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Residential Distance to High-Voltage Power Lines and Risk of

Neurodegenerative Diseases: A Danish Population-Based Case-Control Study

Article  in  American Journal of Epidemiology · April 2013

DOI: 10.1093/aje/kws334 · Source: PubMed

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April 9, 2013

Original Contribution

Residential Distance to High-voltage Power Lines and Risk of Neurodegenerative

Diseases: a Danish Population-based Case-Control Study

Patrizia Frei, Aslak Harbo Poulsen*, Gabor Mezei, Camilla Pedersen, Lise Cronberg Salem,
Christoffer Johansen, Martin Röösli, and Joachim Schüz
* Correspondence to Aslak Harbo Poulsen, Danish Cancer Society Research Center, Danish Cancer Society, Strandboulevarden, 2100
Copenhagen Ø, Denmark (e-mail: aslak@cancer.dk).

Initially submitted March 22, 2012; accepted for publication July 23, 2012.

The aim of this study was to investigate the possible association between residential distance to high-voltage
power lines and neurodegenerative diseases, especially Alzheimer’s disease. A Swiss study previously found
increased risk of Alzheimer’s disease for people living within 50 m of a power line. A register-based case-control
study including all patients diagnosed with neurodegenerative diseases during the years 1994–2010 was con-
ducted among the entire adult population of Denmark. Using conditional logistic regression models, hazard ratios
for ever living close to a power line in the time period 5–20 years before diagnosis were computed. The risks for
developing dementia, Parkinson’s disease, multiple sclerosis, and motor neuron disease were not increased in
persons living within close vicinity of a power line. The risk of Alzheimer’s disease was not increased for ever living
within 50 m of a power line (hazard ratio = 1.04, 95% confidence interval: 0.69, 1.56). No dose-response according
to number of years of living within 50 m of a power line was observed, but there were weak indications of an
increased risk for persons diagnosed by the age of 75 years. Overall, there was little support for an association
between neurodegenerative disease and living close to power lines.

dementia; environmental exposure; magnetic fields; neurodegenerative diseases

Abbreviations: CI, confidence interval; CPR, Central Population Register; ELF-MF, extremely low frequency magnetic field(s);
HR, hazard ratio; ICD-10, International Classification of Diseases, Tenth Revision.

Transmission of electric power is a prerequisite of modern
life and gives rise to extremely low frequency (ELF) electric
and magnetic fields (MF) in the vicinity of power lines.
ELF-MF have been classified as “possibly carcinogenic” by
the International Agency for Research on Cancer because of
limited evidence in humans in relation to childhood leuke-
mia and inadequate evidence in experimental animal
studies, as well as a lack of a known biological mechanism
(1, 2). For noncancer endpoints, a 3- to 4-fold risk increase
for Alzheimer’s disease related to occupational exposure to
ELF-MF was suggested in an initial report by Sobel et al.
(3). Subsequent studies summarized in reviews and meta-
analyses on occupational ELF-MF exposure (4–6) found
less consistent results, but indications of an increased risk of
Alzheimer’s disease remained, with reported risks on the
order of 1.5–2 for exposure levels of ≥0.1 µT to ≥0.5 µT
(4). A Swedish study suggested that the increased risk might
be restricted to cases with disease onset by age 75 years (7),
which was confirmed in 2 subsequent studies (8, 9), and the
risk was found to be higher in men than in women (8). For
other neurodegenerative diseases, amyotrophic lateral scle-
rosis, the most frequent motor neuron disease, has been
quite consistently linked with electrical occupations (5, 6).
Even if an association were found in workers, extrapolation
to the general public would remain difficult—for example,
due to occupational coexposure to other potential risk
factors, particularly electric shocks (6).
Recently, the first study analyzing a possible association
between residential ELF-MF exposure and neurodegenera-
tive diseases was conducted in Switzerland (10). An
increased risk of Alzheimer’s disease was observed for
people living within 50 m of a high-voltage power line com-
pared with people living at a distance of ≥600 m, and risks
were highest for people who had lived within 50 m of a

