Poisoning and associated factors to death from pesticides: case-control study, Brazil, 2017. / Intoxicações e fatores associados ao óbito por agrotóxicos: estudo caso controle, Brasil, 2017.

BACKGROUND: Pesticide poisoning causes high morbidity and mortality. Surveillance is required for post-marketing monitoring of these products. AIM: To assess poisonings and associated factors with lethality by pesticides. METHOD: This is a case-control study based on the cases of pesticide poisoning assisted in 2017 by Brazilian Poison Control Centers. Patients who died were the cases and the survivors, the control. The odds ratio (OR) of death and 95% confidence interval (CI) were calculated. From the regression model, a predictive model of death was developed, stratified by age, gender and occupational context to investigate the risk of agricultural workers poisoned by extremely hazardous agents. RESULTS: 3,826 patients poisoned by pesticides were identified, of which 146 died. Older people (OR = 4.94; 95%CI 2.49 - 9.80), males (OR = 1.68; 95%CI 1.15 - 2.46), agricultural workers (OR = 2.20; 95%CI 1.15 - 4.24), suicide attempts (OR = 13.27; 95%CI 6.48 - 27.19) and exposure to extremely hazardous products (OR = 2.77; 95%CI 1.84 - 4.16) odds of death from pesticide poisoning. CONCLUSION: Out of 100 pesticides poisoning, four died. Elderly, males, working in the agricultural sector, suicide attempts and extremely hazardous products had a higher risk of death.

Intoxicações e fatores associados ao óbito por agrotóxicos: estudo caso controle, Brasil, 2017 / Poisoning and associated factors to death from pesticides: case-control study, Brazil, 2017

Resumo: Introdução: As intoxicações por agrotóxicos causam elevada morbimortalidade. A vigilância é necessária da produção até o uso desses produtos. Objetivo: Analisar as intoxicações e os fatores associados à letalidade por agrotóxicos. Método: Trata-se de estudo caso controle baseado nos atendimentos de intoxicação por agrotóxicos realizados em 2017 por centros de informação e assistência toxicológica do Brasil. Pacientes que evoluíram a óbito compuseram o grupo caso, e os sobreviventes, o grupo controle. Calculou-se odds ratio (OR) dos fatores de risco para óbito, com intervalo de confiança (IC) de 95%. Com base no modelo de regressão, desenvolveu-se um modelo preditivo de morte, estratificado por faixa etária, sexo e contexto ocupacional, para investigação do risco dos trabalhadores agropecuários intoxicados por agentes extremamente tóxicos. Resultados: Identificaram-se 3.826 pacientes intoxicados por agrotóxicos, dos quais 146 evoluíram para óbito. Idosos (OR = 4,94; IC95% 2,49 - 9,80), homens (OR = 1,68; IC95% 1,15 - 2,46), trabalhadores do setor agropecuário (OR = 2,20; IC95% 1,15 - 4,24), tentativas de suicídio (OR = 13,27; IC95% 6,48 - 27,19) e exposição a produtos extremamente tóxicos (OR = 2,77; IC95% 1,84 - 4,16) apresentaram mais chances de óbito nas intoxicações por agrotóxicos. Conclusão: Em cada 100 intoxicações por agrotóxicos, quatro evoluíram para óbito. Idosos, homens, trabalho no setor agropecuário, tentativas de suicídio e produtos extremamente tóxicos apresentaram mais chances de óbito.

ABSTRACT: Background: Pesticide poisoning causes high morbidity and mortality. Surveillance is required for post-marketing monitoring of these products. Aim: To assess poisonings and associated factors with lethality by pesticides. Method: This is a case-control study based on the cases of pesticide poisoning assisted in 2017 by Brazilian Poison Control Centers. Patients who died were the cases and the survivors, the control. The odds ratio (OR) of death and 95% confidence interval (CI) were calculated. From the regression model, a predictive model of death was developed, stratified by age, gender and occupational context to investigate the risk of agricultural workers poisoned by extremely hazardous agents. Results: 3,826 patients poisoned by pesticides were identified, of which 146 died. Older people (OR = 4.94; 95%CI 2.49 - 9.80), males (OR = 1.68; 95%CI 1.15 - 2.46), agricultural workers (OR = 2.20; 95%CI 1.15 - 4.24), suicide attempts (OR = 13.27; 95%CI 6.48 - 27.19) and exposure to extremely hazardous products (OR = 2.77; 95%CI 1.84 - 4.16) odds of death from pesticide poisoning. Conclusion: Out of 100 pesticides poisoning, four died. Elderly, males, working in the agricultural sector, suicide attempts and extremely hazardous products had a higher risk of death.

