data, hospitalization and pre-hospitalization information were recorded, and descriptive statistics were generated. RESULTS Of the 83 patients identified, 52% were male with a mean age of 66.8 years. Fifty-two percent were undiagnosed prior to hospitalization, with significantly longer ICU stays compared to those diagnosed prior to admission (49.4 ± 46.6 vs. 21.9 ± 32.0 days; p = 0.0003). Eighty-nine percent of all admissions (n = 118) were non-elective. Although respiratory dysfunction was the most common reason for admission (n = 41, 49%), and all ICU admissions were for respiratory dysfunction, only 2% were on non-invasive ventilation prior to ICU admission. All tracheostomies (n =10, 12%) were placed non-electively, and 50% were in previously undiagnosed patients. Thirty-four percent (n = 28) of patients died in hospital in an ICU (n = 8, 29%) and hospital wards (n = 20, 71%). CONCLUSION ALS patients in Saskatoon had high non-elective admission rates, with over half undiagnosed prior to hospitalization, and high rates of emergent tracheostomy. This study highlights the need for early diagnosis and coordinated multidisciplinary care for improved outpatient management of ALS to reduce lengthy and complicated hospitalizations.
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Affiliation(s)
- Adrianna Gunton
- a College of Medicine , University of Saskatchewan , Saskatoon , SK , Canada
| | - Gregory Hansen
- b Divison of Critical Care, Department of Paediatrics , University of Saskatchewan , Saskatoon , SK , Canada , and
| | - Kerri Lynn Schellenberg
- c Division of Neurology, Department of Medicine , University of Saskatchewan , Saskatoon , SK , Canada
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27
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Pedersen C, Poulsen AH, Rod NH, Frei P, Hansen J, Grell K, Raaschou-Nielsen O, Schüz J, Johansen C. Occupational exposure to extremely low-frequency magnetic fields and risk for central nervous system disease: an update of a Danish cohort study among utility workers. Int Arch Occup Environ Health 2017; 90:619-628. [PMID: 28429106 DOI: 10.1007/s00420-017-1224-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 04/11/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Evidence of whether exposure to extremely low-frequency magnetic fields (ELF-MF) is related to central nervous system diseases is inconsistent. This study updates a previous study of the incidence of such diseases in a large cohort of Danish utility workers by almost doubling the period of follow-up. METHODS We investigated the risks for dementia, motor neurone disease, Parkinson disease, multiple sclerosis and epilepsy among 32,006 men employed at the 99 utility companies that supplied Denmark with electricity during the period 1900-1993. Cases were identified in the Danish National Patient Registry and the cohort was followed during 1982-2010. Exposure was estimated from a job-exposure matrix based on company records of job title and area of work and cohort members were allocated to one of three categories (<0.1, 0.1-0.99 and ≥1.0 µT). RESULTS For dementia, multiple sclerosis and epilepsy the incidence rate ratios (IRR) were close to unity, but higher for motor neurone disease [IRR 1.24, 95% confidence interval (CI) 0.86-1.79] and lower for Parkinson disease (IRR 0.81, 95% CI 0.67-0.97) among workers exposed to ≥0.1 µT compared with the Danish population. For the highest level of exposure (≥1.0 µT), IRRs of 1.44, 1.78, 1.40 and 1.34 were observed for dementia, motor neurone disease, multiple sclerosis and epilepsy, respectively. CONCLUSIONS We observed elevated risks of dementia, motor neurone disease, multiple sclerosis and epilepsy and lower risks of Parkinson disease in relation to exposure to ELF-MF in a large cohort of utility employees.
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Affiliation(s)
- Camilla Pedersen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark.