970 Am J Epidemiol. 2013;177(9):970–978


power line for at least 15 years (hazard ratio (HR) = 2.00,
95% confidence interval (CI): 1.21, 3.33). However, the
study had to rely on information from death certificates, with
likely underreporting of neurodegenerative diseases. Fur-
thermore, it was not possible to take into account full resi-
dential histories, due to reliance on census data that were
collected only every 10 years. Because of the intriguing
Swiss findings for Alzheimer’s disease, independent replica-
tion became a key research priority, as recommended by the
World Health Organization (2) and the Scientific Committee
on Emerging and Newly Identified Health Risks (11). Our
aim in this study was to investigate the association between
residential distance to power lines and risk of neurodegener-
ative diseases, particularly Alzheimer’s disease, in Denmark,
using data that allowed an improved study design in compar-
ison with the original Swiss study.
MATERIALS AND METHODS
We conducted a register-based case-control study among
the entire adult population of Denmark (approximately 5.5
million inhabitants). Since 1968, the Central Population
Register (CPR) has assigned each Danish resident a personal
identification number (CPR number) at birth or on the date
of immigration, making it possible to track every resident in
and across all Danish registers.
Identification of cases and controls
Cases and controls were selected among all adult (aged
≥20 years) residents of Denmark (excluding Greenland and
the Faroe Islands) with a valid CPR number. Cases were
identified from the Danish Hospital Discharge Registry,
which was established by the Danish National Board of
Health in 1977 and in which more than 99% of all hospital-
izations for somatic diseases are registered (12), including
outpatients from 1994 onwards. The dates of admission and
discharge and up to 20 diagnoses per discharge, according
to a modified Danish version of the International Classifica-
tion of Diseases, Tenth Revision (ICD-10) (from 1994
onwards), are available for each patient. All persons hospi-
talized for the first time with a neurodegenerative disease
from January 1, 1994, to December 31, 2010, were defined
as cases. The following groups of neurodegenerative dis-
eases were defined: Alzheimer’s disease (ICD-10 codes F00
and G30), vascular dementia (ICD-10 code F01), other
dementia (ICD-10 codes F02, F03, A81.0, B22.0, G10, and
G31), Parkinson’s disease (ICD-10 code G20), multiple
sclerosis (ICD-10 code G35), and motor neuron disease
(ICD-10 code G12). Any person with 2 or more of the above
diagnoses was considered a case for all registered diagnoses.
Cases with dementia (Alzheimer’s disease, vascular demen-
tia, and other dementia) were included only if their first
diagnosis was made at the age of ≥65 years, because of dif-
ferences in etiology between very-early-onset (≤65 years)
dementia cases and later-onset dementia cases and because
dementia diagnoses in the registers have been validated pri-
marily in the elderly population (ages ≥65 years) so far (13).
For each case, 6 controls were randomly selected from the
CPR, individually matched by gender and date of birth (±30
Am J Epidemiol. 2013;177(9):970–978
Power Lines and Neurodegenerative Diseases 971
days). The controls had to be free of the disease and alive at
the date of diagnosis of the matched case. Information on
marital and vital status for cases and controls was extracted
from the CPR.
Residential history and geocoding of addresses
The residential history of all cases and controls from 1968
onwards was obtained from the CPR. The data set included
addresses and all dates of moving in and out. Because of
poor address quality before 1974 (mainly due to missing
house numbers), we chose to consider address history only
up to 20 years before diagnosis. Information on geographi-
cal coordinates, placed within the house or, where appli-
cable, the apartment (estimated deviation not more than
1–2 m), and number of floors in the building was obtained
from the Danish Building and Dwelling Register, which is
maintained by the Danish enterprise and construction
authority for 95.2% of the 2,044,842 relevant addresses.
Persons with a continuous geocoded address history dating
back to 20 years before diagnosis were included in the analy-
sis (94.2% of eligible cases and 89.1% of eligible controls).
Socioeconomic variables
On the basis of a 100- × 100-m grid cell net of Denmark
maintained by Statistics Denmark, we obtained information
on socioeconomic indicators for all addresses. Income was
provided as average disposable income per household in the
grid cell, and information on education was based on the
person with the highest level of education in the household.
Location of power lines
For all current and historical overhead power lines oper-
ated with alternating current at a voltage level of ≥132 kV,
we obtained the geographical location, the date of entering
service and, where appropriate, the date of termination of
operation from all 7 Danish transmission companies respon-
sible for these voltage levels. The majority of the power
lines were digitalized from orthophotos, and the accuracy of
these is estimated to be 3–5 m. For some historical lines, the
geographical coordinates were identified through land sur-
veying. The locations of the power lines were validated
against current maps of power lines in Denmark and, for a
sample of lines, historical maps of power lines. The mapped
grid totaled 4,336 km of current and historical power lines
(23.1% 400 kV, 0.9% 220 kV, 46.3% 150 kV, and 29.8%
132 kV). For lines for which only the year of entering and
exiting service was available (77.5%), we set the date of
entering service to December 31 and the date of termination
to January 1 to avoid erroneously classifying people as
exposed. For each address, we determined the shortest dis-
tance to any of the power lines. Geographical data were pro-
cessed in ArcGIS 9.3 (ESRI, Redlands, California).
Statistical analysis
Using conditional logistic regression, we calculated
hazard ratios and associated 95% confidence intervals for
972 Frei et al.

