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Association between Parkinson's Disease and Cigarette Smoking, Rural Living, Well-Water Consumption, Farming and Pesticide Use: Systematic Review and Meta-Analysis.
PLoS One. 2016; 11(4):e0151841.Plos

Abstract

OBJECTIVE

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.

METHODS

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.

FINDINGS

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.

CONCLUSION

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.

Authors+Show Affiliations

Syngenta Crop Protection, LLC, Greensboro, NC, 27419, United States of America.Queen Mary, Univ. of London, London, E1 4NS, United Kingdom.Exponent, Inc., Menlo Park, CA, 94025, United States of America.Sielken & Associates Consulting, Inc., College Station, TX, 77845, United States of America.Exponent, Inc., Menlo Park, CA, 94025, United States of America.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

27055126

Citation

Breckenridge, Charles B., et al. "Association Between Parkinson's Disease and Cigarette Smoking, Rural Living, Well-Water Consumption, Farming and Pesticide Use: Systematic Review and Meta-Analysis." PloS One, vol. 11, no. 4, 2016, pp. e0151841.
Breckenridge CB, Berry C, Chang ET, et al. Association between Parkinson's Disease and Cigarette Smoking, Rural Living, Well-Water Consumption, Farming and Pesticide Use: Systematic Review and Meta-Analysis. PLoS One. 2016;11(4):e0151841.
Breckenridge, C. B., Berry, C., Chang, E. T., Sielken, R. L., & Mandel, J. S. (2016). Association between Parkinson's Disease and Cigarette Smoking, Rural Living, Well-Water Consumption, Farming and Pesticide Use: Systematic Review and Meta-Analysis. PloS One, 11(4), e0151841. https://doi.org/10.1371/journal.pone.0151841
Breckenridge CB, et al. Association Between Parkinson's Disease and Cigarette Smoking, Rural Living, Well-Water Consumption, Farming and Pesticide Use: Systematic Review and Meta-Analysis. PLoS One. 2016;11(4):e0151841. PubMed PMID: 27055126.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between Parkinson's Disease and Cigarette Smoking, Rural Living, Well-Water Consumption, Farming and Pesticide Use: Systematic Review and Meta-Analysis. AU - Breckenridge,Charles B, AU - Berry,Colin, AU - Chang,Ellen T, AU - Sielken,Robert L,Jr AU - Mandel,Jack S, Y1 - 2016/04/07/ PY - 2016/01/07/received PY - 2016/03/05/accepted PY - 2016/4/8/entrez PY - 2016/4/8/pubmed PY - 2016/8/17/medline SP - e0151841 EP - e0151841 JF - PloS one JO - PLoS One VL - 11 IS - 4 N2 - OBJECTIVE: 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. METHODS: 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. FINDINGS: 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. CONCLUSION: 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. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/27055126/Association_between_Parkinson's_Disease_and_Cigarette_Smoking_Rural_Living_Well_Water_Consumption_Farming_and_Pesticide_Use:_Systematic_Review_and_Meta_Analysis_ L2 - https://dx.plos.org/10.1371/journal.pone.0151841 DB - PRIME DP - Unbound Medicine ER -