Abstract
Amyotrophic lateral sclerosis (ALS) and Parkinson's disease, both progressive neurodegenerative diseases, affect >1 million Americans (1,2). Consistently reported risk factors for ALS include increasing age, male sex, and cigarette smoking (1); risk factors for Parkinson's disease include increasing age, male sex, and pesticide exposure, whereas cigarette smoking and caffeine consumption are inversely associated (2). Relative to cancer or respiratory diseases, the role of occupation in neurologic diseases is much less studied and less well understood (3). CDC evaluated associations between usual occupation and ALS and Parkinson's disease mortality using data from CDC's National Institute for Occupational Safety and Health (NIOSH) National Occupational Mortality Surveillance (NOMS), a population-based surveillance system that includes approximately 12.1 million deaths from 30 U.S. states.* Associations were estimated using proportionate mortality ratios (PMRs), standardizing indirectly by age, sex, race, and calendar year to the standard population of all NOMS deaths with occupation information. Occupations associated with higher socioeconomic status (SES) had elevated ALS and Parkinson's disease mortality. The shifts in the U.S. workforce toward older ages and higher SES occupations† highlight the importance of understanding this finding, which will require studies with designs that provide evidence for causality, detailed exposure assessment, and adjustment for additional potential confounders.
Highlights
What is already known about this topic?
Adjusting for potential confounding by cigarette smoking and socioeconomic status, using incidence rather than mortality to ascertain outcomes, and incorporating information regarding the timing of exposures relative to the timing of outcomes might help further elucidate the reasons for these findings, so that strategies for prevention could be developed
Summary
Mortality from Amyotrophic Lateral Sclerosis and Parkinson’s Disease Among Different Occupation Groups — United States, 1985–2011. CDC evaluated associations between usual occupation and ALS and Parkinson’s disease mortality using data from CDC’s National Institute for Occupational Safety and Health (NIOSH) National Occupational Mortality Surveillance (NOMS), a population-based surveillance system that includes approximately 12.1 million deaths from 30 U.S states.* Associations were estimated using proportionate mortality ratios (PMRs), standardizing indirectly by age, sex, race, and calendar year to the standard population of all NOMS deaths with occupation information. Usual occupation,** recorded on death certificates in a text field, was assigned a U.S Census 1990 or 2000 occupation code.†† These were converted to 2000 codes using a crosswalk based on U.S Census data.§§ Occupation codes were grouped into 26 categories based on similar job duties and ordered roughly from high SES (e.g., management) to low SES (e.g., transportation and material moving) (Table 1).¶¶ Associations between the 26 categories and ALS and Parkinson’s disease mortality were estimated via PMRs, standardizing indirectly by age, sex, race, and calendar year (4)***; 95% confidence.
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