title: Association between extremely low-frequency electromagnetic fields occupations and amyotrophic lateral sclerosis: a meta-analysis.
abstract: OBJECTIVE
  To estimate the relationship between exposure to extremely low-frequency electromagnetic fields (ELF-EMF) and the risk of amyotrophic lateral sclerosis (ALS) by a meta-analysis.
  
  
  METHODS
  Through searching PubMed databases (or manual searching) up to April 2012 using the following keywords: "occupational exposure", "electromagnetic fields" and "amyotrophic lateral sclerosis" or "motor neuron disease", seventeen studies were identified as eligible for this meta-analysis. The associations between ELF-EMF exposure and the ALS risk were estimated based on study design (case-control or cohort study), and ELF-EMF exposure level assessment (job title or job-exposure matrix). The heterogeneity across the studies was tested, as was publication bias.
  
  
  RESULTS
  Occupational exposure to ELF-EMF was significantly associated with increased risk of ALS in pooled studies (RR = 1.29, 95%CI = 1.02-1.62), and case-control studies (OR = 1.39, 95%CI = 1.05-1.84), but not cohort studies (RR = 1.16, 95% CI = 0.80-1.69). In sub-analyses, similar significant associations were found when the exposure level was defined by the job title, but not the job-exposure matrix. In addition, significant associations between occupational exposure to ELF-EMF and increased risk of ALS were found in studies of subjects who were clinically diagnosed but not those based on the death certificate. Moderate heterogeneity was observed in all analyses.
  
  
  CONCLUSIONS
  Our data suggest a slight but significant ALS risk increase among those with job titles related to relatively high levels of ELF-EMF exposure. Since the magnitude of estimated RR was relatively small, we cannot deny the possibility of potential biases at work. Electrical shocks or other unidentified variables associated with electrical occupations, rather than magnetic-field exposure, may be responsible for the observed associations with ALS.
authors.affiliation: Bioelectromagnetics Laboratory, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Hongjie
authors.initials: H
authors.lastname: Zhou
authors.forename: Guangdi
authors.initials: G
authors.lastname: Chen
authors.forename: Chunjing
authors.initials: C
authors.lastname: Chen
authors.forename: Yunxian
authors.initials: Y
authors.lastname: Yu
authors.forename: Zhengping
authors.initials: Z
authors.lastname: Xu
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000453:epidemiology / Q000209:etiology*; D004574:Electromagnetic Fields / Q000009:adverse effects*; D006801:Humans; D016273:Occupational Exposure; D016017:Odds Ratio; D017594:Publication Bias