Overall and cause-specific mortality in a cohort of farmers and their spouses.

OBJECTIVES: Lower mortality rates compared with the general population have been reported for Agricultural Health Study (AHS) participants (enrolled 1993-1997) followed through 2007. We extended analysis of mortality among AHS participants (51 502 private pesticide applicators, their 31 867 spouses and 4677 commercial pesticide applicators from North Carolina and Iowa) through 2015 and compared results using several analytical approaches. METHODS: We calculated standardised mortality ratios (SMRs), causal mortality ratios (CMR) and relative SMRs (rSMR) using state-specific mortality rates of the general populations as the referent. RESULTS: Over the average 16 years of follow-up (1999-2015), 9305 private applicators, 3384 spouses and 415 commercial applicators died. SMRs and CMRs, with expected deaths calculated using the person-time among the cohort and the general population, respectively, indicated lower overall mortality in all study subgroups (SMRs from 0.61 to 0.69 and CMRs from 0.74 to 0.89), although CMRs indicated elevated mortality in private applicators from North Carolina and in ever-smokers. In SMR analyses, there were fewer than expected deaths from many causes, but deaths from some external causes including transportation-related injuries and mechanical forces were elevated in private applicators. CMRs indicated higher than expected deaths from prostate cancer, lymphohaematopoietic cancers, Parkinson's and Alzheimer's disease, and chronic glomerulonephritis in private applicators, and non-Hodgkin's lymphoma in spouses (from 1.19 to 1.53). rSMR results were generally elevated, similar to CMR findings. CONCLUSIONS: AHS participants experienced lower overall mortality than the general population.Mortality from a few specific causes was increased in private applicators, specifically when CMR and rSMR approaches were used.

Farming and mortality rates attributed to non-Hodgkin's lymphoma in Taiwan.

Previous studies suggested an elevated risk of non-Hodgkin's lymphoma (NHL) among farmers. To date, no apparent study examined the association between farming and NHL in Asian countries. The aim of this study was to investigate whether farmers in Taiwan exhibited an increased risk of mortality attributed to NHL. To this end, a mortality odds ratio (MOR) study was conducted to estimate the relative risk of mortality attributed to NHL for farmers in Taiwan. Data on the decedents enrolled in this investigation were derived from the death certificate database for the period 1997-2009. The study group comprised individuals who died from NHL and who were 50 years or older. The control group consisted of subjects who died from all other causes, excluding cancers, in the corresponding age group. Multiple logistic regression analysis was performed to compute the MOR, with adjustments for gender, age at death, year of death, marital status, and urbanizational levels. Among 32,456 deceased farmers, 205 died due to NHL. Farmers were found to have a nonsignificantly higher MOR than nonfarmers. This risk estimate is similar to estimates in previous meta-analyses. The MOR for NHL was higher among farmers who died 65 years or older than among those who died at younger ages. The findings indicate that farming in Taiwan may increase the risk of death attributed to NHL. Exposure to pesticides might be an influential factor contributing to high risk of mortality attributed to NHL among farmers and therefore needs to be further investigated.

Non-Hodgkin lymphoma among Brazilian agricultural workers: A death certificate case-control study.

