Systematiska kunskapsöversikter; 7. Epidemiologiskt påvisade samband mellan Amyotrofisk Lateral Skleros (ALS) och faktorer i arbetsmiljön

In this systematic literature review we identified 60 original publications on associations between work and ALS. GRADE guidelines were used to secure high scientific quality and reliable guidelines were applied to classify the papers. Thirty-three papers fulfilled high quality standards while 27 were methodologically deficient and thus were excluded from our meta-analyses. Exposure to chemicals was evaluated in seven studies and the weighted relative risk (RR) estimate was 1.67 (95% confidence interval 1.14-2.44). The highest risks were found among those exposed to pesticides (RR 2.4-4.7) and there was no evidence of publication bias. In 16 publications exposure to electromagnetic fields was considered and there seemed to be an association, RR 1.32 (95% confidence interval 1.08-1.63). However publication bias might explain some of the risk as well as other exposures associated with electric work, i. e. electric shocks and muscle trauma. In three studies the association between ALS and the nursing profession was studied and there seemed to be an increased risk. There are indications of an association between ALS and exposure to heavy muscle work especially in combination with muscle trauma, i.e. professional football players are reported to have an elevated risk. More studies are needed with more precise measures on these exposures