Impact of environmental and lifestyle factors on progression and survival in a large Chinese amyotrophic lateral sclerosis cohort

Abstract

Objective: To investigate the impacts of environmental and lifestyle factors on progression and survival in a large Chinese amyotrophic lateral sclerosis (ALS) cohort.

Methods: We investigated a cohort of 1,312 sALS patients prospectively. A questionnaire was designed to collect information on environmental exposure and lifestyle at baseline. Uni- and multivariate analysis were performed to analyze the influence of environmental and lifestyle factors on the onset age, bulbar onset, progression rate and survival time of ALS.

Results: A total of 1,050 questionnaires were finally received from the patients, among which 407 questionnaires were fully filled out. Low educational level and ever smoked were significantly related to late onset in both univariate and multivariate analysis with backward section (p<0.05). Exposure to organophosphorus pesticide was significantly related to bulbar onset (p=0.027) and rapid progression (p=0.007). Ever drinking alcohol was related to longer survival time in Cox regression model (p=0.040) and the mean survival time of non-drinkers was significantly higher than patients with history of drinking alcohol (p=0.023).

Conclusion: In Chinese ALS population, low educational level was an independent indicator of late onset. Exposure to organophosphorus pesticide was the risk factor for bulbar onset and rapid progression. Smoking and drinking alcohol were less common among ALS patients with late onset and long survival time.