Table 1. Characteristics of Cases (at Diagnosis) With Neurodegenerative Disease and Controls in a Study of Residential Distance to High-
voltage Power Lines and Risk of Neurodegenerative Diseases, Denmark, 1994–2010

Diagnosis
Alzheimer’s Disease Vascular Dementia Other Dementia
No. of No. of No. of No. of No. of No. of
% % % % % %
Cases Controls Cases Controls Cases Controls
Total no. 20,575 113,217 10,207 55,969 68,752 376,897
Female gender 13,248 64.4 74,072 65.4 5,606 54.9 31,413 56.1 42,750 62.2 238,225 63.2
Mean age, years (SD) 81.0 (6.5) 81.1 (6.5) 80.6 (6.7) 80.7 (6.7) 82.5 (7.0) 82.6 (6.9)
Marital statusa
Missing datab 675 3.3 3,176 2.8 463 4.5 1,924 3.4 4,042 5.9 15,228 4.0
Never married 4,522 22.0 25,561 22.6 2,135 20.9 11,455 20.5 17,064 24.8 88,672 23.5
Ever marriedc 9,433 45.8 62,352 55.1 4,217 41.3 29,499 52.7 28,810 41.9 190,330 50.5
Married at diagnosis 5,945 28.9 22,128 19.5 3,392 33.2 13,091 23.4 18,836 27.4 82,667 21.9
Disposable income
First quartile 6,898 33.5 32,299 28.5 3,548 34.8 15,564 27.8 26,202 38.1 111,179 29.5
Second and third 9,403 45.7 57,042 50.4 4,856 47.6 28,512 50.9 30,905 45.0 189,712 50.3
quartiles (plus
missing data)d
Fourth quartile 4,274 20.8 23,876 21.1 1,803 17.7 11,893 21.2 11,645 16.9 76,006 20.2
% in highest
educational levele
<23.5 6,852 33.3 41,239 36.4 3,674 36.0 20,072 35.9 26,694 38.8 138,347 36.7
≥23.5–<36.0 (plus 6,517 31.7 37,664 33.3 3,325 32.6 18,938 33.8 21,192 30.8 125,431 33.3
missing data)f
≥36.0 7,206 35.0 34,314 30.3 3,208 31.4 16,959 30.3 20,866 30.3 113,119 30.0
No. of floors in
residential building
1 floor (plus missing 12,051 58.6 76,674 67.7 5,910 57.9 38,271 68.4 39,131 56.9 250,514 66.5
data)g
>1 floor 8,524 41.4 36,543 32.3 4,297 42.1 17,698 31.6 29,621 43.1 126,383 33.5
Urbanity of residence
Urban 17,140 83.3 85,680 75.7 8,373 82.0 42,029 75.1 56,683 82.4 285,738 75.8
Rural 3,435 16.7 27,537 24.3 1,834 18.0 13,940 24.9 12,069 17.6 91,159 24.2
Table continues

persons who had, during the time period of 5–20 years
before diagnosis, ever lived within a certain distance (in cat-
egories: <50 m, 50–<200 m, or 200–<600 m) of a power
line, compared with those who never did (considering the
closest category for each person). We estimated crude
hazard ratios as well as hazard ratios adjusted for relevant
confounders, which were collected for the address at which
the participant lived at diagnosis (listed in Table 1). To
investigate a potential dose-response relationship, we further
categorized exposure according to time of residency within
50 m of a power line. For better comparability with the
Swiss study (10), we also performed all analyses for only
220- to 400-kV lines using the same reference category as
for the main analyses (≥600 m from all ≥132-kV lines). We
also repeated the analyses taking into account exposure
during the whole time period of ≤20 years before diagnosis.
For Alzheimer’s disease, we performed secondary analyses
by age at diagnosis (65–75 years vs. >75 years) and by
gender. Because of remarkable changes in clinical dementia
practice in the past 2 decades owing to major advances in
the understanding of the pathophysiology of the disease and
in diagnostics and treatment (14), we investigated whether
the risk was different for more recently diagnosed Alz-
heimer’s disease cases. The validity of registered dementia
diagnoses in 2003 was shown to be high (14) and thereby
suitable for register-based epidemiologic studies about
dementia. On the basis of this knowledge, we used the year
2003 as a cutoff. Data were analyzed using SAS 9.2 (SAS
Institute Inc., Cary, North Carolina).
RESULTS
The numbers and characteristics of cases and controls at
the date of diagnosis are shown by disease in Table 1. More
cases than controls were married at the time of diagnosis.
More cases with dementia or Parkinson diagnoses tended to

Am J Epidemiol. 2013;177(9):970–978
 Power Lines and Neurodegenerative Diseases 973

