title: Geographic distributions of motor neuron disease mortality and well water use in U.S. counties.
abstract: We recently reported that U.S. mortality rates for motor neuron disease (MND) at the level of the state are associated with well water use. However, data at the state level may not accurately reflect data at the individual level. We therefore examined the association between MND mortality and well water use utilizing data from smaller geographic units that may better reflect exposure and disease at the individual level.
  
  
  
  We used data on age-adjusted MND mortality rates at the level of the county, obtained from the CDC, and corresponding data on the prevalence of well water use, obtained from the U.S. Geological Survey. Data were analyzed by multivariate linear regression and by Getis-Ord Gi*, a measure of spatial clustering.
  
  
  
  Age-adjusted mortality rates for MND in 923 U.S. counties were significantly correlated with the prevalence of well water (p < 0.0001). 'Hot spots' of MND mortality were significantly associated with 'hot spots' of well water use (p < 0.0005).
  
  
  
  These findings support the hypothesis that an agent present in well water plays an etiologic role in ALS. Further study of water use among individuals with ALS is warranted.
authors.affiliation: a Department of Population Health , University of North Dakota School of Medicine & Health Sciences , Grand Forks , ND , USA and.
authors.forename: Gary G
authors.initials: GG
authors.lastname: Schwartz
authors.affiliation: b Department of Geography , University of North Dakota College of Arts and Sciences , Grand Forks , ND , USA.
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Rundquist
authors.affiliation: b Department of Geography , University of North Dakota College of Arts and Sciences , Grand Forks , ND , USA.
authors.forename: Isaac J
authors.initials: IJ
authors.lastname: Simon
authors.affiliation: b Department of Geography , University of North Dakota College of Arts and Sciences , Grand Forks , ND , USA.
authors.forename: Sami E
authors.initials: SE
authors.lastname: Swartz
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000453:epidemiology; D006801:Humans; D016472:Motor Neuron Disease / Q000453:epidemiology* / Q000401:mortality*; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D014881:Water Supply
keywords: Amyotrophic lateral sclerosis; spatial epidemiology; well water