Investigation Of SLE in Nogales, AZ

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American Journal of Epidemiology Vol. 154, No. 11 : 1029-1036 Copyright © 2001 by The s Hopkins University School of Hygiene and Public Health

ORIGINAL CONTRIBUTIONS

Investigation of Systemic Lupus Erythematosus in Nogales, Arizona Lina Balluz1,2, Rossanne Philen2, Ortega3, Cecilia les3, Brock4, Dana Barr4 and Kieszak2

1 Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA.2 Centers for Disease Control and Prevention, National Center for Environmental Health, Health Studies Branch, Atlanta, GA.3 Arizona Department of Health Services, Office of Border Health, Tucson, AZ.4 Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, Atlanta, GA.

In 1996, a citizens group in Nogales, Arizona, reported to the Arizona Department of Health their concerns about a possible excess prevalence of systemic lupus erythematosus (SLE) due to exposure to environmental contamination in the area. The authors conducted a two-phase study in which the objectives of phase I were to identify potential SLE cases and to determine the prevalence of SLE and the objectives of phase II were to identify potential risk factors associated with the development of SLE and to evaluate the possible association between SLE and environmental exposure to pesticides and inorganic compounds. Participants included 20 confirmed cases and 36 controls. The authors found the prevalence of SLE to be 103 cases per 100,000 population (95 percent confidence interval: 56, 149), two to seven times higher than the prevalence in the US population. They detected elevated levels of 1,1-dichloro-2,2-bis-(p-chorophenyl)ethylene and organophosphate metabolites among cases and controls. In both, levels were higher than the reference mean for the US population. The authors found no statistical association between elevated levels of pesticides and disease status. Their results show that the prevalence of SLE in Nogales is higher than the reported prevalence in the US population and that both cases and controls had past exposure to chlorinated pesticides and have ongoing exposure to organophosphates.

Key Words: biological markers • case-control studies • DDE • lupus erythematosus, systemic • pesticides • prevalence ACR, American College of Rheumatology • ANA, antinuclear antibody • CDC, Centers for Disease Control and Prevention • CI, confidence interval • DDE, 1,1-dichloro-2,2-bis-(p-chlorophenyl)ethylene • DDT, 1,1,1-trichloro-2,2-bis-(p-chlorophenyl)-ethane • DEP, diethylphosphate • OR, odds ratio • SLE, systemic lupus erythematosus

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