| | - Aslak Harbo Poulsen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark
| | - Naja Hulvej Rod
- Social Medicine Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Patrizia Frei
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark
| | - Johnni Hansen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark
| | - Kathrine Grell
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark
| | - Ole Raaschou-Nielsen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark
| | - Joachim Schüz
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark
- International Agency for Research on Cancer (IARC), Section of Environment and Radiation, 150 Cours Albert Thomas, 69372, Lyon Cedex 08, France
| | - Christoffer Johansen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark
- Oncology Clinic, Finsen Centre, Rigshospitalet 5073, University of Copenhagen, Blegdamsvej, 2100, Copenhagen Ø, Denmark
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Occupational formaldehyde and amyotrophic lateral sclerosis. Eur J Epidemiol 2017; 32:893-899. [PMID: 28585120 DOI: 10.1007/s10654-017-0249-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 04/27/2017] [Indexed: 10/19/2022]
Abstract
Prior studies have yielded inconsistent evidence regarding the association between formaldehyde exposure and amyotrophic lateral sclerosis (ALS). We conducted a population case-control study in the Danish National Registries on the relationship between occupationally-derived formaldehyde exposure and ALS. Occupational history was obtained from a comprehensive and prospectively recorded pension database of all paid work in Denmark since 1964, and was linked to a job-exposure matrix to derive individual exposure estimates. Each case was matched to 4 age- and sex-matched population controls alive on the date of the case diagnosis via risk set sampling, and odds ratios and confidence intervals (CI) were calculated via conditional logistic regression, adjusting for potential confounders. There were 3650 incident cases of ALS in the Danish National Patient Register from 1982 to 2009. Among controls, 25% were ever employed in jobs with a positive prevalence of formaldehyde exposure. Exposure to formaldehyde was associated with a 1.3-fold increased rate of ALS (95% CI 1.2-1.4). This study suggests that formaldehyde exposure, or employment in formaldehyde-exposed occupations, is related to the risk of ALS.
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Kab S, Moisan F, Preux PM, Marin B, Elbaz A. Nationwide incidence of motor neuron disease using the French health insurance information system database. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:426-433. [PMID: 28387141 DOI: 10.1080/21678421.2017.1306566] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE There are no estimates of the nationwide incidence of motor neuron disease (MND) in France. We used the French health insurance information system to identify incident MND cases (2012-2014), and compared incidence figures to those from three external sources. METHODS We identified incident MND cases (2012-2014) based on three data sources (riluzole claims, hospitalisation records, long-term chronic disease benefits), and computed MND incidence by age, gender, and geographic region. We used French mortality statistics, Limousin ALS registry data, and previous European studies based on administrative databases to perform external comparisons. RESULTS We identified 6553 MND incident cases. After standardisation to the United States 2010 population, the age/gender-standardised incidence was 2.72/100,000 person-years (males, 3.37; females, 2.17; male:female ratio = 1.53, 95% CI1.46-1.61). There was no major spatial difference in MND distribution. Our data were in agreement with the French death database (standardised mortality ratio = 1.01, 95% CI = 0.96-1.06) and Limousin ALS registry (standardised incidence ratio = 0.92, 95% CI = 0.72-1.15). Incidence estimates were in the same range as those from previous studies. CONCLUSIONS We report French nationwide incidence estimates of MND. Administrative databases including hospital discharge data and riluzole claims offer an interesting approach to identify large population-based samples of patients with MND for epidemiologic studies and surveillance.
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Affiliation(s)
- Sofiane Kab
- a Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM , Villejuif , France.,b Santé publique France , Direction santé travail , Saint-Maurice, France
| | - Frédéric Moisan
- a Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM , Villejuif , France
| | - Pierre-Marie Preux
- c INSERM, U1094 , Tropical Neuroepidemiology , Limoges , France.,d Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology , Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000 , Limoges , France , and.,e CHU Limoges , Centre d'Epidémiologie de Biostatistique et de Méthodologie dela Recherche , Limoges , France
| | - Benoît Marin
- c INSERM, U1094 , Tropical Neuroepidemiology , Limoges , France.,d Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology , Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000 , Limoges , France , and.,e CHU Limoges , Centre d'Epidémiologie de Biostatistique et de Méthodologie dela Recherche , Limoges , France
| | - Alexis Elbaz
- a Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM , Villejuif , France.,b Santé publique France , Direction santé travail , Saint-Maurice, France
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Horrocks S, Wilkinson T, Schnier C, Ly A, Woodfield R, Rannikmäe K, Quinn TJ, Sudlow CLM. Accuracy of routinely-collected healthcare data for identifying motor neurone disease cases: A systematic review. PLoS One 2017; 12:e0172639. [PMID: 28245254 PMCID: PMC5330471 DOI: 10.1371/journal.pone.0172639] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 02/07/2017] [Indexed: 11/19/2022] Open
Abstract
Background Motor neurone disease (MND) is a rare neurodegenerative condition, with poorly understood aetiology. Large, population-based, prospective cohorts will enable powerful studies of the determinants of MND, provided identification of disease cases is sufficiently accurate. Follow-up in many such studies relies on linkage to routinely-collected health datasets. We systematically evaluated the accuracy of such datasets in identifying MND cases. Methods We performed an electronic search of MEDLINE, EMBASE, Cochrane Library and Web of Science for studies published between 01/01/1990-16/11/2015 that compared MND cases identified in routinely-collected, coded datasets to a reference standard. We recorded study characteristics and two key measures of diagnostic accuracy—positive predictive value (PPV) and sensitivity. We conducted descriptive analyses and quality assessments of included studies. Results Thirteen eligible studies provided 13 estimates of PPV and five estimates of sensitivity. Twelve studies assessed hospital and/or death certificate-derived datasets; one evaluated a primary care dataset. All studies were from high income countries (UK, Europe, USA, Hong Kong). Study methods varied widely, but quality was generally good. PPV estimates ranged from 55–92% and sensitivities from 75–93%. The single (UK-based) study of primary care data reported a PPV of 85%. Conclusions Diagnostic accuracy of routinely-collected health datasets is likely to be sufficient for identifying cases of MND in large-scale prospective epidemiological studies in high income country settings. Primary care datasets, particularly from countries with a widely-accessible national healthcare system, are potentially valuable data sources warranting further investigation.