Table 1. Continued
Diagnosis
Parkinson’s Disease Multiple Sclerosis Motor Neuron Disease
No. of No. of No. of No. of No. of No. of
% % % % % %
Cases Controls Cases Controls Cases Controls
Total no. 16,925 90,060 8,234 34,535 2,990 14,996
Female gender 7,452 44.0 40,825 45.3 5,547 67.4 23,562 68.2 1,375 46.0 7,239 48.3
Mean age, years (SD) 74.4 (10.1) 75.0 (9.6) 44.7 (13.2) 46.5 (13.5) 64.9 (13.0) 66.2 (12.3)
Marital statusa
Missing datab 839 5.0 3,024 3.4 880 10.7 3,065 8.9 212 7.1 441 2.9
Never married 2,416 14.3 14,224 15.8 1,805 21.9 6,677 19.3 343 11.5 2,290 15.3
Ever marriedc 7,397 43.7 47,983 53.3 4,297 52.2 20,556 59.5 1,014 33.9 9,120 60.8
Married at diagnosis 6,273 37.1 24,829 27.6 1,252 15.2 4,237 12.3 1,421 47.5 3,145 21.0
Disposable income
First quartile 4,477 26.5 20,822 23.1 1,325 16.1 4,942 14.3 531 17.8 2,800 18.7
Second and third 8,400 49.6 46,772 51.9 4,215 51.2 17,678 51.2 1,554 52.0 7,665 51.1
quartiles (plus
missing data)d
Fourth quartile 4,048 23.9 22,466 24.9 2,694 32.7 11,915 34.5 905 30.3 4,531 30.2
% in highest
educational levele
<23.5 5,755 34.0 29,659 32.9 2,091 25.4 8,675 25.1 835 27.9 4,384 29.2
≥23.5–<36.0 (plus 5,685 33.6 31,216 34.7 2,875 34.9 12,060 34.9 1,026 34.3 5,225 34.8
missing data)f
≥36.0 5,485 32.4 29,185 32.4 3,268 39.7 13,800 40.0 1,129 37.8 5,387 35.9
No. of floors in
residential building
1 floor (plus missing 11,498 67.9 64,754 71.9 6,047 73.4 26,492 76.7 2,232 74.6 11,399 76.0
data)g
>1 floor 5,427 32.1 25,306 28.1 2,187 26.6 8,043 23.3 758 25.4 3,597 24.0
Urbanity of residence
Urban 12,695 75.0 65,411 72.6 5,950 72.3 23,952 69.4 2,145 71.7 10,654 71.0
Rural 4,230 25.0 24,649 27.4 2,284 27.7 10,583 30.6 845 28.3 4,342 29.0

Abbreviation: SD, standard deviation.

a
Being in a registered partnership is considered equivalent to being married.
b
4.2% of data were missing.
c
But not married at the time of diagnosis.
d
1% of data were missing.
e
Percentage of persons with more than 12 years of education, grouped into 3 equal-sized groups.
f
1% of data were missing.
g
5.1% of data were missing.

be in the lowest income group compared with their controls,
which was not observed for multiple sclerosis and motor
neuron disease. The distribution of educational levels was
similar for cases and controls, except for Alzheimer’s
disease, where the proportion of cases in the highest educa-
tion group was higher than for the controls. Cases more
often lived in multistory apartment buildings and in urban
environments.
The risks of developing a neurodegenerative disease
according to distance from a 132- to 400-kV power line
are shown in Table 2. Overall, risks were not elevated for
people living closest (<50 m) to a power line. The risk of
Alzheimer’s disease for people living within 50 m of a
power line was 1.04 (95% CI: 0.69, 1.56). Results of analy-
ses considering only 220-kV and 400-kV power lines were
based on smaller numbers but were similar. The adjusted
hazard ratio for Alzheimer’s disease for people living within
50 m of a 220- or 400-kV power line was 1.31 (95% CI:
0.50, 3.46; n = 5). There was no dose-response according to
the number of years spent living within 50 m of a power line
for any of the diseases (Table 3). For Alzheimer’s disease,
the highest risk estimate was observed in the middle group
(between 5 and 9 years), and the risk for those living within
50 m of a power line for 10 or more years was slightly

