Journal
AMERICAN JOURNAL OF EPIDEMIOLOGY
Volume 173, Issue 1, Pages 71-83Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwq323
Keywords
agriculture; healthy worker effect; mortality; neoplasms; pesticides; wounds and injuries
Categories
Funding
- Association of Schools of Public Health/Centers for Disease Control
- National Institute for Occupational Safety and Health
- National Institutes of Health
- National Institutes of Health, National Institute of Environmental Health Sciences [Z01-ES049030]
- National Institutes of Health National Cancer Institute [Z01-CP010119]
- NATIONAL CANCER INSTITUTE [Z01CP010119, ZIACP010119] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES [Z01AI000732] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES [ZIAES045005, ZIAES049030, Z01ES049030, ZIAES043012] Funding Source: NIH RePORTER
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Comparing agricultural cohorts with the general population is challenging because the general healthiness of farmers may mask potential adverse health effects of farming. Using data from the Agricultural Health Study, a cohort of 89,656 pesticide applicators and their spouses (N = 89, 656) in North Carolina and Iowa, the authors computed standardized mortality ratios (SMRs) comparing deaths from time of the enrollment (1993-1997) through 2007 to state-specific rates. To compensate for the cohort's overall healthiness, relative SMRs were estimated by calculating the SMR for each cause relative to the SMR for all other causes. In 1,198,129 person-years of follow-up, 6,419 deaths were observed. The all-cause mortality rate was less than expected (SMRapplicators = 0.54, 95% confidence interval (CI): 0.52, 0.55; SMRspouses = 0.52, 95% CI: 0.50, 0.55). SMRs for all cancers, heart disease, and diabetes were significantly below 1.0. In contrast, applicators experienced elevated numbers of machine-related deaths (SMR = 4.15, 95% CI: 3.18, 5.31), motor vehicle nontraffic accidents (SMR = 2.80, 95% CI: 1.81, 4.14), and collisions with objects (SMR = 2.12, 95% CI: 1.25, 3.34). In the relative SMR analysis for applicators, the relative mortality ratio was elevated for lymphohematopoietic cancers, melanoma, and digestive system, prostate, kidney, and brain cancers. Among spouses, relative SMRs exceeded 1.0 for lymphohematopoietic cancers and malignancies of the digestive system, brain, breast, and ovary. Unintentional fatal injuries remain an important risk for farmers; mortality ratios from several cancers were elevated relative to other causes.
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