To estimate the non-Hodgkin lymphoma (NHL) mortality risk among agricultural workers in Brazil's southern states, we used death certificates to identify cases of NHL between the ages of 20 and 69 years from residents of nonurban municipalities between 1996 and 2005 (n = 1,317). Controls were randomly selected from those whose underlying cause of death did not include neoplasm or hematological diseases and paired with cases by sex, age, year of death, and state of residence (n = 2,634). Odds of being an agricultural worker among cases and controls were estimated by conditional logistic regression, stratified and adjusted by sex, state, education, and race. An increased risk of death by NHL was observed among agricultural workers 20-39 years old (ORadj = 2.06; 95% CI 95%, 1.20-3.14). Our results suggest that the young agricultural workers from southern Brazil were more likely to die of NHL compared to nonagricultural workers.

Desigualdades en la mortalidad por enfermedades cardiovasculares en los municipios del Eje Cafetero, 2009-2011 / Inequalities in mortality by cardiovascular diseases in the Colombian Coffee Growing Region, 2009-2011

Introducción. El impacto de la mortalidad por enfermedades cardiovasculares requiere medir la relación entre las condiciones socioeconómicas locales y estas causas de muerte. Objetivo. Determinar la desigualdad en la mortalidad por enfermedades cardiovasculares en los municipios del Eje Cafetero (2009-2011). Materiales y métodos. Se hizo un estudio ecológico en el que se comparó la mortalidad por enfermedades cardiovasculares (hipertensivas, isquémicas, cerebrovasculares) en los municipios con base en su situación económica. Los datos de mortalidad y el índice de necesidades básicas insatisfechas se obtuvieron de las estadísticas vitales del Departamento Administrativo Nacional de Estadística (DANE), en tanto que el producto interno bruto municipal per cápita se calculó para el estudio. Los índices de desigualdad empleados se calcularon por rangos y en modelos de regresión, así como con los índices de concentración, y de Theil, utilizando el programa Epidat 3.1. Resultados. El riesgo de morir por enfermedad isquémica e hipertensiva resultó mayor en los municipios con el mayor índice de necesidades básicas insatisfechas. La mortalidad por enfermedad hipertensiva también tendió a concentrarse en dichos municipios. Se encontraron más muertes por enfermedad hipertensiva en los municipios con menor producto interno bruto per cápita en 2009 y 2010, y por enfermedad isquémica, en 2010 y 2011. No obstante, este indicador no mide la brecha entre las comunidades pobres. Conclusiones. Se carece de indicadores de desigualdad desagregados a nivel de municipio. Los sugeridos con este propósito se calculan para el nivel nacional y departamental, lo que no favorece la caracterización de las desigualdades sociales en salud a nivel territorial.

Introduction: The impact of mortality from cardiovascular diseases requires the measurement of the relationship between the local socioeconomic conditions and these death causes. Objective: To determine the inequality in mortality from cardiovascular diseases in the municipalities of the Colombian Coffee Growing Region (2009-2011). Materials and methods: We conducted an ecological study to compare the mortality from cardiovascular diseases (hypertensive, ischemic, cerebrovascular) in municipalities and their economic situation. Mortality rates and the index of unsatisfied basic needs were obtained from the Colombian Departamento Administrativo Nacional de Estadística (DANE) vital statistics, while the municipal gross domestic product per capita was estimated for this study. The inequality indices were calculated using regression models, and concentration and Theil indices with Epidat 3.1. Results: The death risk resulting from ischemic or hypertensive diseases was greater in those municipalities with a higher index of unsatisfied basic needs. Mortality due to hypertensive disease tended to concentrate in municipalities with a higher level of unsatisfied basic needs. The municipalities with a lower gross domestic product showed a higher rate of deaths due to hypertensive disease in years 2009 and 2010, and due to ischemic disease in years 2010 and 2011. Nevertheless, this indicator does not measure the gap existing among poor communities. Conclusions: Disaggregated inequality indicators at municipal level are lacking. Suggested indicators are estimated only for country and provincial levels and they do not favor the characterization of health social inequalities at territorial level.