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Affiliation(s)
- Sophie Horrocks
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Tim Wilkinson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
| | - Christian Schnier
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Amanda Ly
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Rebecca Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Kristiina Rannikmäe
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Terence J. Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Cathie L. M. Sudlow
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- UK Biobank, Stockport, United Kingdom
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Amyotrophic Lateral Sclerosis and the Military: A Population-based Study in the Danish Registries. Epidemiology 2017; 27:188-93. [PMID: 26583610 DOI: 10.1097/ede.0000000000000417] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Prior studies have suggested that military service may be associated with the development of amyotrophic lateral sclerosis (ALS). We conducted a population-based case-control study in Denmark to assess whether occupation in the Danish military is associated with an increased risk of developing ALS. METHODS There were 3,650 incident cases of ALS recorded in the Danish National Patient Registry between 1982 and 2009. Each case was matched to 100 age- and sex-matched population controls alive and free of ALS on the date of the case diagnosis. Comprehensive occupational history was obtained from the Danish Pension Fund database, which began in 1964. RESULTS 2.4% (n = 8,922) of controls had a history of employment in the military before the index date. Military employees overall had an elevated rate of ALS (odds ratio [OR] = 1.3; 95% confidence interval [CI]: 1.1, 1.6). A 10-year increase in years employed by the military was associated with an OR of 1.2 (95% CI: 1.0, 1.4), and all quartiles of time employed were elevated. There was little suggestion of a pattern across calendar year of first employment, but there was some evidence that increasing age at first employment was associated with increased ALS rates. Rates were highest in the decade immediately following the end of employment (OR = 1.6; 95% CI: 1.2, 2.2). CONCLUSIONS In this large population-based case-control study, employment by the military is associated with increased rates of ALS. These findings are consistent with earlier findings that military service or employment may entail exposure to risk factors for ALS.
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Schwartz GG, Rundquist BC, Simon IJ, Swartz SE. Geographic distributions of motor neuron disease mortality and well water use in U.S. counties. Amyotroph Lateral Scler Frontotemporal Degener 2016; 18:279-283. [PMID: 28019106 DOI: 10.1080/21678421.2016.1264975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We recently reported that U.S. mortality rates for motor neuron disease (MND) at the level of the state are associated with well water use. However, data at the state level may not accurately reflect data at the individual level. We therefore examined the association between MND mortality and well water use utilizing data from smaller geographic units that may better reflect exposure and disease at the individual level. METHODS We used data on age-adjusted MND mortality rates at the level of the county, obtained from the CDC, and corresponding data on the prevalence of well water use, obtained from the U.S. Geological Survey. Data were analyzed by multivariate linear regression and by Getis-Ord Gi*, a measure of spatial clustering. RESULTS Age-adjusted mortality rates for MND in 923 U.S. counties were significantly correlated with the prevalence of well water (p < 0.0001). 'Hot spots' of MND mortality were significantly associated with 'hot spots' of well water use (p < 0.0005). CONCLUSIONS These findings support the hypothesis that an agent present in well water plays an etiologic role in ALS. Further study of water use among individuals with ALS is warranted.
