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Original Article
Occupational exposure and amyotrophic lateral sclerosis in a prospective cohort
  1. Tom Koeman1,
  2. Pauline Slottje1,
  3. Leo J Schouten2,
  4. Susan Peters1,3,
  5. Anke Huss1,
  6. Jan H Veldink3,
  7. Hans Kromhout1,
  8. Piet A van den Brandt2,
  9. Roel Vermeulen1,4
  1. 1 Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, The Netherlands, Utrecht Netherlands
  2. 2 Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht Netherlands
  3. 3 Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands, Utrecht Netherlands
  4. 4 Julius Centre for Public Health Sciences and Primary Care, University Medical Center, Utrecht Netherlands
  1. Correspondence to Professor Roel Vermeulen, Institute for Risk Assessment Sciences, Division of Environmental Epidemiology, Utrecht University; P.O. Box 80.178, 3584 TD, Utrecht, The Netherlands; r.c.h.vermeulen{at}


Objective To prospectively study suspected occupational risk factors for amyotrophic lateral sclerosis (ALS).

Methods For this case–cohort analysis within the prospective Netherlands Cohort Study, 58 279 men and 62 573 women aged 55–69 years at enrolment in 1986 were followed up for 17.3 years on ALS mortality. Information on occupational history and potential confounders were collected at baseline through a self-administered questionnaire and entered for a random subcohort (2092 men and 2074 women) and ALS deaths (76 men and 60 women). Occupational exposure to solvents, pesticides, metals, extremely low frequency magnetic fields (ELF-MFs) and electrical shocks was estimated by means of job exposure matrices (JEMs). Associations between ever/never occupationally exposed and cumulative exposure and ALS mortality were analysed by gender using Cox regression.

Results Occupational exposure to ELF-MF showed a possible association with ALS mortality among men: HR for ever holding a job with high exposure versus background 2.19 (95% (CI): 1.02 to 4.73) and HR for the highest tertile of cumulative exposure versus background 1.93 (95% CI 1.05 to 3.55).

Interpretation These results strengthen the evidence suggesting a positive association between ELF-MF exposure and ALS. We did not replicate earlier positive findings for other occupational exposures.

  • Electromagnetic fields
  • Amyotrophic Lateral Sclerosis
  • occupation
  • pesticides
  • metals

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  • Funding This work was supported by The Netherlands Organization for Health Research (ZonMW) within the programme Electromagnetic Fields and Health Research under grant numbers 85200001 and 85800001.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.