Ética sobre el envenenamiento ofídico en el paisaje agrario de Guatemala / Ethics of snakebite envenoming in agrarian landscapes of Guatemala

El envenenamiento ofídico es una enfermedad accidental, no infecciosa o contagiosa, causada por los efectos de los venenos de serpientes de las familias Viperidae, Elapidae y Colubridae. Esta enfermedad representa un problema de salud pública a nivel mundial, afectando principalmente a los trabajadores agrícolas. A pesar de derivarse de una relación ecológica antagónica natural entre humanos y serpientes el accidente ofídico es moralmente juzgado como algo malo. En tal sentido, el examen de esta relación supone un componente ético. En el presente ensayo se discute cuál es el significado moral de las serpientes venenosas bajo las perspectivas antropocentrista y biocentrista. Se abordan los temas de riesgo ocupacional y vulnerabilidad del trabajador agrícola a la enfermedad, se elabora sobre las causas de la desatención de esta enfermedad y se reflexiona sobre cuál es la responsabilidad ética del estado, del empresario y del consumidor, en la existencia de ésta enfermedad. Finalmente se discute el papel de la epidemiología social, como una herramienta generadora de información útil para la comprensión de la realidad multidimensional del envenenamiento ofídico.

Snakebite envenoming is an accidental, non-infectious, non-contagious disease, caused by the effects of snake venoms. This disease is a relevant worldwide public health problem in tropical countries. Agricultural workers are highly exposed and therefore, commonly affected. The occurrence of snake envenoming involves some ethics concerns. In this assay, the moral significance of venomous snakes under anthropocentric and biocentric perspectives is discussed. Occupational risk and vulnerability of agricultural workers are also addressed. The ethical roles of government, agricultural enterprises and consumers in the occurrence of the disease are analyzed to try to explain why snakebite envenoming is a neglected disease. Finally, the role of the emerging social epidemiology as the contributor factor to gain involvement of stakeholders ‒which should be responsible for mitigation, prevention, treatment and control of snakebite envenoming‒ is discussed.

The AGRIculture and CANcer (AGRICAN) cohort study: enrollment and causes of death for the 2005-2009 period.

OBJECTIVE: To elaborate and describe a large prospective agricultural cohort including males and females in France with various agricultural activities and to study causes of death. METHODS: To date, few large prospective cohorts have been conducted among agricultural population. AGRIculture and CANcer cohort is a large prospective cohort of subjects in agriculture studying cancer among active and retired males and females, farm owners and workers, living in eleven areas of France with a population-based cancer registry. RESULTS: Enrollment was conducted from 2005 to 2007 with a postal questionnaire. In January 2008, 180,060 individuals (54 % males, 54 % farm owners, 50 % retired) were enrolled. Mortality was studied until December 2009 (605,956 person-years with standardized mortality ratio (SMR) by comparison with the general population of the areas. Over this period, 11,450 deaths 6,741 in men and 4,709 in women were observed, including 3,405 cancer-related deaths. SMRs were significantly reduced for global mortality (SMR = 0.68, 95 % CI 0.67-0.70 in males and SMR = 0.71, 95 % CI 0.69-0.73 in females) and for death by cancer (SMR = 0.67, 95 % CI 0.65, 0.70 in males and SMR = 0.76, 95 % C: 0.71, 0.80 in females). These results were mainly explained by less frequent smoking-related causes of death (lung cancer, cardiovascular diseases). Nonsignificant excesses of death were observed only for rheumatoid arthritis and arthrosis, suicides (in females), death for event of undetermined intent (in males) and breast cancer in male agricultural workers. CONCLUSIONS: These first results are the first ones obtained in France based on a large prospective agricultural cohort showing that farmers would be in healthier condition than the general population.

Brain cancer mortality in an agricultural and a metropolitan region of Rio de Janeiro, Brazil: a population-based, age-period-cohort study, 1996-2010.

