{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T16:24:19Z","timestamp":1787502259246,"version":"build-2736575974"},"reference-count":60,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002343","name":"Institut de recherche Robert-Sauv\u00e9 en sant\u00e9 et en s\u00e9curit\u00e9 du travail","doi-asserted-by":"crossref","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100002343","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Occup Environ Med"],"accepted":{"date-parts":[[2026,6,16]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To systematically review the evidence on the association between occupational exposure to pesticides and the risk of amyotrophic lateral sclerosis (ALS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search, conducted in eight bibliographic databases for publications between 1990 and 2025, identified observational studies estimating the risk of ALS after occupational pesticide exposure. Study quality was assessed using the WHO Risk of Bias (RoB) assessment instrument for systematic reviews, with the ROBINS-E (RoB in non-randomised studies of exposure) tool domains of bias. Pooled risk estimates were produced using random-effects models with restricted maximum likelihood, heterogeneity was assessed with I\u00b2 statistics, and meta-regressions and publication bias explored with funnel plots and Egger\u2019s test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eight case-control studies (1734 cases) were retained for meta-analysis from 767 initially screened articles. \u2018Ever\u2019 occupational exposure to pesticides was associated with an increased risk of ALS (n=6 studies, pooled OR (pOR)=1.6; 95% CI 1.1, 2.2; I\u00b2=57%), for combined sexes. The risk for exposure to herbicides was slightly greater (pOR=1.7, I\n                      <jats:sup>2<\/jats:sup>\n                      =0.0%) than for exposure to insecticides or fungicides (pORs=1.6, I\n                      <jats:sup>2<\/jats:sup>\n                      =0.0%). Based on three studies, ever exposure to high levels of pesticides was associated with a higher risk (pOR=2.7; 95% CI=1.4, 5.0) than exposure to low levels (pOR=1.9; 95% CI=1.0, 3.7). Self-reported exposure assessment methods and older publication dates (&lt;2015) were statistically significant predictors of the effect size.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite the small number of studies and some heterogeneity, our results add to the evidence suggesting that occupational exposure to pesticides may increase the risk of ALS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/oemed-2025-110662","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:10Z","timestamp":1785888010000},"page":"291-300","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Occupational exposure to pesticides increases the risk of amyotrophic lateral sclerosis: a systematic review and meta-analysis"],"prefix":"10.1136","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8722-0433","authenticated-orcid":false,"given":"France","family":"Labr\u00e8che","sequence":"first","affiliation":[{"name":"Service de la recherche, Institut de recherche Robert-Sauv\u00e9 en sant\u00e9 et en securit\u00e9 du travail, Montr\u00e9al, Qu\u00e9bec, Canada"},{"name":"Sant\u00e9 environnementale et sant\u00e9 au travail, \u00c9cole de sant\u00e9 publique (ESPUM), Universit\u00e9 de Montr\u00e9al, Montreal, Qu\u00e9bec, Canada"},{"name":"Centre de recherche en sant\u00e9 publique (CReSP), Universit\u00e9 de Montr\u00e9al et CIUSSS du Centre-Sud-de-l\u2019\u00cele-de-Montr\u00e9al, Montr\u00e9al, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Prud\u2019homme","sequence":"additional","affiliation":[{"name":"Service de la recherche, Institut de recherche Robert-Sauv\u00e9 en sant\u00e9 et en securit\u00e9 du travail, Montr\u00e9al, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryse","family":"Gagnon","sequence":"additional","affiliation":[{"name":"Direction de la veille et de la mobilisation des connaissances, Institut de recherche Robert-Sauv\u00e8 en sant\u00e9 et en securit\u00e9 du travail, Montr\u00e9al, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Dupr\u00e9","sequence":"additional","affiliation":[{"name":"Axe Neuroscience, Centre hospitalier universitaire (CHU) de Qu\u00e9bec-Universit\u00e9 Laval, Ville de Qu\u00e9bec, Qu\u00e9bec, Canada"},{"name":"D\u00e9partement de m\u00e9decine, Facult\u00e9 de M\u00e9decine, Universit\u00e9 Laval, Ville de Qu\u00e9bec, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2553-2700","authenticated-orcid":false,"given":"Sabrina","family":"Gravel","sequence":"additional","affiliation":[{"name":"Service de la recherche, Institut de recherche Robert-Sauv\u00e9 en sant\u00e9 et en securit\u00e9 du travail, Montr\u00e9al, Qu\u00e9bec, Canada"},{"name":"Sant\u00e9 environnementale et sant\u00e9 au travail, \u00c9cole de sant\u00e9 publique (ESPUM), Universit\u00e9 de Montr\u00e9al, Montreal, Qu\u00e9bec, Canada"},{"name":"Centre de recherche en sant\u00e9 publique (CReSP), Universit\u00e9 de Montr\u00e9al et CIUSSS du Centre-Sud-de-l\u2019\u00cele-de-Montr\u00e9al, Montr\u00e9al, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"2026082308400582000_83.5.291.1","unstructured":"FAO . 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