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Affiliation(s)
- Gary G Schwartz
- a Department of Population Health , University of North Dakota School of Medicine & Health Sciences , Grand Forks , ND , USA and
| | - Bradley C Rundquist
- b Department of Geography , University of North Dakota College of Arts and Sciences , Grand Forks , ND , USA
| | - Isaac J Simon
- b Department of Geography , University of North Dakota College of Arts and Sciences , Grand Forks , ND , USA
| | - Sami E Swartz
- b Department of Geography , University of North Dakota College of Arts and Sciences , Grand Forks , ND , USA
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Roberts AL, Johnson NJ, Chen JT, Cudkowicz ME, Weisskopf MG. Race/ethnicity, socioeconomic status, and ALS mortality in the United States. Neurology 2016; 87:2300-2308. [PMID: 27742817 PMCID: PMC5135021 DOI: 10.1212/wnl.0000000000003298] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 08/16/2016] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To determine whether race/ethnicity and socioeconomic status are associated with amyotrophic lateral sclerosis (ALS) mortality in the United States. METHODS The National Longitudinal Mortality Study (NLMS), a United States-representative, multistage sample, collected race/ethnicity and socioeconomic data prospectively. Mortality information was obtained by matching NLMS records to the National Death Index (1979-2011). More than 2 million persons (n = 1,145,368 women, n = 1,011,172 men) were included, with 33,024,881 person-years of follow-up (1,299 ALS deaths , response rate 96%). Race/ethnicity was by self-report in 4 categories. Hazard ratios (HRs) for ALS mortality were calculated for race/ethnicity and socioeconomic status separately and in mutually adjusted models. RESULTS Minority vs white race/ethnicity predicted lower ALS mortality in models adjusted for socioeconomic status, type of health insurance, and birthplace (non-Hispanic black, HR 0.61, 95% confidence interval [CI] 0.48-0.78; Hispanic, HR 0.64, 95% CI 0.46-0.88; other races, non-Hispanic, HR 0.52, 95% CI 0.31-0.86). Higher educational attainment compared with < high school was in general associated with higher rate of ALS (high school, HR 1.23, 95% CI 1.07-1.42; some college, HR 1.24, 95% CI 1.04-1.48; college, HR 1.10, 95% CI 0.90-1.36; postgraduate, HR 1.31, 95% CI 1.06-1.62). Income, household poverty, and home ownership were not associated with ALS after adjustment for race/ethnicity. Rates did not differ by sex. CONCLUSION Higher rate of ALS among whites vs non-Hispanic blacks, Hispanics, and non-Hispanic other races was not accounted for by multiple measures of socioeconomic status, birthplace, or type of health insurance. Higher rate of ALS among whites likely reflects actual higher risk of ALS rather than ascertainment bias or effects of socioeconomic status on ALS risk.
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Affiliation(s)
- Andrea L Roberts
- From the Departments of Social and Behavioral Sciences (A.L.R., J.T.C.), Environmental Health (M.G.W.), and Epidemiology (M.G.W.), Harvard T.H. Chan School of Public Health, Boston, MA; United States Census Bureau (N.J.J.), Washington, DC; Harvard Medical School (M.E.C.); and MGH Neurological Clinical Research Institute (M.E.C.), Department of Neurology, Massachusetts General Hospital, Boston.
| | - Norman J Johnson
- From the Departments of Social and Behavioral Sciences (A.L.R., J.T.C.), Environmental Health (M.G.W.), and Epidemiology (M.G.W.), Harvard T.H. Chan School of Public Health, Boston, MA; United States Census Bureau (N.J.J.), Washington, DC; Harvard Medical School (M.E.C.); and MGH Neurological Clinical Research Institute (M.E.C.), Department of Neurology, Massachusetts General Hospital, Boston
| | - Jarvis T Chen
- From the Departments of Social and Behavioral Sciences (A.L.R., J.T.C.), Environmental Health (M.G.W.), and Epidemiology (M.G.W.), Harvard T.H. Chan School of Public Health, Boston, MA; United States Census Bureau (N.J.J.), Washington, DC; Harvard Medical School (M.E.C.); and MGH Neurological Clinical Research Institute (M.E.C.), Department of Neurology, Massachusetts General Hospital, Boston
| | - Merit E Cudkowicz
- From the Departments of Social and Behavioral Sciences (A.L.R., J.T.C.), Environmental Health (M.G.W.), and Epidemiology (M.G.W.), Harvard T.H. Chan School of Public Health, Boston, MA; United States Census Bureau (N.J.J.), Washington, DC; Harvard Medical School (M.E.C.); and MGH Neurological Clinical Research Institute (M.E.C.), Department of Neurology, Massachusetts General Hospital, Boston
| | - Marc G Weisskopf
- From the Departments of Social and Behavioral Sciences (A.L.R., J.T.C.), Environmental Health (M.G.W.), and Epidemiology (M.G.W.), Harvard T.H. Chan School of Public Health, Boston, MA; United States Census Bureau (N.J.J.), Washington, DC; Harvard Medical School (M.E.C.); and MGH Neurological Clinical Research Institute (M.E.C.), Department of Neurology, Massachusetts General Hospital, Boston
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Cragg JJ, Seals R, Cashman N, Weisskopf MG. Journal Club: Depression before and after diagnosis with amyotrophic lateral sclerosis. Neurology 2016; 87:e257-e259. [PMID: 27872230 DOI: 10.1212/wnl.0000000000003363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jacquelyn J Cragg
- From the Department of Medicine (Neurology) (J.J.C., N.C.), University of British Columbia and Vancouver Coastal Health Research Institute, Brain Research Centre, Vancouver, Canada; and Departments of Environmental Health (J.J.C., R.S., M.G.W.) and Epidemiology (M.G.W.), Harvard T.H. Chan School of Public Health, Boston, MA.