BACKGROUND: Individuals who live in rural areas are at greater risk for brain cancer, and pesticide exposure may contribute to this increased risk. The aims of this research were to analyze the mortality trends and to estimate the age-period-cohort effects on mortality rates from brain cancer in two regions in Rio de Janeiro, Brazil. METHODS: This descriptive study examined brain cancer mortality patterns in individuals of both sexes, >19 years of age, who died between 1996 and 2010. They were residents of a rural (Serrana) or a non-rural (Metropolitan) area of Rio de Janeiro, Brazil. We estimated mortality trends using Joinpoint Regression analysis. Age-period-cohort models were estimated using Poisson regression analysis. RESULTS: The estimated annual percentage change in mortality caused by brain cancer was 3.8% in the Serrana Region (95% confidence interval (CI): 0.8-5.6) and -0.2% (95% CI: -1.2-0.7) in the Metropolitan Region. The results indicated that the relative risk was higher in the rural region for the more recent birth cohorts (1954 and later). Compared with the reference birth cohort (1945-49, Serrana Region), the relative risk was four times higher for individuals born between 1985 and 1989. CONCLUSIONS: The results of this study indicate that there is an increasing trend in brain cancer mortality rates in the rural Serrana Region in Brazil. A cohort effect occurred in the birth cohorts born in this rural area after 1954. At the ecological level, different environmental factors, especially the use of pesticides, may explain regional disparities in the mortality patterns from brain cancers.

Agricultural exposures and stroke mortality in the Agricultural Health Study.

Exposures associated with common agricultural activities may increase risk of stroke. The authors evaluated associations between self-reported agricultural activities including pesticide use and handling of crops and stroke mortality among 51,603 male pesticide applicators enrolled in the Agricultural Health Study (AHS). Vital status was obtained through 2008. Stroke mortality was defined by underlying or contributing cause of death (ICD-9 430-438, ICD-10 I60-I69). Information regarding lifetime pesticide use, working with crops or animals, engagement in other agricultural activities, and potential confounders was self-reported at enrollment. Cox proportional hazards models, with age as the time scale, were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) adjusted for state of residence, smoking status, and alcohol consumption. Median follow-up time was 13 yr, during which 308 stroke deaths occurred. No measure of overall or specific pesticide use was positively associated with mortality due to stroke. Stroke mortality was inversely associated with handling hay, grain, or silage at least once each year as reported at enrollment (HR: 0.75; 95% CI: 0.58, 0.98). There was no evidence of an association between pesticide use and stroke mortality. The inverse association between handling of hays and grains and stroke mortality may be due to (1) those engaging in such activities being healthier than those who did not or (2) exposure to some biological agent present in hays and grains. Further investigation of incident stroke, rather than stroke mortality, as well as stroke subtypes, is needed to determine the full role of agricultural exposures and stroke.

Mortalidade por intoxicacao ocupacional relacionada a agrotoxicos, 2000-2009, Brasil / Occupational pesticide poisoning mortality, 2000-2009, Brazil / Occupational pesticide poisoning mortality, 2000-2009, Brazil / Mortalidad por intoxicacion ocupacional relacionada con agrotoxicos, 2000-2009, Brasil

OBJETIVO: Estimar o coeficiente de mortalidade por intoxicações ocupacionais relacionadas aos agrotóxicos no Brasil. MÉTODOS: Utilizaram-se dados do Sistema de Informações sobre Mortalidade de 2000 a 2009 referentes aos diagnósticos de intoxicação por agrotóxicos, T60.0-T60.4, T60.8 e T60.9, X48, Y18, e Z578 da CID-10, para a causa básica ou associadas; a natureza ocupacional foi identificada pelo registro no campo <acidente de trabalho>, <circunstância do óbito> e se a <ocupação> era na agropecuária. Foram excluídos homicídios e suicídios. Para cálculo da mortalidade, o número de trabalhadores da agropecuária foi obtido do Instituto Brasileiro de Geografia e Estatística, projeções do Sistema de Contas Nacionais. RESULTADOS: Foram encontrados registros de 2.052 óbitos por intoxicação por agrotóxicos no Brasil, dos quais 36,2% (n = 743) não continham dados sobre a ocupação. Dentre os 1.309 restantes, 679 (51,9%) eram trabalhadores da agropecuária. A mortalidade por intoxicação ocupacional por agrotóxicos caiu de 0,56/100.000 (2000 a 2001) para 0,39/100.000 (2008 a 2009) entre trabalhadores no período, maior queda entre os homens que entre as mulheres. Os homens tiveram maiores estimativas de mortalidade por esse tipo de intoxicação em todos os anos. A maior parte dos óbitos foi causada por agrotóxicos do tipo organofosforados e carbamatos. O número de óbitos por esse tipo de intoxicação declinou em todas as regiões, exceto no Nordeste. CONCLUSÕES: É necessária a melhoria dos registros das declarações de óbito, em especial da ocupação e da relação dos diagnósticos com o trabalho, fundamentais para o controle e prevenção ...

