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Occupation and Risk of ParkinsonismA Multicenter Case-Control Study
Caroline M. Tanner, MD, PhD;
G. Webster Ross, MD;
Sarah A. Jewell, MD, MPH;
Robert A. Hauser, MD;
Joseph Jankovic, MD;
Stewart A. Factor, DO;
Susan Bressman, MD;
Amanda Deligtisch, MD;
Connie Marras, MD, PhD, FRCPC;
Kelly E. Lyons, PhD;
Grace S. Bhudhikanok, PhD;
Diana F. Roucoux, MPH;
Cheryl Meng, MS;
Robert D. Abbott, PhD;
J. William Langston, MD
Arch Neurol. 2009;66(9):1106-1113.
Background We examined risk of parkinsonism in occupations (agriculture, education, health care, welding, and mining) and toxicant exposures (solvents and pesticides) putatively associated with parkinsonism.
Objective To investigate occupations, specific job tasks, or exposures and risk of parkinsonism and clinical subtypes.
Design Case-control.
Setting Eight movement disorders centers in North America.
Participants Inclusion criteria were parkinsonism ( 2 cardinal signs), diagnosis within 8 years of recruitment (to minimize survival bias), and ability to participate in detailed telephone interviews. Control subjects were primarily nonblood relatives or acquaintances of patients.
Main Outcome Measures This multicenter case-control study compared lifelong occupational and job task histories to determine associations with parkinsonism and certain clinical subtypes (postural instability and gait difficulty and age at diagnosis  50 years).
Results Findings in 519 cases and 511 controls were analyzed. Work in agriculture, education, health care, or welding was not associated with increased risk of parkinsonism. Unexpected increased risks associated with legal, construction and extraction, or religious occupations were not maintained after adjustment for duration. Risk of parkinsonism increased with pesticide use (odds ratio, 1.90; 95% confidence interval, 1.12-3.21), use of any of 8 pesticides mechanistically associated with experimental parkinsonism (2.20; 1.02-4.75), and use of 2,4-dichlorophenoxyacetic acid (2.59; 1.03-6.48). None of the specific occupations, job tasks, or task-related exposures were associated with younger age at diagnosis (50 years). Ever working in business and finance, legal occupations, construction and extraction, or transportation and material moving was associated with postural instability and gait difficulty subtype of parkinsonism. Tobacco use was inversely associated with parkinsonism risk.
Conclusion The association of disease risk with pesticides support a toxicant-induced cause of parkinsonism.
Author Affiliations: Department of Clinical Research, The Parkinson's Institute, Sunnyvale, California (Drs Tanner, Jewell, Bhudhikanok, and Langston and Mss Roucoux and Meng); Department of Research and Development, Veterans Affairs Pacific Islands Health Care System, Honolulu, Hawaii (Dr Ross); Department of Neurology, University of South Florida, Tampa, (Dr Hauser); Department of Neurology, Baylor College of Medicine, Houston, Texas (Dr Jankovic); Department of Neurology, Emory University School of Medicine, Atlanta, Georgia (Dr Factor); Department of Neurology, Beth Israel Medical Center, New York, New York (Drs Bressman and Deligtisch); Department of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada (Dr Marras); Department of Neurology, University of Kansas Medical Center, Kansas City (Dr Lyons); and Department of Statistics, University of Virginia School of Medicine, Charlottesville (Dr Abbott).
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