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Comment
. 2023 Jul 1;80(7):673-681.
doi: 10.1001/jamaneurol.2023.1168.

Risk of Parkinson Disease Among Service Members at Marine Corps Base Camp Lejeune

Samuel M Goldman  1   2 , Frances M Weaver  3   4 , Kevin T Stroupe  3   4 , Lishan Cao  3 , Beverly Gonzalez  3 , Kalea Colletta  3 , Ethan G Brown  2   5 , Caroline M Tanner  2   5
Affiliations
Comment

Risk of Parkinson Disease Among Service Members at Marine Corps Base Camp Lejeune

Samuel M Goldman et al. JAMA Neurol. .

Abstract

Importance: An increased risk of Parkinson disease (PD) has been associated with exposure to the solvent trichloroethylene (TCE), but data are limited. Millions of people in the US and worldwide are exposed to TCE in air, food, and water.

Objective: To test whether the risk of PD is higher in veterans who served at Marine Corps Base Camp Lejeune, whose water supply was contaminated with TCE and other volatile organic compounds (VOCs), compared with veterans who did not serve on that base.

Design, setting, and participants: This population-based cohort study examined the risk for PD among all Marines and Navy personnel who resided at Camp Lejeune, North Carolina (contaminated water) (n = 172 128), or Camp Pendleton, California (uncontaminated water) (n = 168 361), for at least 3 months between 1975 and 1985, with follow-up from January 1, 1997, until February 17, 2021. Veterans Health Administration and Medicare databases were searched for International Classification of Diseases diagnostic codes for PD or other forms of parkinsonism and related medications and for diagnostic codes indicative of prodromal disease. Parkinson disease diagnoses were confirmed by medical record review.

Exposures: Water supplies at Camp Lejeune were contaminated with several VOCs. Levels were highest for TCE, with monthly median values greater than 70-fold the permissible amount.

Main outcome and measures: Risk of PD in former residents of Camp Lejeune relative to residents of Camp Pendleton. In those without PD or another form of parkinsonism, the risk of being diagnosed with features of prodromal PD were assessed individually and cumulatively using likelihood ratio tests.

Results: Health data were available for 158 122 veterans (46.4%). Demographic characteristics were similar between Camp Lejeune (5.3% women, 94.7% men; mean [SD] attained age of 59.64 [4.43] years; 29.7% Black, 6.0% Hispanic, 67.6% White; and 2.7% other race and ethnicity) and Camp Pendleton (3.8% women, 96.2% men; mean [SD] age, 59.80 [4.62] years; 23.4% Black, 9.4% Hispanic, 71.1% White, and 5.5% other race and ethnicity). A total of 430 veterans had PD, with 279 from Camp Lejeune (prevalence, 0.33%) and 151 from Camp Pendleton (prevalence, 0.21%). In multivariable models, Camp Lejeune veterans had a 70% higher risk of PD (odds ratio, 1.70; 95% CI, 1.39-2.07; P < .001). No excess risk was found for other forms of neurodegenerative parkinsonism. Camp Lejeune veterans also had a significantly increased risk of prodromal PD diagnoses, including tremor, anxiety, and erectile dysfunction, and higher cumulative prodromal risk scores.

Conclusions and relevance: The study's findings suggest that the risk of PD is higher in persons exposed to TCE and other VOCs in water 4 decades ago. Millions worldwide have been and continue to be exposed to this ubiquitous environmental contaminant.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Weaver reported receiving grants from the Edward Hines, Jr VA Hospital during the conduct of the study and outside the submitted work. Dr Brown reported receiving grants from the Michael J. Fox Foundation and the National Institute on Aging and personal fees from Gateway Consulting, LLC, outside the submitted work. Dr Tanner reported receiving personal fees from Lundbeck Pharma, CNS Ratings, Adamas, Cadent, and Evidera; serving on advisory boards for Kyowa Kirin, Acorda, Australia Parkinson’s Mission; serving on a clinical trial steering committee for Jazz Pharmaceuticals/Cavion; and receiving grants from the National Institutes of Health, Biogen Idec, Parkinson Foundation, Michael J. Fox Foundation, Department of Defense Parkinson’s Research Program, Roche, Genentech, BioElectron, and Gateway Institute for Brain Research, LLC, outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Duration From Start of Camp Residence Until Parkinson Disease Diagnosis
See this image and copyright information in PMC

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