Abstract
Objectives: We conducted a systematic literature review to identify studies fulfilling good scientific epidemiological standards for use in meta-analyses of occupational risk factors for amyotrophic lateral sclerosis (ALS). Methods: We identified 79 original publications on associations between work and ALS. The MOOSE (Meta-analysis Of Observational Studies in Epidemiology) and GRADE (Grading of Recommendations, Assessment, Development and Evaluations) guidelines were used to ensure high scientific quality, and reliable protocols were applied to classify the articles. Thirty-seven articles fulfilled good scientific standards, while 42 were methodologically deficient and thus were excluded from our meta-analyses. Results: The weighted relative risks for the various occupational exposures were respectively; 1.29 (95% confidence interval (CI): 0.97–1.72; six articles) for heavy physical work, 3.98 (95% CI: 2.04–7.77; three articles) for professional sports, 1.45 (95% CI: 1.07–1.96; six articles) for metals, 1.19 (95% CI: 1.07–1.33; 10 articles) for chemicals, 1.18 (95% CI: 1.07–1.31; 16 articles) for electromagnetic fields or working with electricity, and 1.18 (95% CI: 1.05–1.34; four articles) for working as a nurse or physician. Conclusions: Meta-analyses based only on epidemiologic publications of good scientific quality show that the risk of ALS is statistically significantly elevated for occupational exposures to excessive physical work, chemicals (especially pesticides), metals (especially lead), and possibly also to electromagnetic fields and health care work. These results are not explained by publication bias.
Highlights
The average onset of amyotrophic lateral sclerosis (ALS) is between 58 and 60 years of age and the incidence is around two per 100,000 persons [1]
Since the object of our study was restricted to occupational exposures, only risk rates directly related to physical activities at work were considered
Published reviews and meta-analyses have shown that the relative risks (RR) is not elevated for moderate physical activity and we only included the results from studies on occupational exposure to heavy physical work [18,25,30,37,50,53] and likewise work as a professional athlete [20,36,50]
Summary
The average onset of amyotrophic lateral sclerosis (ALS) is between 58 and 60 years of age and the incidence is around two per 100,000 persons [1]. The disease is characterized by an adult-onset progressive degeneration of the motor neurons. The resulting paresis begins focally, spreads contiguously and causes death from respiratory failure when breathing muscles become involved [2]. An observational study indicated that heavy work load was associated with. Since many epidemiological studies have been performed on diverse risk factors. Eight systematic literature reviews with meta-analyses have been published regarding associations between
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