title: Occupational exposure to pesticides and endotoxin and Parkinson disease in the Netherlands.
abstract: OBJECTIVE
  Previous research has indicated that occupational exposure to pesticides and possibly airborne endotoxin may increase the risk of developing Parkinson disease (PD). We studied the associations of PD with occupational exposure to pesticides, specifically to the functional subclasses insecticides, herbicides and fungicides, and to airborne endotoxin. In addition we evaluated specific pesticides (active ingredients) previously associated with PD.
  
  
  METHODS
  We used data from a hospital-based case-control study, including 444 patients with PD and 876 age and sex matched controls. Exposures to pesticides from application and re-entry work were estimated with the ALOHA+job-exposure matrix and with an exposure algorithm based on self-reported information on pesticide use. To assess exposure to specific active ingredients a crop-exposure matrix was developed. Endotoxin exposure was estimated with the DOM job-exposure matrix.
  
  
  RESULTS
  The results showed almost no significant associations. However, ORs were elevated in the higher exposure categories for pesticides in general, insecticides, herbicides and fungicides, and below unity for endotoxin exposure. The analyses on specific active ingredients showed a significant association of PD risk with the fungicide benomyl.
  
  
  CONCLUSIONS
  This study did not provide evidence for a relation between pesticide exposure and PD. However, the consistently elevated ORs in the higher exposure categories suggest that a positive association may exist. The possible association with the active ingredient benomyl requires follow-up in other studies. This study did not provide support for a possible association between endotoxin exposure and PD.
authors.affiliation: Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: Marianne
authors.initials: M
authors.lastname: van der Mark
authors.affiliation: Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Roel
authors.initials: R
authors.lastname: Vermeulen
authors.affiliation: St Elisabeth Hospital Tilburg, Tilburg, The Netherlands TweeSteden Hospital Tilburg, Tilburg, The Netherlands.
authors.forename: Peter C G
authors.initials: PC
authors.lastname: Nijssen
authors.affiliation: Canisius-Wilhelmina Hospital Nijmegen, Nijmegen, The Netherlands.
authors.forename: Wim M
authors.initials: WM
authors.lastname: Mulleners
authors.affiliation: Vlietland Hospital Schiedam, Schiedam, The Netherlands.
authors.forename: Antonetta M G
authors.initials: AM
authors.lastname: Sas
authors.affiliation: University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Teus
authors.initials: T
authors.lastname: van Laar
authors.affiliation: Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: Maartje
authors.initials: M
authors.lastname: Brouwer
authors.affiliation: Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: Anke
authors.initials: A
authors.lastname: Huss
authors.affiliation: Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Kromhout
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001542:Benomyl / Q000506:poisoning*; D016022:Case-Control Studies; D004731:Endotoxins / Q000506:poisoning*; D005260:Female; D005659:Fungicides, Industrial / Q000506:poisoning; D006540:Herbicides / Q000506:poisoning; D006801:Humans; D007306:Insecticides / Q000506:poisoning; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D020258:Neurotoxicity Syndromes / Q000209:etiology*; D009784:Occupational Diseases / Q000139:chemically induced*; D016273:Occupational Exposure / Q000009:adverse effects* / Q000032:analysis; D010300:Parkinson Disease / Q000209:etiology*; D010575:Pesticides / Q000506:poisoning*
chemical_list: D004731:Endotoxins; D005659:Fungicides, Industrial; D006540:Herbicides; D007306:Insecticides; D010575:Pesticides; D001542:Benomyl
keywords: Parkinson disease; endotoxins; pesticides