Healthy rural living: a misplaced optimism? : District-level agricultural index and Parkinson's disease risk in Austria.

BACKGROUND: Occupational exposure to pesticides is a well-established environmental risk factor for Parkinson's disease (PD). Living in agricultural regions has also been associated with PD risk, although evidence remains inconsistent. This study examines whether past district-level agricultural intensity is associated with current Parkinson's disease hospitalization prevalence across Austrian districts. METHODS: We obtained district-level hospitalization prevalence data for individuals with a main or secondary diagnosis of PD from the Austrian national hospital discharge register for the years 2015-2023. Agricultural employment is quantified using an Agricultural Index (ACI), defined as the proportion of the working population employed in agriculture and forestry, derived from national population censuses conducted in 1981, 1991, and 2001. Associations between the cumulative ACI and cumulative PD hospitalization prevalence per region among the general population are assessed using Pearson correlation and linear regression analyses. RESULTS: The cumulative ACI from 1981, 1991, and 2001 is significantly associated with PD hospitalization prevalence between 2015 and 2023 at the district level. In linear regression analysis, the cumulative ACI significantly predicts PD hospitalization prevalence (p = 0.01), explaining 6.8% of the variance (R2 = 0.068). CONCLUSION: Austrian districts with historically higher agricultural employment and intensity exhibit higher contemporary hospitalization prevalences among individuals with Parkinson's disease (PD). These findings support existing evidence linking rural environments to increased PD risk and suggest that agricultural environmental exposures can affect not only agricultural workers but also the general population residing in highly agricultural regions.