| | - Ryan Seals
- From the Department of Medicine (Neurology) (J.J.C., N.C.), University of British Columbia and Vancouver Coastal Health Research Institute, Brain Research Centre, Vancouver, Canada; and Departments of Environmental Health (J.J.C., R.S., M.G.W.) and Epidemiology (M.G.W.), Harvard T.H. Chan School of Public Health, Boston, MA
| | - Neil Cashman
- From the Department of Medicine (Neurology) (J.J.C., N.C.), University of British Columbia and Vancouver Coastal Health Research Institute, Brain Research Centre, Vancouver, Canada; and Departments of Environmental Health (J.J.C., R.S., M.G.W.) and Epidemiology (M.G.W.), Harvard T.H. Chan School of Public Health, Boston, MA
| | - Marc G Weisskopf
- From the Department of Medicine (Neurology) (J.J.C., N.C.), University of British Columbia and Vancouver Coastal Health Research Institute, Brain Research Centre, Vancouver, Canada; and Departments of Environmental Health (J.J.C., R.S., M.G.W.) and Epidemiology (M.G.W.), Harvard T.H. Chan School of Public Health, Boston, MA
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Vasta R, Boumédiene F, Couratier P, Nicol M, Nicoletti A, Preux PM, Marin B. Validity of medico-administrative data related to amyotrophic lateral sclerosis in France: A population-based study. Amyotroph Lateral Scler Frontotemporal Degener 2016; 18:24-31. [DOI: 10.1080/21678421.2016.1241280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Rosario Vasta
- INSERM, U1094, Neuroépidémiologie Tropicale, Limoges, France,
- Univ. Limoges, UMR_S 1094, Neuroépidémiologie Tropicale, Institut d’Epidémiologie Neurologique et de Neurologie Tropicale, CNRS FR 3503 GEIST, Limoges, France,
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy,
| | - Farid Boumédiene
- INSERM, U1094, Neuroépidémiologie Tropicale, Limoges, France,
- Univ. Limoges, UMR_S 1094, Neuroépidémiologie Tropicale, Institut d’Epidémiologie Neurologique et de Neurologie Tropicale, CNRS FR 3503 GEIST, Limoges, France,
- CHU Limoges, Centre d’Epidémiologie de Biostatistique et de Méthodologie de la Recherche, Limoges, France
| | - Philippe Couratier
- INSERM, U1094, Neuroépidémiologie Tropicale, Limoges, France,
- Univ. Limoges, UMR_S 1094, Neuroépidémiologie Tropicale, Institut d’Epidémiologie Neurologique et de Neurologie Tropicale, CNRS FR 3503 GEIST, Limoges, France,
- CHU Limoges, Service de Neurologie, Centre Expert SLA, Limoges, France, and
| | - Marie Nicol
- INSERM, U1094, Neuroépidémiologie Tropicale, Limoges, France,
- Univ. Limoges, UMR_S 1094, Neuroépidémiologie Tropicale, Institut d’Epidémiologie Neurologique et de Neurologie Tropicale, CNRS FR 3503 GEIST, Limoges, France,
- CHU Limoges, Service de Neurologie, Centre Expert SLA, Limoges, France, and
| | - Alessandra Nicoletti
- Section of Neurosciences, Department GF Ingrassia, University of Catania, Catania, Italy,
| | - Pierre-Marie Preux
- INSERM, U1094, Neuroépidémiologie Tropicale, Limoges, France,
- Univ. Limoges, UMR_S 1094, Neuroépidémiologie Tropicale, Institut d’Epidémiologie Neurologique et de Neurologie Tropicale, CNRS FR 3503 GEIST, Limoges, France,
- CHU Limoges, Centre d’Epidémiologie de Biostatistique et de Méthodologie de la Recherche, Limoges, France
| | - Benoit Marin
- INSERM, U1094, Neuroépidémiologie Tropicale, Limoges, France,
- Univ. Limoges, UMR_S 1094, Neuroépidémiologie Tropicale, Institut d’Epidémiologie Neurologique et de Neurologie Tropicale, CNRS FR 3503 GEIST, Limoges, France,
- CHU Limoges, Centre d’Epidémiologie de Biostatistique et de Méthodologie de la Recherche, Limoges, France
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Schwartz GG, Klug MG. Motor neuron disease mortality rates in U.S. states are associated with well water use. Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:528-534. [PMID: 27324739 PMCID: PMC5152538 DOI: 10.1080/21678421.2016.1195409] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/04/2016] [Accepted: 04/25/2016] [Indexed: 12/12/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with an unknown cause and invariably fatal outcome. We sought to evaluate a correlation between motor neuron disease (MND) mortality rates and residential radon levels that was previously reported for counties in the United Kingdom. We examined the relationships between age-adjusted MND mortality rates in U.S. states with residential radon levels, well water use, and other variables using structural equation modeling. We observed a significant correlation between MND mortality rates and radon levels. However, in