Sanchez-Diaz, GermanEscobar, FranciscoBadland, HannahArias-Merino, GretaPosada De la Paz, ManuelAlonso-Ferreira, Veronica2020-01-152020-01-152018Int J Environ Res Public Health. 2018 Nov 11;15(11). pii: E2522.1660-4601http://hdl.handle.net/20.500.12105/8901The etiology of motor neuron disease (MND) is still unknown. The aims of this study were to: (1) analyze MND mortality at a fine-grained level; and (2) explore associations of MND and heavy metals released into Spanish river basins. MND deaths were extracted from the Spanish nationwide mortality registry (2007⁻2016). Standardized mortality ratios (SMRs) for MND were estimated at a municipal level. Sites that emitted quantities of heavy metals above the regulatory thresholds were obtained from the European Pollutant Release and Transfer Register database (2007⁻2015). The relative risks for non-exposed and exposed municipalities (considering a downstream 20 km river section) by type of heavy metal were analyzed using a log-linear model. SMRs were significantly higher in central and northern municipalities. SMRs were 1.14 (1.10⁻1.17) higher in areas exposed to heavy metals than in non-exposed areas: 0.95 (0.92⁻0.96). Considering the different metals, we found the following increased MND death risks in exposed areas: 20.9% higher risk for lead, 20.0% for zinc, 16.7% for arsenic, 15.7% for chromium, 15.4% for cadmium, 12.7% for copper, and 12.4% for mercury. This study provides associations between MND death risk and heavy metals in exposed municipalities. Further studies investigating heavy metal exposure are needed to progress in MND understanding.engVoRhttp://creativecommons.org/licenses/by/4.0/Environmental factorsGeographical analysisHeavy metalsMotor neuron diseasePopulation-based mortalityEnvironmental ExposureHumansMetals, HeavyMotor Neuron DiseaseRisk FactorsRiversSpainWater Pollutants, ChemicalAtribución 4.0 Internacional304238741511252210.3390/ijerph151125221660-4601International journal of environmental research and public healthopen access