Studies demonstrate both an association (73-75) and lack of an association (51,76,77) between PD and farming. Duration of plantation work demonstrated a significant relationship with PD in the population-based Honolulu Heart study (78). In a nonpopulation-based case-control study (67), orchard workers had a higher risk of PD. The association between rural residences is difficult to dissociate from farming as an occupation for the more traditional family farms. Not all studies corrected for established PD confounders, such as tobacco use, and less-established environmental confounders, such as pesticide/herbicide use or well water. Most of these studies used standard clinical criteria or expert diagnosis and had relatively small sample sizes. Furthermore, none of the studies reported detailed clinical information that might suggest clinical differences between exposed and nonexposed subjects.

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