Association between Parkinson's Disease and Cigarette Smoking, Rural Living, Well-Water Consumption, Farming and Pesticide Use: Systematic Review and Meta-Analysis.
Association between Parkinson's Disease and Cigarette Smoking, Rural Living, Well-Water Consumption, Farming and Pesticide Use: Systematic Review and Meta-Analysis.
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DOI：
10.1371/journal.pone.0151841
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Mandel JS
中科院分区：
文献类型：
--
作者：
Breckenridge CB;Berry C;Chang ET;Sielken RL Jr;Mandel JS
Bradford Hill的观点被用于对帕金森病（PD）与农村生活，农业和农药使用之间的关联进行证据权重评估。将结果与基于荟萃分析的评估进行比较。为了比较，我们还评估了PD和吸烟之间的关联作为“阳性对照”，因为文献中一致描述了强烈的负相关。系统检索PubMed，以确定所有已发表的流行病学研究，这些研究评估了帕金森病（PD）与吸烟、农村生活、井水消耗、农业和杀虫剂、除草剂、杀虫剂、杀真菌剂或百草枯的使用之间的关联。研究分为两个研究质量组（第1层或第2层）;提取数据，并为每个风险因素绘制相对风险（RR）森林图。此外，如果有，还将暴露程度较高的个人与未暴露的个人的风险比制成表格。通过第1层、第2层和所有研究的荟萃分析计算每个风险因素的汇总RR，敏感性分析按其他研究特征分层。评估了研究间异质性指数和报告偏倚证据。Bradford Hill的观点用于确定PD和每个风险因素之间的因果关系是否得到证据权重的支持。目前吸烟和PD风险之间存在一致的负相关。相比之下，PD和农村生活，井水消费，农业和农药，除草剂，杀虫剂，杀真菌剂或百草枯的使用之间的关联不太一致时，定量或定性评估。证据的权重和荟萃分析支持PD风险与吸烟之间存在因果关系或与吸烟相关的未知因素的结论。可能存在与农村生活、农业、农药使用或井水消耗相关的风险因素，这些因素与PD有因果关系，但迄今为止的研究尚未确定这些因素。为了克服这一领域研究的局限性，未来的研究必须更好地描述PD的发病及其与农村生活、农业和农药暴露的关系。
Bradford Hill’s viewpoints were used to conduct a weight-of-the-evidence assessment of the association between Parkinson’s disease (PD) and rural living, farming and pesticide use. The results were compared with an assessment based upon meta-analysis. For comparison, we also evaluated the association between PD and cigarette smoking as a “positive control” because a strong inverse association has been described consistently in the literature. PubMed was searched systematically to identify all published epidemiological studies that evaluated associations between Parkinson’s disease (PD) and cigarette smoking, rural living, well-water consumption, farming and the use of pesticides, herbicides, insecticides, fungicides or paraquat. Studies were categorized into two study quality groups (Tier 1 or Tier 2); data were abstracted and a forest plot of relative risks (RRs) was developed for each risk factor. In addition, when available, RRs were tabulated for more highly exposed individuals compared with the unexposed. Summary RRs for each risk factor were calculated by meta-analysis of Tier 1, Tier 2 and all studies combined, with sensitivity analyses stratified by other study characteristics. Indices of between-study heterogeneity and evidence of reporting bias were assessed. Bradford Hill’s viewpoints were used to determine if a causal relationship between PD and each risk factor was supported by the weight of the evidence. There was a consistent inverse (negative) association between current cigarette smoking and PD risk. In contrast, associations between PD and rural living, well-water consumption, farming and the use of pesticides, herbicides, insecticides, fungicides or paraquat were less consistent when assessed quantitatively or qualitatively. The weight of the evidence and meta-analysis support the conclusion that there is a causal relationship between PD risk and cigarette smoking, or some unknown factor correlated with cigarette smoking. There may be risk factors associated with rural living, farming, pesticide use or well-water consumption that are causally related to PD, but the studies to date have not identified such factors. To overcome the limitations of research in this area, future studies will have to better characterize the onset of PD and its relationship to rural living, farming and exposure to pesticides.