structural equation models, radon did not have a significant, direct effect on MND mortality rates. Conversely, MND mortality rates were significantly and directly predicted by race and by the percentage of the population of each state using well water (p < 0.001 and p = 0.022). We observed similar, significant effects for well water use and MND mortality for males and females separately (p < 0.05). In conclusion, we hypothesize that the association of MND mortality rates with well water use reflects contamination of wells with Legionella, a bacterium common in well water that is known to cause neurologic disease. A Legionella hypothesis is a biologically plausible cause of ALS and suggests new avenues for etiologic research.
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Affiliation(s)
- Gary G. Schwartz
- Department of Population Health, University of North Dakota School of Medicine & Health Sciences,
Grand Forks,
ND,
USA
| | - Marilyn G. Klug
- Department of Population Health, University of North Dakota School of Medicine & Health Sciences,
Grand Forks,
ND,
USA
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Weil C, Zach N, Rishoni S, Shalev V, Chodick G. Epidemiology of Amyotrophic Lateral Sclerosis: A Population-Based Study in Israel. Neuroepidemiology 2016; 47:76-81. [DOI: 10.1159/000448921] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/05/2016] [Indexed: 11/19/2022] Open
Abstract
Background: Globally, the annual incidence and prevalence of amyotrophic lateral sclerosis (ALS) are estimated at 1.9 and 4.5 per 100,000 population, respectively. This study is aimed at describing the epidemiology of ALS in Israel in a real-world setting. Methods: A retrospective study was performed using the databases of Maccabi Healthcare Services (MHS), a 2-million-member health maintenance organization in Israel. The study included all MHS adults diagnosed with ALS between 1997 and 2013. In 2013, characteristics of ALS patients were compared to those of age-sex-matched patients without ALS. Survival after ALS diagnosis was assessed until death and until tracheostomy or death (follow-up through 2014). Results: In 2013 (n = 158), the prevalence of ALS was 8.1 per 100,000 population in MHS. In 1997-2013, a total of 375 ALS patients were diagnosed, corresponding to an average annual incidence of 1.8 per 100,000 population in MHS. The median survival from diagnosis to death was 3.5 years (95% CI 2.9-4.1), with approximately 28% surviving at least 10 years. Median tracheostomy-free survival was 2.5 years (95% CI 2.1-2.9). Conclusions: Results suggest that there is a relatively high prevalence of ALS in Israel. Further research is needed to investigate factors that may contribute to the survival of patients with ALS in Israel.
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Kioumourtzoglou MA, Seals RM, Gredal O, Mittleman MA, Hansen J, Weisskopf MG. Cardiovascular disease and diagnosis of amyotrophic lateral sclerosis: A population based study. Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:548-554. [PMID: 27436717 DOI: 10.1080/21678421.2016.1208247] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a rapidly fatal neurodegenerative disease of unknown etiology. We investigated the association between ALS diagnosis and prior cardiovascular disease (CVD), and CVD-specific, hospital admissions in the Danish population. We conducted a population based nested case-control study, including 3182 Danish residents diagnosed with ALS at age ≥20 years (1982-2009) and 100 randomly selected controls for each case, matched on age, gender and vital status. We estimated odds ratios (OR) associated with CVD, and CVD-specific hospital admissions, adjusting for socioeconomic and marital status, region of residence and past diabetes and obesity diagnoses. The estimated adjusted OR for any CVD admission at least three years prior to the date of ALS diagnosis was 1.15 (95% CI 1.04-1.27). Our results varied across cause-specific admissions; for atherosclerosis the OR was 1.36 (95% CI 1.02-1.80) and for ischemic heart disease 1.14 (95% CI 0.99-1.31), while we observed no association with hypertensive and cerebrovascular diseases. Adjusting for or stratifying by COPD status, a cigarette-smoking correlate, did not change our results. In conclusion, in our population based study we found evidence for a moderately elevated association with CVD that was stronger for specific conditions, such as atherosclerosis. Our findings may have important implications for ALS pathogenesis.
