Most amyotrophic lateral sclerosis (ALS) cases are considered sporadic, without a known genetic basis, and environmental exposures are thought to play a causal role. To learn more about sporadic ALS etiology, we recruited n = 188 ALS patients from northern New England and Ohio and matched controls 2:1 from the general population of the same regions. Questionnaires evaluated the association between a variety of lifestyle, behavioral (ie, hobbies and activities), and occupational factors and the risk of ALS, including the duration of time between exposure and ALS onset, and exposure frequency. Head trauma was associated with increased ALS risk (adjusted odds ratio [OR] 1.60 95% confidence interval [CI] 1.04‐2.45), with significantly greater effects for injuries occurring 10 or more years prior to symptom onset (P = .037). ALS risk was increased for those reporting severe electrical burns (adjusted OR 2.86, 95% CI 1.37‐6.03), with odds ratios highest for burns after age 30 (OR 3.14), and for burns 10 or more years prior to symptom onset (OR 3.09). Hobbies involving lead were the most strongly associated with ALS risk (adjusted OR 2.92, 95% CI 1.45‐5.91). Exposures to lead 20 or more years prior to diagnosis had larger effect sizes compared to those occurring more recently. Holding a job in mechanics, painting, or construction was associated with ALS. The identification of these specific environmental factors associated with ALS highlight the need for future prospective and laboratory studies to assess causality, biological mechanisms, and find prevention or treatment opportunities.

中文翻译：

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肌萎缩性侧索硬化的危险因素：美国区域性病例对照研究

大多数肌萎缩性侧索硬化症（ALS）病例是零星的，没有已知的遗传基础，环境暴露被认为是起因果作用的。要了解有关散发性ALS病因的更多信息，我们从新英格兰北部和俄亥俄州招募了188例ALS患者，并从同一地区的总人群中以2：1的比例进行了匹配。调查表评估了各种生活方式，行为（即嗜好和活动），职业因素与ALS风险之间的关联，包括暴露与ALS发作之间的持续时间以及暴露频率。头部外伤与ALS风险增加相关（校正比值比[OR] 1.60 95％置信区间[CI] 1.04-2.45），对症状发作前10年或10年以上发生的伤害产生更大的影响（P= .037）。报告严重电灼伤的人（调整后的OR为2.86，95％CI为1.37-6.03）的ALS风险增加，30岁以后的灼伤（OR 3.14）和症状发作前10年或更长时间的灼伤（OR 3.09）。与铅相关的嗜好与ALS风险最相关（校正后的OR为2.92，95％CI为1.45-5.91）。与最近发生的情况相比，在诊断之前暴露于铅的时间为20年或更长时间的影响量更大。从事机械，油漆或建筑工作与ALS有关。对这些与ALS相关的特定环境因素的识别突出表明，有必要进行未来的前瞻性和实验室研究，以评估因果关系，生物学机制并找到预防或治疗的机会。