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. 2025 May 12;22(5):763.
doi: 10.3390/ijerph22050763.

Life Course Exposure to Cyanobacteria and Amyotrophic Lateral Sclerosis Survival

Stuart A Batterman  1 , Md Kamrul Islam  1 , Dae Gyu Jang  2   3 , Eva L Feldman  2   3 , Stephen A Goutman  2   3
Affiliations

Life Course Exposure to Cyanobacteria and Amyotrophic Lateral Sclerosis Survival

Stuart A Batterman et al. Int J Environ Res Public Health. .

Abstract

Cyanobacterial harmful algal blooms (cyanoHABs) occur worldwide and can cause ingestion and inhalation exposure to microcystin and other potent toxins. This study develops life course exposure measures for cyanobacteria for application in population studies and then associates these measures with the survival of individuals with amyotrophic lateral sclerosis (ALS). The exposure measures utilize an individual's residence history, date of disease onset, and satellite data from the Cyanobacteria Assessment Network. Residence duration for selected exposure windows referenced to disease onset date was used to weight cyanobacteria concentrations in water bodies within 0.25 to 10 km of each residence. Different concentration metrics, buffer sizes, and exposure windows were evaluated. The 2.5 and 5 km buffers best balanced the likelihood and plausibility of exposure while still resolving exposure contrasts. Over their lifetime, most study participants lived within 5 km of cyanobacteria blooms, and the exposure was associated with up to 0.89 years shorter survival, with significant interactions for individuals reporting swimming, fishing, and private wells. Our findings suggest a new and modifiable risk factor for ALS survival, and a need to confirm exposures and epidemiological findings. These cyanoHAB exposure estimates can facilitate population studies that can discover new relationships with neurodegenerative and other diseases.

Keywords: cyanobacteria; environmental exposure; geostatistics; harmful algae bloom; neurological degenerative disease; residence; survival; water.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Hypothetical exposure scenarios showing the effect of buffer size. (A) CyanoHAB exposure captured in 1, 5, and 10 km buffers (red line). (B) CyanoHAB exposure captured only in a 10 km buffer. The grid depicts a 300 m grid resolution of satellite pixels. Portions of 1, 5, and 10 km buffers around a residence are shown as red partial and complete circles. Cyanobacteria levels are shown as colored pixels from low (pink) to high (red) concentration.
Figure 2
Figure 2
Comparison of three concentration metrics for a hypothetical lake (blue line), 2.5 km buffer (red line), and 300 m grid (satellite pixels). (A) Depiction of pixels with HAB detections representing the highest daily or annual average levels in a year. (B) Equivalent water-averaged concentration metric. (C) Equivalent land-averaged concentration. Cyanobacteria levels are shown as pixels colored from low (pink) to high (red) concentration.
Figure 3
Figure 3
Map showing the counties of study participants’ residences. Includes 1504 residences in 178 counties, of which 69 counties had cyanoHAB occurrences during the lifetime exposure window. Red color depicts residences within 5 km of a cyanoHAB event when the participant lived there; yellow depicts counties without cyanoHAB events when the participant lived there.
Figure 4
Figure 4
Covariate-adjusted Cox survival curves for upper versus lower exposure groups for the water-averaged concentration metric with a 5 km buffer and a 0–20-year exposure window. (a) CyanoHAB exposure alone; (b) Interaction with water source; (c) Interaction with fishing/swimming activities. Median survival is shown for each exposure group (and interaction). Survival differences in parentheses and red. In 4b, lines for “City water + Low HAB” and “Well water + Low HAB” overlap. N = 303.
See this image and copyright information in PMC

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