Am J Epidemiol. 2013;177(9):970–978
974 Frei et al.
decreased. Results remained virtually unchanged when we
used the exposure window of ≤20 years before diagnosis
(data not shown).
Subgroup analyses on Alzheimer’s disease
With regard to Alzheimer’s disease, there was no differ-
ence in risk estimates between men and women; adjusted
hazard ratios for living within 50 m of a power line were
0.99 (95% CI: 0.53, 1.85) for men and 1.07 (95% CI: 0.63,
1.83) for women. Table 4 presents secondary analyses by
age at diagnosis and calendar year of diagnosis. The risk for
persons diagnosed at ages 65–75 years was increased for
those living within 50 m of a power line (adjusted
HR = 1.92, 95% CI: 0.95, 3.87), while among those diag-
nosed at a later age, the hazard ratio was slightly decreased
(HR = 0.81, 95% CI: 0.48, 1.34). In addition, the risk was
slightly increased for cases living within 50 m of a power
line diagnosed in 2003 or later, but those diagnosed earlier
had a decreased hazard ratio (n = 2). Restricting analyses of
age at diagnosis to persons diagnosed in 2003 or later
yielded a significantly increased risk for those diagnosed by
the age of 75 years (HR = 2.59, 95% CI: 1.17, 5.76), based
on 9 cases, and a risk close to 1 for those diagnosed after the
age of 75 years (Table 4).
DISCUSSION
The results of our population-based study do not suggest
an increased risk of developing neurodegenerative diseases
from living within close vicinity of a high-voltage power
line. Overall, the risk of Alzheimer’s disease was not
increased. There were some weak indications from second-
ary analyses of an increased risk for persons diagnosed by
the age of 75 years among people living within 50 m of a
power line, which became statistically significant when data
were restricted to cases diagnosed in 2003 or later, but with
the overall finding of no association, other subgroups also
yielded somewhat decreased risk estimates.
Strengths and limitations
The current study was register-based, covering the entire
Danish population, and therefore eliminated the problem of
selection bias. Although slightly more cases than controls
had a full address history up to 20 years before diagnosis
(94.2% vs. 89.1%), the exposure distribution for the cases
and controls for which we had partial address information
was similar to the distribution for cases and controls with
complete address histories (cases: 0.14% vs. 0.15% had ever
lived within 50 m of a power line; controls: 0.24% vs.
0.17%). We had individual information on relevant con-
founders such as socioeconomic variables and very accurate
address information for determination of the geographical
coordinates.
Our study provides improvements over the Swiss study
(10) in several respects. Our results were based on hospital-
ization data rather than information from death certificates,
where underreporting of neurodegenerative diseases can be
expected, especially for dementia diagnoses (15, 16). In
Denmark, it is legally possible to obtain reimbursement for
medication expenses only if the drug has been prescribed by
a neurologist; therefore, we would expect that only a few
patients with these diagnoses were not registered in the
Danish Hospital Discharge Registry. Additionally, we had
continuous information on the residential history of all study
participants, while census data collected every 10 years were
used for the Swiss study. This allowed us to calculate cumu-
lative exposure more precisely. We were able to take into
account a large time window for exposure (up to 20 years
before diagnosis). By doing this, we allowed for the fact that
the pathophysiological processes, especially for dementia
diseases, begin years before diagnosis. It has been suggested
that there is a temporal lag of about a decade between the
deposition of amyloid β and the clinical manifestation of
Alzheimer’s disease (17). Usually, cognitive symptoms
exist for a few years in dementia patients before admission
to a hospital (13); therefore, we excluded the time period of
5 years before diagnosis. Conducting the analyses using the
time frame ≤20 years before diagnosis yielded virtually the
same results. We put a lot of effort into identifying all
current and historical power lines with voltage levels of
≥132 kV.
While the validity of Parkinson’s disease diagnoses (18)
and dementia diagnoses (in the elderly population of
Denmark (evaluated in the year 2003 (13))) was found to be
quite high, the validity of dementia subtypes was shown to
be less reliable (13): 33% of Alzheimer’s disease cases in
2003 were misclassified as dementia without specification.
Nevertheless, for 81% of all patients recorded as having Alz-
heimer’s disease, the recorded diagnosis was correct. Thus,
the majority of our identified Alzheimer’s disease cases
would have been true cases of Alzheimer’s disease, which is
reassuring for the results. For vascular dementia, however,
only 18.5% of 27 cases recorded as vascular dementia were
confirmed as vascular dementia, with the rest being mainly
dementia without specification (48.1%) and Alzheimer’s
disease (22.2%); therefore, the results for vascular dementia
must be interpreted with caution.
A limitation of our study was the potential for exposure
misclassification. Distance to a power line is only a crude
proxy for exposure to magnetic fields (19), as the magnetic
field generated by power lines is determined by other
factors, including load characteristics and placement of
phases. However, a study in Denmark using personal mea-
surement devices found that the magnetic fields in resi-
dences near power lines (defined as <100 m from 400-kV
lines, <50 m from 132-/150-kV lines, and <25 m from 50-/
60-kV lines) were markedly higher than those in houses
farther away (geometric mean: 0.29 µT vs. 0.04 µT) (20).
Other potential sources of ELF-MF from power lines not
considered in this study were underground transmission
cables, overhead power lines with lower voltage (≤132 kV),
and transformer stations. In Denmark, most of the urban
Copenhagen area is served by underground cables. In most
situations, the field generated by an underground cable only
exceeds background levels within a few meters of the cable,
limiting the number of potentially exposed residences (21).
Therefore, although there will be some highly exposed resi-
dences among persons classified as living beyond 600 m
Am J Epidemiol. 2013;177(9):970–978
 Power Lines and Neurodegenerative Diseases 975

