Lifetime occupation, education, smoking, and risk of ALS
N. A. Sutedja, MD, J. H. Veldink, MD, K. Fischer, MD, H. Kromhout, PhD, J.H.J. Wokke, MD, M. H.B. Huisman, MSc, D. J.J. Heederik, PhD and L. H. Van den Berg, MD
From the Departments of Neurology (N.A.S., J.H.V., J.H.J.W., M.H.B.H., L.H.V.d.B.) and Julius Center for Health Sciences and Primary Care (K.F.), University Medical Center Utrecht; and the Institute for Risk Assessment Sciences, Division of Environmental Epidemiology (H.K., D.J.J.H.), Utrecht, The Netherlands.

Address correspondence and reprint requests to Dr Van den Berg, Department of Neurology, G03.228, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands l.h.vandenberg@umcutrecht.nl

Objective: To investigate the association between cigarette smoking, level of education, occupation, and the occurrence of sporadic amyotrophic lateral sclerosis (ALS).

Methods: A total of 364 patients and 392 controls completed a questionnaire covering smoking habits, level of education, and occupational history. Main occupations were coded according to the International Standard Classification of Occupations and compared between patients and controls.

Results: The univariate analysis showed an increased risk of developing ALS among current cigarette smokers (OR = 1.7; 95% CI = 1.1 to 2.6; p = 0.01), those with a low level of education (elementary school) (OR = 2.2; 95% CI = 1.2 to 3.8; p < 0.01), and among women whose main occupation was classified as crafts and related trades workers (OR = 8.4; 95% CI = 1.0 to 70.1; p = 0.05). Multivariate analysis (with covariates age, smoking, education, and occupation) showed an increased risk for current smokers of cigarettes (OR = 1.6; 95% CI = 1.0 to 2.5; p = 0.04).

Conclusions: Occupation, education, and cigarette smoking are risk factors for amyotrophic lateral sclerosis, but only smoking appeared independently associated.

GLOSSARY: ALS = amyotrophic lateral sclerosis; ILO = International Labor Organization; ISCO = International Standard Classification of Occupations; JEM = job-exposure matrix.



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http://www.neurology.org/cgi/content/short/69/15/1508