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Neurologic Implications of White Collar Jobs
Veronica Hackethal, MD
Jobs associated with higher economic status appear to be risk factors for these neurologic disorders.
Jobs associated with higher economic status appear to be risk factors for these neurologic disorders.
Higher Socioeconomic Status (SES) Occupation: New Risk Factor for ALS and PD?[1]
. PD and ALS affect > 1 million Americans
. Known ALS risk factors include older age, male sex, smoking
. Known PD risk factors include older age, male sex, pesticide exposure
Smoking, caffeine associated with decreased PD risk
. Past studies on occupation and neurological disease have focused on exposure to toxins in jobs associated with lower socioeconomic status (SES)
CDC Study of Occupation, PD, and ALS
. Data from CDC national surveillance data
Over 12.1 million deaths from 30 states between 1985-2011
26,917 ALS deaths
115,262 PD deaths
Used proportionate mortality ratios (PMRs) to estimate associations between cause of death and occupation
Increased PD Mortality with Higher SES Jobs
13 occupation categories had PMRs significantly over 1.00 (increased risk)
None had PMR ≥1.50
Highest: Community and social services (PMR 1.48 [1.41-1.56])
Increased ALS Mortality with Higher SES Jobs
14 occupation categories had PMRs significantly over 1.00 (increased risk)
Four categories had PMRs ≥1.50:
Computer and mathematical (PMR 1.66 [1.43-1.91])
Architecture and engineering (PMR 1.55 [1.45-1.66])
Legal (PMR 1.62 [1.39-1.87])
Education, training and library (PMR 1.67 [1.58-1.76])
Limitations
Occupation came from death certificate, which could be incorrect
Occupation categories could have diluted the association:
Some farmers (higher insecticide exposure) may have been grouped with fishing and forestry (lower insecticide exposure)
Some confounders like smoking not included
PMRs have inherent limitations
What it Could Mean
“The shifts in the US 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,” first author John Beard, PhD, Epidemic Intelligence Service, CDC (Atlanta, Georgia), and colleagues.
Take Home Points
. CDC study of deaths from 1985-2011 identified higher SES occupation as a potential new risk factor for ALS and PD
. Reasons unknown, future studies needed to confirm and explore these findings
Reference
1. Beard JD, Steege AL, Ju J, et al. Mortality from amyotrophic lateral sclerosis and Parkinson’s disease among different occupation groups - United States, 1985–2011. MMWR. 2017;66:718–722.
mmwr.mm6627a2
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