Table 2. Hazard Ratios for Neurodegenerative Disease Among Persons Who Had Ever Lived Within a Certain
Distance of 132- to 400-kV Power Lines in the Time Span 5–20 Years Before Diagnosis, Denmark, 1994–2010

Diagnosis and Distance Crude Adjustedb

No. of No. of
From 132- to 400-kV
Casesa Controls HR 95% CI HR 95% CI
Power Line, m

Alzheimer’s disease
0–<50 28 165 0.92 0.62, 1.37 1.04 0.69, 1.56
50–<200 184 1,178 0.85 0.73, 0.99 0.95 0.81, 1.12
200–<600 907 5,181 0.95 0.89, 1.03 1.05 0.98, 1.13
≥600 19,456 106,693 1 Referent 1 Referent
Vascular dementia
0–<50 11 82 0.75 0.40, 1.40 0.80 0.43, 1.52
50–<200 92 596 0.83 0.67, 1.04 0.94 0.75, 1.17
200–<600 420 2,558 0.89 0.80, 0.99 0.99 0.89, 1.11
≥600 9,684 52,733 1 Referent 1 Referent
Other dementia
0–<50 87 583 0.82 0.65, 1.02 0.93 0.74, 1.17
50–<200 591 3,770 0.85 0.78, 0.93 0.97 0.89, 1.06
200–<600 2,635 16,237 0.88 0.84, 0.92 0.97 0.93, 1.01
≥600 65,439 356,307 1 Referent 1 Referent
Parkinson’s disease
0–<50 35 179 1.03 0.71, 1.48 1.14 0.79, 1.64
50–<200 207 1,067 1.01 0.87, 1.17 1.07 0.92, 1.25
200–<600 819 4,650 0.92 0.85, 1.00 0.97 0.90, 1.05
≥600 15,864 84,164 1 Referent 1 Referent
Multiple sclerosis
0–<50 27 106 1.05 0.69, 1.61 1.03 0.67, 1.58
50–<200 200 775 1.05 0.89, 1.23 1.06 0.90, 1.24
200–<600 787 3,135 1.02 0.94, 1.11 1.03 0.95, 1.12
≥600 7,220 30,519 1 Referent 1 Referent
Motor neuron disease
0–<50 7 38 0.94 0.42, 2.10 0.80 0.34, 1.89
50–<200 45 227 0.96 0.69, 1.33 0.94 0.66, 1.32
200–<600 184 897 0.98 0.83, 1.16 0.97 0.81, 1.16
≥600 2,754 13,834 1 Referent 1 Referent

Abbreviation: CI, confidence interval; HR, hazard ratio.

a
Persons diagnosed with a neurodegenerative disease in Denmark during 1994–2010.
b
Adjusted for disposable income, education, urbanization category, number of floors in the residential building,
and marital status.

from a power line, they are likely to constitute a very small
percentage of the total reference population. We were not
able to investigate occupational exposures, which could
have constituted an additional source of ELF-MF exposure
for some of the study participants.
Comparison with previous studies and interpretation
Except for the Swiss study (10), most studies that have
investigated the relationship between exposure to ELF-MF
and neurodegenerative diseases have been conducted in occu-
pational settings. The direct comparison of residential studies
with occupational studies is generally limited because of
potential occupational coexposures and different exposure pat-
terns. Exposures in occupational settings are generally greater
than those in the general population (4, 6). In addition, while
exposure levels in residential settings can be expected to be
fairly constant, they might be more variable in occupational
settings. Since no established mechanism by which magnetic
fields could produce neurodegenerative diseases has been
identified so far (2, 22), it is unclear which aspect of exposure

Am J Epidemiol. 2013;177(9):970–978
976 Frei et al.

Table 3. Hazard Ratios for Neurodegenerative Disease According to Cumulative Duration of Residency Within 50 m of 132- to 400-kV Power
Lines in the Time Span 5–20 Years Before Diagnosis, Denmark, 1994–2010

Diagnosis and Cumulative Crude Adjustedb

Duration of Residency No. of No. of
Within 50 m of a 132- to Casesa Controls HR 95% CI HR 95% CI
400-kV Power Line, years

