Green space exposure and risk of amyotrophic lateral sclerosis: a population-based case-control study in Northern Italy.
Level 4 - case-series / case-control
Population-based case-control study
PubMed 42169130 · doi:10.1186/s12940-026-01311-w
What was done
A population-based case-control study in Northern Italy (Modena, Reggio Emilia, and Parma provinces) evaluated the association between residential green space exposure and ALS risk. The study analyzed 499 newly diagnosed ALS cases (1998–2011) and 1,935 sex-, age-, and province-matched controls. Residential exposure was quantified via six satellite- and land-use-derived indices, including NDVI (annual, seasonal, weighted), green cover ratio, accessibility index, and a combined Green Exposure Index (GEI). Conditional logistic regression with restricted cubic splines was used, adjusting for magnetic fields and light at night.
What was found
A non-linear U-shaped association was observed between greenness and ALS risk, with increased odds ratios at both low and high levels of exposure relative to intermediate levels. Associations were more defined for NDVI-based metrics and smoother for GEI, with females showing more distinct associations for GEI. The abstract does not report specific numerical odds ratios or confidence intervals.
Why it matters
It suggests that the health benefits of green spaces may not follow a simple linear dose-response for ALS, highlighting intermediate greenness as inversely associated with risk while extremely high greenness may reflect agricultural or pesticide-related exposures.
Limits
The abstract provides no point estimates or confidence intervals. Exposure was based entirely on residential proximity rather than personal or lifetime activity, creating potential exposure misclassification and unmeasured confounding.
Cited by
- context A published study has linked green space workers to an increased risk of developing amyotrophic lateral sclerosis (ALS).