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A Pilot Case-Control Study

Daniel Strickland, PhD; Stephen A. Smith, MD; Gail Dolliff, RN; Linda Goldman, MD; Robert I. Roelofs, MD

Arch Neurol. 1996;53(8):730-733.

Abstract
Objective
To assess the association of a number of occupational and industrial exposures with amyotrophic lateral sclerosis (ALS).

Design
A case-control study of ALS cases matched by age and sex to 2 controls each: 1 from a neurology clinic and 1 from a local community. Exposures were ascertained by questionnaire, and patients were requested before the interview to be prepared to supply occupational histories.

Setting
Patients with ALS were enrolled at the University of Minnesota ALS Clinic in Minneapolis.

Patients
Patients with ALS (n=25) were from the University of Minnesota ALS Clinic, and clinic controls (n=25) were patients with other neuromuscular diseases from the university's Muscle Disease Clinic, selected on the basis of clinic enrollment date nearest to that of the matched case. Clinic controls were principally patients with myopathies. Community controls (n=25) were selected from the community using a random-digit—dialing protocol matching on the first 5 digits of the case patient's telephone number.

Results
The strongest association with disease was exposure to welding or soldering materials (odds ratio, 5.0) and the welding industry (odds ratio, 5.3). Electric plating showed a high odds ratio of 8 (95% confidence interval, 0.9-72.0), but low statistical significance (P<.07). Several exposures or industries, while not statistically different, showed enough difference that to ignore them might lead to a Type II error, a result of the pilot nature and small sample size. These included paint or pigment manufacturing, the petroleum industry, the printing industry, and shipbuilding.

Conclusions
The association with welding, soldering, and the welding industry is strong and suggests a need for further work. This is despite the small numbers studied, thus making most industrial or occupational exposures too limited to draw conclusions or detect associations. Perhaps the most obvious candidate from the welding, soldering exposure for a common toxin would be lead. Other suggestions of risk were seen for paint or pigment manufacture, shipbuilding, electric plating, and the dairy industry. The degree of association for these, while high, is not statistically significant, and suggests that there may be 1 or more environmental toxins common to these industries that need more precise measurement.

Author Affiliations
From the Division of Epidemiology, School of Public Health (Dr Strickland and Ms Dolliff), and Department of Neurology, School of Medicine (Dr Roelofs), University of Minnesota, and Hennepin Faculty Association, Neuromuscular Center (Dr Smith), Minneapolis, Minn; and Neurological Association of St Paul, St Paul, Minn (Dr Goldman). Dr Strickland is now with the University of Nebraska Medical Center, Omaha.

Footnotes
Deceased.

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