Abstract
BackgroundMultiple studies have suggested that various pesticides are associated with a higher risk of developing Parkinson’s disease (PD) and may influence the progression of the disease. However, the evidence regarding the impact of pesticide exposure on mortality among patients with PD is equivocal. This study examines whether pesticide exposure influences the risk of mortality among patients with PD in Southern Brazil.MethodsA total of 150 patients with idiopathic PD were enrolled from 2008 to 2013 and followed until 2019. In addition to undergoing a detailed neurologic evaluation, patients completed surveys regarding socioeconomic status and environmental exposures.ResultsTwenty patients (13.3%) reported a history of occupational pesticide exposure with a median duration of exposure of 10 years (mean = 13.1, SD = 11.2). Patients with a history of occupational pesticide exposure had higher UPDRS-III scores, though there were no significant differences in regards to age, sex, disease duration, Charlson Comorbidity Index, and age at symptom onset. Patients with occupational pesticide exposure were more than twice as likely to die than their unexposed PD counterparts (HR = 2.32, 95% CI [1.15, 4.66], p = 0.018). Occupational pesticide exposure was also a significant predictor of death in a cox-proportional hazards model which included smoking and caffeine intake history (HR = 2.23, 95% CI [1.09, 4.59], p = 0.03)) and another which included several measures of socioeconomic status (HR = 3.91, 95% CI [1.32, 11.58], p = 0.01).ConclusionIn this prospective cohort study, we found an increased all-cause mortality risk in PD patients with occupational exposure to pesticides. More studies are needed to further analyze this topic with longer follow-up periods, more detailed exposure information, and more specific causes of mortality.
Highlights
Multiple studies have suggested that various pesticides are associated with a higher risk of developing Parkinson’s disease (PD) and may influence the progression of the disease
Because the number of individuals exposed to occupational pesticides in our sample was low, we examined the association between occupational exposure to pesticides and mortality adjusting for confounders through two separate multivariable cox proportional hazards models
The existing literature regarding the risk of premature mortality among PD patients is equivocal – multiple studies have indirectly linked pesticide exposure to an increased numerical rate of mortality, not all of these results have reached the threshold of statistical significance [14, 16, 17]
Summary
Multiple studies have suggested that various pesticides are associated with a higher risk of developing Parkinson’s disease (PD) and may influence the progression of the disease. This study examines whether pesticide exposure influences the risk of mortality among patients with PD in Southern Brazil. The etiology of Parkinson’s disease (PD) is a complex interplay of environmental and genetic factors. The remaining 90% of the cases are idiopathic, and different environmental exposures have been implicated as either protective factors (such as tobacco smoking and caffeine intake) or risk factors (such as heavy metals and pesticides exposure) [1]. A herbicide with molecular similarities to MPP+ (1-methyl-4-phenylpyridinium, a metabolite of the neurotoxin MPTP (1methyl-4-phenyl-1,2,3,6-tetrahydropyridine)), is among the earliest and most well studied pesticides linked to an increased risk of developing PD. In addition to preferentially damaging dopaminergic neurons, these agents share several common mechanisms of action including increasing neuronal oxidating stress, damaging mitochondrial complex I, and impairing the ubiquitinproteasome system [3, 4]
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