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From page 156... ...
. The committee has detailed literature search results in sections for some of these specific pollutant components, even if no specific studies on burn pits were identified in the search.
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From page 158... ...
ALS = amyotrophic lateral sclerosis; CI = confidence interval; ILER = Individual Longitudinal Exposure Record; OR = odds ratio; PM = particulate matter.
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From page 159... ...
Five studies assessed the relationship between diesel exhaust and ALS, of which one was among veteran populations. This veterans' study found that self-reported exposure to exhaust from heaters or generators during deployment was not significantly associated with ALS survival PREPUBLICATION COPY: UNCORRECTED PROOFS
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From page 160... ...
. The review also identified one study that found that truck driving, which involves occupational exposure to diesel exhaust, was also significantly associated with increased odds of ALS.
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From page 161... ...
However, use of occupation as proxy for lead exposure cannot distinguish unique effects of lead from other neurotoxicants associated with these occupations, such as diesel exhaust or pesticides. Regarding environmental lead exposure, a meta-analysis reported that environmental lead exposure significantly increased odds of ALS based on nine studies of moderate quality (Duan et al., 2023)
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From page 162... ...
, with mixed results. Whereas a study of residential exposure to industrial chemicals released in air using EPA Toxics Release Inventory data found that higher chromium exposure was associated with increased ALS odds (Andrew et al., 2022)
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From page 163... ...
. Two case-control studies examined residential exposure to solvents using exposure data from the National Air Toxics Assessment and ALS and found that residential aromatic organic/chlorinated solvent exposure significantly increased likelihood of developing ALS (Malek et al., 2015; Wu et al., 2024)
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From page 164... ...
The committee does not find a possible risk-conferring relationship between exposure to burn pits, dust and particulate matter (PM) , fuels, incinerator emissions, metals, mold, radiation, or solvents and amyotrophic lateral sclerosis (ALS)
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From page 166... ...
CI = confidence interval; ILER = Individual Longitudinal Exposure Record; OR = odds ratio; PM = particulate matter.
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From page 167... ...
. An ecological study on environmental exposures and prevalence rates of a composite measure of neurodegenerative diseases, including Alzheimer's disease, PREPUBLICATION COPY: UNCORRECTED PROOFS
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From page 168... ...
and the ecological study found that cadmium concentrations in sewer sludge were significantly associated with prevalence of neurodegenerative disease including Alzheimer's (Newell et al., 2024) , while the case-control study by Yang and colleagues (2018)
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From page 169... ...
In another analysis, however, the authors calculated a pooled relative risk from three studies on medical radiation workers and did not find significantly increased risk of mortality from nervous system diseases between exposed people and unexposed controls (Lopes et al., 2022)
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From page 171... ...
CI = confidence interval; ILER = Individual Longitudinal Exposure Record; MS = multiple sclerosis; OR = odds ratio; PM = particulate matter.
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From page 172... ...
. Fuels and MS The literature search produced one meta-analysis that investigated occupational exposures, including offshore petroleum workers and workers exposed to oil well fumes, and MS (Vitturi et al., 2023)
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From page 173... ...
and an additional case-control study (Armon-Omer et al., 2024) found higher concentrations of arsenic in MS patients compared to controls, though PREPUBLICATION COPY: UNCORRECTED PROOFS
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From page 174... ...
. The umbrella review reported that organic solvent exposure significantly increased odds of MS, but this was based on weak evidence (Mentis et al., 2021)
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From page 175... ...
Burn Pits or Mold and MS The committee's search yielded zero results on the possible relationships between exposure to burn pits or mold and the risk of MS. Conclusion Conclusion 7-3: Based on its analysis of the available data, the committee does not find a possible risk-conferring relationship between exposure to burn pits, dust and particulate matter (PM)
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From page 177... ...
CI = confidence interval; ILER = Individual Longitudinal Exposure Record; OR = odds ratio; PM = particulate matter.
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From page 178... ...
found a positive association with nitrogen oxides, but the umbrella review, a meta-analysis, and a cohort study found no association (Dhiman et al., 2023; Peters et al., 2024; Tan et al., 2022)
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From page 179... ...
. The study found that exposure to hydrocarbons, the main component of fuels like petroleum and natural gas, was associated with significantly increased odds of developing Parkinson's, but this association was based on weak evidence.
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From page 180... ...
However, in pooled excess relative risk analysis, the authors did find significant evidence of a dose-response relationship between exposure and Parkinson's disease mortality and incidence -- i.e., that increased exposure to ionizing radiation was significantly associated with increased risk. Solvents and Parkinson's Disease The literature search yielded three studies, including an umbrella review of umbrella reviews of systematic review and meta-analyses (Mentis et al., 2021)
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From page 181... ...
Synthesizing evidence from data analyses and a structured literature review, the committee concluded that six possible risk-conferring relationships exist between any exposure of interest and any neurologic outcome -- between exhaust and ALS, solvents and ALS, PM and dementia, solvents and MS, dust and Parkinson's disease, and exhaust and Parkinson's disease. Dust and PM, exhaust, and solvents were associated with possible risk-conferring relationships; evidence was inadequate or insufficient of a possible riskconferring relationship between burn pits, fuels, incinerator emissions, metals, mold, or radiation and any neurologic outcome.
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From page 182... ...
2023. Amyotrophic lateral sclerosis and air pollutants in the province of Ferrara, northern Italy: An ecological study.
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From page 183... ...
2023. Risk factors of amyotrophic lateral sclerosis: A global meta-summary.
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From page 184... ...
2023. Metal concentrations in cerebrospinal fluid, blood, serum, plasma, hair, and nails in amyotrophic lateral sclerosis: A systematic review and meta analysis.
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From page 185... ...
2023. Urbanization, air pollution, and water pollution: Identification of potential environmental risk factors associated with amyotrophic lateral sclerosis using systematic reviews.
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From page 186... ...
2024. Exposure to ambient air toxicants and the risk of amyotrophic lateral sclerosis (ALS)
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From page 187... ...
2023. Environmental and occupational solvents exposure and amyotrophic lateral sclerosis: A systematic review and meta-analysis.
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