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Affiliation(s)
| | - Ryan M Seals
- b Epidemiology , Harvard T.H. Chan School of Public Health , Boston , Massachusetts , USA
| | - Ole Gredal
- c National Rehabilitation Center for Neuromuscular Disorders , Copenhagen , and
| | - Murray A Mittleman
- b Epidemiology , Harvard T.H. Chan School of Public Health , Boston , Massachusetts , USA
| | - Johnni Hansen
- d Danish Cancer Society Research Center , Copenhagen , Denmark
| | - Marc G Weisskopf
- a Departments of Environmental Health.,b Epidemiology , Harvard T.H. Chan School of Public Health , Boston , Massachusetts , USA
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Seals RM, Hansen J, Gredal O, Weisskopf MG. Physical Trauma and Amyotrophic Lateral Sclerosis: A Population-Based Study Using Danish National Registries. Am J Epidemiol 2016; 183:294-301. [PMID: 26825926 DOI: 10.1093/aje/kwv169] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/22/2015] [Indexed: 11/14/2022] Open
Abstract
Prior studies have suggested that physical trauma might be associated with the development of amyotrophic lateral sclerosis (ALS). We conducted a population-based, individually matched case-control study in Denmark to assess whether hospitalization for trauma is associated with a higher risk of developing ALS. There were 3,650 incident cases of ALS in the Danish National Patient Register from 1982 to 2009. We used risk-set sampling to match each case to 100 age- and sex-matched population controls alive on the date of the case's diagnosis. Odds ratios and 95% confidence intervals were calculated using a conditional logistic regression model. History of trauma diagnosis was also obtained from the Danish Patient Register. When traumas in the 5 years prior to the index date were excluded, there was a borderline association between any trauma and ALS (odds ratio (OR) = 1.09, 95% confidence interval (CI): 0.99, 1.19). A first trauma before age 55 years was associated with ALS (OR = 1.22, 95% CI: 1.08, 1.37), whereas first traumas at older ages were not (OR = 0.97, 95% CI: 0.85, 1.10). Our data suggest that physical trauma at earlier ages is associated with ALS risk. Age at first trauma could help explain discrepancies in results of past studies of trauma and ALS.
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Schmidt M, Schmidt SAJ, Sandegaard JL, Ehrenstein V, Pedersen L, Sørensen HT. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 2015; 7:449-90. [PMID: 26604824 PMCID: PMC4655913 DOI: 10.2147/clep.s91125] [Citation(s) in RCA: 3047] [Impact Index Per Article: 338.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background The Danish National Patient Registry (DNPR) is one of the world’s oldest nationwide hospital registries and is used extensively for research. Many studies have validated algorithms for identifying health events in the DNPR, but the reports are fragmented and no overview exists. Objectives To review the content, data quality, and research potential of the DNPR. Methods We examined the setting, history, aims, content, and classification systems of the DNPR. We searched PubMed and the Danish Medical Journal to create a bibliography of validation studies. We included also studies that were referenced in retrieved papers or known to us beforehand. Methodological considerations related to DNPR data were reviewed. Results During 1977–2012, the DNPR registered 8,085,603 persons, accounting for 7,268,857 inpatient, 5,953,405 outpatient, and 5,097,300 emergency department contacts. The DNPR provides nationwide longitudinal registration of detailed administrative and clinical data. It has recorded information on all patients discharged from Danish nonpsychiatric hospitals since 1977 and on psychiatric inpatients and emergency department and outpatient specialty clinic contacts since 1995. For each patient contact, one primary and optional secondary diagnoses are recorded according to the International Classification of Diseases. The DNPR provides a data source to identify diseases, examinations, certain in-hospital medical treatments, and surgical procedures. Long-term temporal trends in hospitalization and treatment rates can be studied. The positive predictive values of diseases and treatments vary widely (<15%–100%). The DNPR data are linkable at the patient level with data from other Danish administrative registries, clinical registries, randomized controlled trials, population surveys, and epidemiologic field studies – enabling researchers to reconstruct individual life and health trajectories for an entire population. Conclusion The DNPR is a valuable tool for epidemiological research. However, both its strengths and limitations must be considered when interpreting research results, and continuous validation of its clinical data is essential.
