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Department of Epidemiology and Social Medicine, Hannover Medical University, Hannover, Germany (Dr. Seidler) (Dr. Nischan)
Institute for Social Medicine, Faculty of Medicine, Otto-von-Guericke University, Magdeburg, Germany (Dr. Hellenbrand) (Dr. Robra)
Department of Neurology, Lübeck Medical University, Lübeck, Germany (Dr. Vieregge)
Neurologic Clinic, Barmen Hospital, Wuppertal, Germany (Dr. Joerg)
Department of Neurology, Ludwig-Maximilians University, Munich, Germany (Dr. Oertel)
Paracelsus-Elena-Clinic, Kassel, Germany (Dr. Ulm)
Department of Neurology, Hamburg-Harburg General Hospital, Hamburg, Germany (Dr. Schneider)
Address correspondence and reprint requests to Dr. W. Hellenbrand, Institute for Social Medicine, Otto-von-Guericke Universität Magdeburg, Leipziger Str. 44, D-39120 Magdeburg, Germany, or Dr. A. Seidler, Department of Epidemiology and Social Medicine, Hannover Medical School, D-30623 Hannover, Germany.
In a case-control study, we investigated the possible etiologic relevance to Parkinson's disease (PD) of rural factors such as farming activity, pesticide exposures, well-water drinking, and animal contacts; toxicologic exposures such as wood preservatives, heavy metals, and solvents; general anesthesia; head trauma; and differences in the intrauterine environment. We recruited 380 patients in nine German clinics, 379 neighborhood control subjects, and 376 regional control subjects in the largest case-control study investigating such factors and collected data in structured personal interviews using conditional logistic regression to control for educational status and cigarette smoking. The latter was strongly inversely associated with PD. There were significantly elevated odds ratios (OR) for pesticide use, in particular, for organochlorines and alkylated phosphates, but no association was present between PD and other rural factors. A significantly elevated OR was present for exposure to wood preservatives. Subjective assessment by the probands indicated that exposure to some heavy metals, solvents, exhaust fumes, and carbon monoxide was significantly more frequent among patients than control subjects, but this was not confirmed by a parallel assessment of job histories according to a job exposure matrix. Patients had undergone general anesthesia and suffered severe head trauma more often than control subjects, but a dose-response gradient was not present. Patients reported a significantly larger number of amalgam-filled teeth before their illness than control subjects. The frequency of premature births and birth order did not differ between patients and control subjects. Patients reported significantly more relatives affected with PD than control subjects. These results support a role for environmental and genetic factors in the etiology of PD.
Supported by the German Federal Ministry for Research and Technology (Grant No. 01K229012).
Received April 5, 1995. Accepted in final form October 27, 1995.
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