Alzheimer’s disease
≥10 11 95 0.60 0.32, 1.13 0.71 0.38, 1.33
5–9 10 31 1.64 0.80, 3.36 1.79 0.87, 3.68
<5 7 39 0.98 0.44, 2.19 1.08 0.48, 2.45
Always lived ≥600 m away 19,456 106,693 1 Referent 1 Referent
Vascular dementia
≥10 7 40 1.01 0.45, 2.26 1.14 0.50, 2.57
5–9 2 13 0.81 0.18, 3.60 0.96 0.21, 4.29
<5 2 29 0.39 0.09, 1.63 0.39 0.09, 1.63
Always lived ≥600 m away 9,684 52,733 1 Referent 1 Referent
Other dementia
≥10 44 317 0.76 0.56, 1.05 0.90 0.66, 1.25
5–9 18 122 0.81 0.49, 1.32 0.87 0.53, 1.43
<5 25 144 0.93 0.61, 1.42 1.01 0.66, 1.56
Always lived ≥600 m away 65,439 356,307 1 Referent 1 Referent
Parkinson’s disease
≥10 15 105 0.76 0.44, 1.31 0.86 0.50, 1.49
5–9 8 28 1.37 0.62, 3.02 1.40 0.63, 3.12
<5 12 46 1.44 0.75, 2.75 1.61 0.84, 3.08
Always lived ≥600 m away 15,864 84,164 1 Referent 1 Referent
Multiple sclerosis
≥10 2 20 0.43 0.10, 1.86 0.43 0.10, 1.86
5–9 3 23 0.47 0.14, 1.58 0.45 0.13, 1.51
<5 22 63 1.56 0.94, 2.59 1.54 0.93, 2.56
Always lived ≥600 m away 7,220 30,519 1 Referent 1 Referent
Motor neuron disease
≥10 3 20 0.81 0.24, 2.74 0.51 0.14, 1.86
5–9 1 6 0.87 0.10, 7.22 1.52 0.18, 13.10
<5 3 12 1.19 0.33, 4.22 1.14 0.30, 4.30
Always lived ≥600 m away 2,754 13,834 1 Referent 1 Referent

Abbreviations: CI, confidence interval; HR, hazard ratio.

a
Persons diagnosed with a neurodegenerative disease in Denmark during 1994–2010.
b
Adjusted for disposable income, education, urbanization category, number of floors in the residential building, and marital status.

is relevant for health, if any, and peak exposures might (for
example) be more influential than average exposures.
There was little evidence of an association between mag-
netic field exposure and Parkinson’s disease in occupational
settings and in the Swiss residential study (5, 6, 10), which
corresponds to our findings. Regarding motor neuron disease,
in the Swiss study (10) and a very recent Brazilian study (23),
no increased risks were observed, but the statistical power of
these studies was very limited because of few cases. The
occupational studies, however, found a more consistent link
between electrical occupations and motor neuron disease (5,
6). Confounding by electric shock has been discussed as a
potential explanation for the findings due to weaker evidence
of an association when magnetic field levels were measured
(6), but the evidence is controversial (9). A recent Danish
study did not find an increased risk of amyotrophic lateral
sclerosis for persons who had experienced an electric shock,
but the statistical power was low in that study as well (24).
With regard to Alzheimer’s disease or dementia, the results
of previous occupational studies are inconsistent but generally
indicate increased risks for stronger magnetic fields (4–6).
Associations for Alzheimer’s disease were found at levels of
≥0.1 µT to ≥0.5 µT (4). Residential exposures within 50 m of
a power line can be on the same order of magnitude: The

Am J Epidemiol. 2013;177(9):970–978
 Power Lines and Neurodegenerative Diseases 977

Table 4. Hazard Ratiosa for Diagnosis of Alzheimer’s Disease Among Persons Living Within 50 m of a 132- to 400-kV Power Line in the Time
Span 5–20 Years Before Diagnosis, According to Age at Diagnosis and Year of Diagnosis, Denmark, 1994–2010

Year of Diagnosis
Age at Diagnosis, <2003 ≥2003 All Years
years
No. of No. of No. of No. of No. of No. of
HR 95% CI HR 95% CI HR 95% CI
Casesb Controls Cases Controls Cases Controls

Crude
estimate
65–75 2 12 0.93 0.21, 4.17 9 23 2.08 0.96, 4.50 11 35 1.70 0.86, 3.35
>75 0 34 —c — 17 96 0.96 0.57, 1.60 17 130 0.71 0.43, 1.18
All ages 2 46 0.24 0.06, 0.99 26 119 1.18 0.77, 1.80 28 165 0.92 0.62, 1.37
Adjusted
estimated
65–75 2 12 0.85 0.18, 3.93 9 23 2.59 1.17, 5.76 11 35 1.92 0.95, 3.87
>75 0 34 —c — 17 96 1.09 0.65, 1.83 17 130 0.81 0.48, 1.34
All ages 2 46 0.26 0.06, 1.07 26 119 1.35 0.88, 2.08 28 165 1.04 0.69, 1.56

Abbreviations: CI, confidence interval; HR, hazard ratio.

a
Reference category: always having lived ≥600 m from a 132- to 400-kV power line.
b
Persons diagnosed with Alzheimer’s disease in Denmark during 1994–2010.
c
No risk calculation was possible because of missing cases.
d
Adjusted for disposable income, education, urbanization category, number of floors in the residential building, and marital status.