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Affiliation(s)
- Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Kioumourtzoglou MA, Rotem RS, Seals RM, Gredal O, Hansen J, Weisskopf MG. Diabetes Mellitus, Obesity, and Diagnosis of Amyotrophic Lateral Sclerosis: A Population-Based Study. JAMA Neurol 2015; 72:905-11. [PMID: 26030836 DOI: 10.1001/jamaneurol.2015.0910] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Although prior studies have suggested a role of cardiometabolic health on pathogenesis of amyotrophic lateral sclerosis (ALS), the association with diabetes mellitus has not been widely examined. Amyotrophic lateral sclerosis is the most common motor neuron disorder. Several vascular risk factors have been associated with decreased risk for ALS. Although diabetes is also a risk factor for vascular disease, the few studies of diabetes and ALS have been inconsistent. OBJECTIVE To examine the association between diabetes and obesity, each identified through International Statistical Classification of Diseases, Eighth or Tenth Revision codes in a hospital registry, and ALS using data from the Danish National Registers. DESIGN, SETTING, AND PARTICIPANTS Population-based nested case-control study of 3650 Danish residents diagnosed as having ALS between January 1, 1982, and December 31, 2009, and 365,000 controls (100 for each ALS case) matched on age and sex. The analysis was conducted in September and October 2014. MAIN OUTCOMES AND MEASURES Adjusted odds ratio for ALS associated with diabetes or obesity diagnoses at least 3 years prior to the ALS diagnosis date. RESULTS When considering diabetes and our obesity indicator together, the estimated odds ratio for ALS was 0.61 (95% CI, 0.46-0.80) for diabetes and 0.81 (95% CI, 0.57-1.16) for obesity. We observed no effect modification on the association with diabetes by sex. We did find a significant modification by age at ALS diagnosis and age at first mention of diabetes in the hospital registers. The protective association was stronger with increasing age at ALS diagnosis (P = .01), and the odds ratio for first mention of diabetes was 1.66 (95% CI, 0.85-3.21) before age 40 years but 0.52 (95% CI, 0.39-0.70) for older ages. These results are consistent with different associations for type 1 vs type 2 diabetes. CONCLUSIONS AND RELEVANCE In this Danish nationwide study to investigate the association between diabetes and ALS diagnosis, our findings are in agreement with previous reports of a protective association between vascular risk factors and ALS and suggest that type 2 diabetes, but not type 1, is protective for ALS.
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Affiliation(s)
| | - Ran S Rotem
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Ryan M Seals
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts2Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Ole Gredal
- National Rehabilitation Center for Neuromuscular Disorders, Copenhagen, Denmark
| | - Johnni Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts2Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Weisskopf MG, Cudkowicz ME, Johnson N. Military Service and Amyotrophic Lateral Sclerosis in a Population-based Cohort. Epidemiology 2015; 26:831-8. [PMID: 26414854 PMCID: PMC4604116 DOI: 10.1097/ede.0000000000000376] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Military service has been suggested to be associated with an increased risk of amyotrophic lateral sclerosis (ALS), but only one prospective study-of a volunteer cohort-has examined this question. METHODS We prospectively assessed the relation between service in the military and ALS mortality among participants in the National Longitudinal Mortality Study, a population-representative cohort of U.S. men and women surveyed from 1973 through 2002. Participant follow-up was conducted from 1979 through 2002 for ALS mortality. There were 696,743 men and 392,571 women who were 25 years old or more with military service data. In this group, there were 375 male ALS deaths and 96 female ALS deaths. Adjusted hazard ratios (HRs) were calculated using Cox proportional hazards. RESULTS Men who served in the military had an increased adjusted ALS death rate [HR: 1.23; 95% confidence interval (CI): 0.98, 1.53] compared with those who did not serve. An increase in ALS mortality was found among those who served during World War II (HR: 1.47; 95% CI: 1.13, 1.91) but not during other time periods. This pattern of results was similar for women, but with larger confidence intervals (HR for military service: 1.26; 95% CI: 0.29, 5.59; HR for service during World War II: 2.03; 95% CI: 0.45, 9.05). CONCLUSIONS Military personnel have an increased risk of ALS, which may be specific to certain service periods although there was no data on actual deployment. Because of the longer follow-up time for World War II veterans, we cannot rule out that increased risk for those who served during other periods would be seen with further follow-up.
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Affiliation(s)
- Marc G. Weisskopf
- From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston, MA; and Center for Administrative Records and Applications, US Bureau of the Census, Washington, DC
| | - Merit E. Cudkowicz
- From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston, MA; and Center for Administrative Records and Applications, US Bureau of the Census, Washington, DC
| | - Norman Johnson
- From the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston, MA; and Center for Administrative Records and Applications, US Bureau of the Census, Washington, DC
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