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Prior studies suggest that environmental exposures may affect PD phenotype or progression, but this has not been reported for VOCs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The objective of this study was to test whether PD progression is faster in individuals exposed to VOCs in water at Camp Lejeune.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cohort of 172,128 marines residing at Camp Lejeune between 1975 and 1985 was previously assembled. We identified individuals with PD in Veterans Health Administration and Medicare databases between 2000 and 2021. Using estimates derived by the US Agency for Toxic Substances and Disease Registry, we classified individuals as exposed or unexposed to VOCs in residential water. We used Kaplan\u2013Meier and Cox regression models to test differences between exposed and unexposed groups in the time from PD diagnosis until psychosis, fracture, fall, or death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 270 persons with PD, 177 (65.6%) were exposed to VOCs in residential water. Median cumulative exposure was 4970\u2009\u03bcg\/L\u2010months, &gt;50\u2010fold the permissible level. Time until psychosis, fracture, and fall were all shorter in the exposed group, with adjusted hazard ratios (HRs) exceeding 2: psychosis HR, 2.19 (95% confidence interval [CI]: 0.99\u20134.83); fracture HR, 2.44 (95% CI: 0.91\u20136.55); and fall HR, 2.64 (95% CI: 0.97\u20137.21). A significant dose response was observed for time to fall (\n                      <jats:italic>P<\/jats:italic>\n                      trend, 0.032). No differences were observed for time until death.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      PD progression may be faster in persons exposed to trichloroethylene and other VOCs in water decades earlier. \u00a9 2024 The Author(s).\n                      <jats:italic>Movement Disorders<\/jats:italic>\n                      published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/mds.29922","type":"journal-article","created":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T03:24:48Z","timestamp":1720668288000},"page":"1732-1739","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Parkinson's Disease Progression and Exposure to Contaminated Water at Camp Lejeune"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3039-9927","authenticated-orcid":false,"given":"Samuel M.","family":"Goldman","sequence":"first","affiliation":[{"name":"Division of Occupational, Environmental, and Climate Medicine University of California San Francisco  San Francisco California USA"},{"name":"Research Service San Francisco Veterans Affairs Health Care System  San Francisco California 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