Environmental and Occupational Risk Factors of Amyotrophic Lateral Sclerosis: A Population-Based Case-Control Study

Tommaso Filippini, Marina Tesauro, Maria Fiore, Carlotta Malagoli, Michela Consonni, Federica Violi, Laura Iacuzio, Elisa Arcolin, Gea Oliveri Conti, Antonio Cristaldi, Pietro Zuccarello, Elisabetta Zucchi, Letizia Mazzini, Fabrizio Pisano, Ileana Gagliardi, Francesco Patti, Jessica Mandrioli, Margherita Ferrante, Marco Vinceti

Research output: Contribution to journalArticlepeer-review


Objectives: Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurodegenerative disease with still unknown etiology. We aimed at investigating the association between environmental and occupational factors with ALS risk. Methods: We performed a population-based case-control study in four Italian provinces (Catania, Modena, Novara, and Reggio Emilia) by administration of tailored questionnaires to ALS cases (n = 95) and randomly selected population referents (n = 135). We estimated ALS risk by calculating the odds ratio (OR) with its 95% confidence interval (CI) using an unconditional logistic regression model. Results: We found a positive association with disease risk for history of occupation in the agricultural sector (OR = 2.09, 95% CI 0.79-7.54), especially for longer than 10 years (OR = 2.72, 95% 1.02-7.20). Overall occupational exposure to solvents also suggested a positive association, especially for thinners (OR = 2.27, 95% CI 1.14-4.54) and paint removers (OR = 2.01, 95% CI 0.90-4.48). Both occupational and environmental exposure to electromagnetic fields show a slightly increased risk with OR = 1.69 (95% CI 0.70-4.09) and 2.41 (95% CI 1.13-5.12), respectively. Occupational but not environmental exposure to pesticides (OR = 1.22, 95% CI 0.63-2.37), particularly fungicides, and exposure to metals (OR = 4.20, 95% CI 1.88-9.38), particularly lead, mercury, and selenium, showed an imprecise but positive association. Finally, there was an indication of increased risk for living in proximity to water bodies. Conclusions: Despite the caution that needs to be used due to some study limitations, such as the low number of exposed subjects and the possibility of recall bias, these results suggest the potential role of some environmental and occupational factors in ALS etiology.

Original languageEnglish
JournalInt J Environ Res Public Health
Issue number8
Publication statusPublished - Apr 22 2020


  • Aged
  • Amyotrophic Lateral Sclerosis/epidemiology
  • Case-Control Studies
  • Female
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Neurodegenerative Diseases
  • Occupational Exposure
  • Risk Factors


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