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. 2025 May 1;8(5):e259198.
doi: 10.1001/jamanetworkopen.2025.9198.

Proximity to Golf Courses and Risk of Parkinson Disease

Brittany Krzyzanowski  1 , Aidan F Mullan  2   3 , E Ray Dorsey  4 , Sai Shivani Chirag  1 , Pierpaolo Turcano  2 , Emanuele Camerucci  5 , James H Bower  2 , Rodolfo Savica  2
Affiliations

Proximity to Golf Courses and Risk of Parkinson Disease

Brittany Krzyzanowski et al. JAMA Netw Open. .

Abstract

Importance: The role of pesticide exposure from golf courses in Parkinson disease (PD) risk remains unclear.

Objective: To assess whether proximity to golf courses is associated with increased PD risk and to use information on groundwater vulnerability and municipal well locations to investigate drinking water contamination as a potential route of exposure.

Design, setting, and participants: This case-control study included patients with incident PD and matched controls from the Rochester Epidemiology Project from 1991 to 2015. Data were analyzed between June and August 2024.

Exposures: Distance to golf courses, living in water service areas with a golf course, living in water service areas in vulnerable groundwater regions, living in water service areas with shallow municipal wells, and living in water service areas with a municipal well on a golf course.

Main outcome and measures: Risk of incident PD. All models adjusted for age, sex, race and ethnicity, year of index, median household income, and urban or rural category.

Results: A total of 419 incident PD cases were identified (median [IQR] age, 73 [65-80] years; 257 male [61.3%]) with 5113 matched controls (median [IQR] age, 72 [65-79] years; 3043 male [59.5%]; 4504 White [88.1%]). After adjusting for patient demographics and neighborhood characteristics, living within 1 mile of a golf course was associated with 126% increased odds of developing PD compared with individuals living more than 6 miles away from a golf course (adjusted odds ratio [aOR], 2.26; 95% CI, 1.09-4.70). Individuals living within water service areas with a golf course had nearly double the odds of PD compared with individuals in water service areas without golf courses (aOR, 1.96; 95% CI, 1.20-3.23) and 49% greater odds compared with individuals with private wells (aOR, 1.49; 95% CI, 1.05-2.13). Additionally, individuals living in water service areas with a golf course in vulnerable groundwater regions had 82% greater odds of developing PD compared with those in nonvulnerable groundwater regions (aOR, 1.82; 95% CI, 1.09-3.03).

Conclusions and relevance: In this population-based case-control study, the greatest risk of PD was found within 1 to 3 miles of a golf course and risk generally decreased with distance. Associations with the largest effect sizes were in water service areas with a golf course and in vulnerable ground water regions.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Dorsey reported receiving honoraria from Adivo Associates France, American Neurological Association, Dartmouth College, Elsevier, HMP Education, International Parkinson and Movement Disorder Society, Massachusetts Medical Society, Michael J. Fox Foundation, National Institutes of Health, National Multiple Sclerosis Society, Northwestern University, Patient-Centered Outcomes Research Institute, Philadelphia Neurological Society, Stanford University, Stony Brook University, Sutter Health, Texas Neurological Society, and University of Toronto; he reported receiving consulting fees Abbott, Abbvie, Acadia, Acorda Therapeutics, Advarra, Aspen Neuroscience Inc, Bial Pharmaceuticals, Biogen, Biohaven Pharmaceuticals, BioSensics, Boehringer Ingelheim, Caraway Therapeutics, Cerevance, CuraSen, DConsult2, Denali Therapeutics, Eli Lilly, Genentech, HanAll BioPharma, Health & Wellness Partners, HMP Education, Kairos Cinema LLC (PBS), Karger, KOL Groups, Life Sciences Consultant, Mediflix, Medrhythms, Merck, Mitsubishi Tanabe Pharma America Inc, MJH Holdings, NACCME, Novartis, Otsuka, Praxis Medicine, Remepy, Sanofi, Seelos Therapeutics, Spark Therapeutics, Springer Healthcare, Theravance Biopharmaceuticals, VivoSense, WebMD; he reported receiving grants from Averitas Pharma, Biogen, Burroughs Wellcome Fund, Michael J. Fox Foundation, National Institutes of Health, Pfizer, Photopharmics, and Roche, Safra Foundation; and he reported ownership interests in Included Health, Mediflix, SemCap, and Synapticure outside the submitted work. Dr Bower reported grants from Novartis and Amylyx Pharmaceuticals outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Overhead Satellite Image of Golf Course Map With Polygon Boundaries
Golf course center points were converted to polygon boundaries outlining the course using manual digitization and satellite imagery for the year 2022 from ESRI, Maxar, and Earthstar Geographics. Imagery from Esri, Maxar, Earthstar Geographics, and the GIS User Community, 2024.
Figure 2.
Figure 2.. Nonlinear Association Between Odds of Parkinson Disease (PD) and Proximity to a Golf Course
Cubic spline fit for the relative risk of Parkinson Disease by proximity to nearest golf course, adjusted for age, sex, race, ethnicity, median household income, rural or urban classification, and health care utilization. aOR indicates adjusted odds ratio; shaded areas represent 95% CIs.
See this image and copyright information in PMC

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