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September 11, 2012; 79 (11) Views and Reviews

Associations of welding and manganese exposure with Parkinson disease

Review and meta-analysis

James A. Mortimer, Amy R. Borenstein, Lorene M. Nelson
First published September 10, 2012, DOI: https://doi.org/10.1212/WNL.0b013e3182698ced
James A. Mortimer
From the Department of Epidemiology and Biostatistics (J.A.M., A.R.B.), University of South Florida, Tampa; and Division of Epidemiology (L.M.N.), Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA.
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Amy R. Borenstein
From the Department of Epidemiology and Biostatistics (J.A.M., A.R.B.), University of South Florida, Tampa; and Division of Epidemiology (L.M.N.), Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA.
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Lorene M. Nelson
From the Department of Epidemiology and Biostatistics (J.A.M., A.R.B.), University of South Florida, Tampa; and Division of Epidemiology (L.M.N.), Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA.
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Citation
Associations of welding and manganese exposure with Parkinson disease
Review and meta-analysis
James A. Mortimer, Amy R. Borenstein, Lorene M. Nelson
Neurology Sep 2012, 79 (11) 1174-1180; DOI: 10.1212/WNL.0b013e3182698ced

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Abstract

Objective: To examine associations of welding and manganese exposure with Parkinson disease (PD) using meta-analyses of data from cohort, case-control, and mortality studies.

Methods: Epidemiologic studies related to welding or manganese exposure and PD were identified in a PubMed search, article references, published reviews, and abstracts. Inclusion criteria were 1) cohort, case-control, or mortality study with relative risk (RR), odds ratio (OR), or mortality OR (MOR) and 95 confidence intervals (95% CI); 2) RR, OR, and MOR matched or adjusted for age and sex; 3) valid study design and analysis. When participants of a study were a subgroup of those in a larger study, only results of the larger study were included to assure independence of datasets. Pooled RR/OR estimates and 95% CIs were obtained using random effects models; heterogeneity of study effects were evaluated using the Q statistic and I2 index in fixed effect models.

Results: Thirteen studies met inclusion criteria for the welding meta-analysis and 3 studies for the manganese exposure meta-analysis. The pooled RR for the association between welding and PD for all study designs was 0.86 (95% CI 0.80–0.92), with absence of between-study heterogeneity (I2 = 0.0). Effect measures for cohort, case-control, and mortality studies were similar (0.91, 0.82, 0.87). For the association between manganese exposure and PD, the pooled OR was 0.76 (95% CI 0.41–1.42).

Conclusions: Welding and manganese exposure are not associated with increased PD risk. Possible explanations for the inverse association between welding and PD include confounding by smoking, healthy worker effect, and hormesis.

GLOSSARY

CI=
confidence interval;
MOR=
mortality odds ratio;
OR=
odds ratio;
PD=
Parkinson disease;
RR=
relative risk
  • Received December 16, 2011.
  • Accepted April 19, 2012.
  • Copyright © 2012 by AAN Enterprises, Inc.
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