Studies of occupational solvent exposures and amyotrophic lateral sclerosis (ALS) have been conflicting. We conducted a population-based case-control study of mixed occupational solvent exposures and ALS. Using the Danish National Patient Registry, we identified ALS cases in Denmark from 1982 to 2013, and matched them to 100 controls based on sex and birth year. We estimated cumulative exposures to solvents (benzene, methylene chloride, toluene, trichloroethylene, perchloroethylene, and 1,1,1-trichloroethane) via job exposure matrices and applied them to occupational history from the Danish Pension Fund. Sex-stratified conditional logistic regression analyses revealed higher adjusted odds of ALS for men with exposure to benzene (aOR = 1.20; 95% CI 1.02, 1.41) and methylene chloride (aOR = 1.23; 95% CI 1.07, 1.42). We used weighted quantile sum regression to explore combined solvent exposures and risk of ALS in exposed subjects and found increased odds of 26 to 28% in all exposure lag periods for every one-unit increase in the mixture index in men. Weights of methylene chloride predominated the mixture index in all lag periods. Our study suggests an increased risk of ALS in men exposed to multiple solvents, with the greatest influence being from methylene chloride. These findings highlight the need to utilize mixtures analysis when considering co-occurring exposures.

译文

职业溶剂暴露和肌萎缩性侧索硬化症 (ALS) 的研究一直存在矛盾。我们对混合职业溶剂暴露和ALS进行了基于人群的病例对照研究。使用丹麦国家患者登记处,我们确定了丹麦1982年2013年的ALS病例,并根据性别和出生年份将其与100个对照进行了匹配。我们通过工作暴露矩阵估算了溶剂 (苯,二氯甲烷,甲苯,三氯乙烯,全氯乙烯和1,1,1-三氯乙烷) 的累积暴露,并将其应用于丹麦养老基金的职业史。性别分层条件logistic回归分析显示,暴露于苯 (aor   =   1.20; 95% CI 1.02,1.41) 和二氯甲烷 (aor   =   1.23; 95% CI 1.07,1.42) 的男性ALS校正几率更高。我们使用加权分位数和回归来探索暴露受试者的组合溶剂暴露和ALS风险,发现男性混合指数每增加一个单位,在所有暴露滞后期,几率增加26到28%。在所有滞后时期,二氯甲烷的重量均占混合指数的主导地位。我们的研究表明,暴露于多种溶剂的男性患ALS的风险增加,其中影响最大的是二氯甲烷。这些发现突显了在考虑同时发生的暴露时需要利用混合物分析。

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