Danish company energinet.dk (Fredericia, Denmark), the Conclusions

owner of the electricity infrastructure in Denmark, has calcu-
lated magnetic field levels for the most common pylons with
average load currents in Denmark: For a 2-system 400-kV
line, calculated magnetic fields at a distance of 50 m from the
line were between 0.3 µT and 0.9 µT for optimal phase config-
urations and up to 1.1 µT for other configurations, and for a
132-kV line, they were approximately 0.1 µT with optimal
phase configurations and 0.3 µT with other configurations (21).
Potential work-related coexposures, such as exposure to sol-
vents, pesticides, and lead, were frequently discussed as poten-
tial confounders for dementia (4, 5).
In addition, Garcia et al. (4) found indications of publica-
tion bias, with larger studies on Alzheimer’s disease showing
a smaller degree of association than smaller studies. Unlike
suggestions in some studies (8, 25), we have not observed
risk differences between men and women for Alzheimer’s
disease. Regarding latency of the effects, the results of some
occupational studies indicate a rather late-acting influence in
the disease process, while other studies have found effects
for accumulated exposure throughout life (4, 7, 9, 25). The
Swiss study found increased risk estimates for persons living
within 50 m of a 220- to 380-kV power line for at least 15
years (HR = 2.00, 95% CI: 1.21, 3.33), indicating a cumula-
tive effect (10). In the present study, we did not observe
such a risk increase for people living close to power lines for
at least 10 years. As suggested by occupational studies in
Sweden (7–9), we found indications that age of onset might
play a role. The proportion of patients with relatively early
Alzheimer’s disease onset might have been increased in the
Swiss study, since underreporting of dementia diagnoses on
death certificates increases with the age of the deceased
(15, 16), which could be a potential explanation for the risk
increase found in the Swiss study.
Overall, we did not observe an increased risk of neurode-
generative diseases among persons living close to power lines.
Our study therefore confirms the findings of a previous study
(10) of no association for Parkinson’s disease, multiple sclero-
sis, motor neuron disease, vascular dementia, and other types
of dementia. Furthermore, it does not confirm the finding of
an increased risk of Alzheimer’s disease. Given the high
quality and representativeness of our study, this is reassuring,
since together the studies provide little evidence that living
close to a power line increases the risk of any neurodegenera-
tive disease. We found some weak suggestions that ELF-MF
exposure might increase the risk of Alzheimer’s disease when
diagnosed by the age of 75 years, although those subgroup
analyses must be interpreted with care given the overall
finding of no association. If the latter observed association
were causal, ELF-MF exposure would explain 5 (0.02%) of
the Alzheimer’s disease cases in our study population.
ACKNOWLEDGMENTS
Author affiliations: Danish Cancer Society Research Center,
Danish Cancer Society, Copenhagen, Denmark (Patrizia Frei,
Aslak Harbo Poulsen, Camilla Pedersen, Christoffer Johansen);
Environment Department, Electric Power Research Institute,
Palo Alto, California (Gabor Mezei); Memory Disorders
Research Group, Department of Neurology, Copenhagen Uni-
versity Hospital, Rigshospitalet, Denmark (Lise Cronberg
Salem); Department of Epidemiology and Public Health,
Swiss Tropical and Public Health Institute, University of
Basel, Basel, Switzerland (Patrizia Frei, Martin Röösli); and

Am J Epidemiol. 2013;177(9):970–978
978 Frei et al.
Section of Environment and Radiation, International Agency
for Research on Cancer, Lyon, France (Joachim Schüz).
This work was supported by a fellowship for prospective
researchers awarded by the Swiss National Science Founda-
tion (stipend PBBSP3-133396) to P.F. A.H.P. was supported
by a stipend for doctoral students from the Danish Graduate
School in Public Health Science. All other authors contrib-
uted to this work on the basis of their respective core budget
positions. Additional funding was provided by the Electric
Power Research Institute to the Danish Cancer Society
Research Center (contract EP-P38793/C17252).
We thank Rikke Baastrup for support with the address
data, Nick Martinussen for help in the preparation of the
data, the power-line companies for providing data on the
locations of their power lines, Kasper Grue Understrup of
the Danish National Board of Health for providing data on
cases and controls, and Henrik Hobel of DM Partner A/S
(Copenhagen, Denmark) for providing geocodes. Special
thanks go to Martin Hertach for supporting our analyses
involving ArcGIS with his excellent expertise.
Conflict of interest: none declared.
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