Environmental Determinants of Parkinson’s Disease and Attributable Burden in Latin America: Findings from the LARGE-PD Consortium

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Abstract
Background: Evidence on environmental determinants of Parkinson’s disease (PD) in Latin America is limited and their attributable burden remains poorly defined in the region. We examined associations between environmental exposures and PD and quantified their contribution to disease burden.Methods: We analyzed 9887 participants from nine Latin American countries in a case control study. Associations between environmental exposures and PD were estimated using logistic regression adjusted for age, sex, and country. Population attributable fractions (PAFs) were calculated for positively associated exposures, defined as severe head trauma or at least 5 years of exposure for other risk factors.Findings: Weekly caffeine consumption and tobacco use for at least 5 years were inversely associated with PD (adjusted OR [aOR] 0·77, p < 0·0001; aOR 0·83, p = 0·0009). Severe head trauma (aOR 1·35, p < 0·0001), occupational pesticide exposure (aOR 1·42, p = 0·0003), occupational metal exposure (aOR 1·29, p = 0·0299), rural living (aOR 1·60, p < 0·0001), and well water consumption (aOR 1·22, p = 0·0014) were positively associated with PD. Dose related associations were observed for caffeine, tobacco, occupational pesticides and metals, rural living, and well water consumption. The joint PAF across five risk exposures was 13·7% (95% CI 9·8 to 17·3), with higher estimates in El Salvador, Brazil, Colombia, males, and participants younger than 60 years. Sensitivity and lag analyses were directionally consistent.Interpretation: Selected environmental exposures may account for a meaningful proportion of PD burden in Latin America, supporting further research and public health attention to environmental determinants in the region.