OBJETIVO: Estimar el coeficiente de mortalidad por intoxicaciones ocupacionales relacionadas con agrotóxicos en Brasil MÉTODOS: Se utilizaron datos del Sistema de Informaciones sobre Mortalidad de 2000 a 2009 sobre los diagnósticos de intoxicación por agrotóxicos, T60.0-T60.4, T60.8 y T60.9, X48, Y18, y Z578 de la CID-10, para la causa básica o asociadas; la naturaleza ocupacional fue identificada por el registro en el campo [accidente en el trabajo], [circunstancia de óbito] y si la [ocupación] era en agropecuaria. Se excluyeron homicidios y suicidios. Para el cálculo de mortalidad, el número de trabajadores de la agropecuaria fue obtenido del Instituto Brasileño de Geografía y Estadística, proyecciones del Sistema de Cuentas Nacionales. RESULTADOS: Se encontraron registros de 2.052 óbitos por intoxicación por agrotóxicos en Brasil, de los cuales 36,2% (n=743) de los registros contenían datos sobre ocupación. Entre los 1.309 restantes, 679 (51,9% eran trabajadores de la agropecuaria). La mortalidad por intoxicación ocupacional por agrotóxicos cayó de 0,56/100.000 (2000 a 2001) a 0,39/100.000 (2008 a 2009) entre trabajadores en el período, mayor disminución entre hombres que entre las mujeres. Los hombres tuvieron mayores estimaciones de mortalidad por ese tipo de intoxicación en todos los años. La mayor parte de los óbitos fue causada por agrotóxicos de tipo organofosforados y carbamatos. El número de óbitos por este tipo de intoxicación declinó en todas las regiones, excepto en el Noreste. CONCLUSIONES: Es necesario mejorar los registros de las declaraciones de óbito, en especial, de la ocupación y de la relación de los diagnósticos con el trabajo, fundamentales para el control y prevención más adecuados para estos accidentes de trabajo. ...

OBJECTIVE: To estimate the mortality rate due to occupational pesticide poisoning in Brazil. METHODS: Data on diagnoses of death from pesticide poisoning between 2000 and 2009 were obtained from the Mortality Information System. ICD-10 codes T60.0-T60.4, T60.8 and T60.9, Y18, X487 and Z578 as the main or secondary cause of death; data on work-related deaths were obtained from the death certificate, from the fields <work related accident>, <circumstances of death> and whether cases were agricultural workers. Homicides and suicides were excluded. To calculate mortality, the number of agricultural workers was obtained from the Brazilian Institute of Geography and Statistics, National System of Accounts estimates. RESULTS: There were 2,052 deaths recorded as caused by pesticide poisoning in Brazil, between 2000 and 2009, of which 36.2% (n = 743) had no occupation data. Of the remaining 1,309, 679 (51.9%) were agricultural workers. Mortality from occupational pesticide poisoning declined from 0.56/100.000 (2000-2001) to 0.39/100.000 (2008-2009) workers during the study period, and there was a larger decrease among men compared with women. Males had a higher mortality from this type of poisoning than women in all study years. Most deaths were caused by organophosphates and carbamate pesticides poisoning. During the study period the number of cases declined in all regions, except for the Northeast. CONCLUSIONS: Improvement in the quality of Death Certificate records is needed, particularly for occupation and the assessment of causes of death as work related, crucial for work injuries control and prevention programs. Special attention is required in the Northeast region. .

Análise da contribuição das variáveis meteorológicas no estresse térmico associada à morte de cortadores de cana-de-açúcar / Analysis of the contribution of meteorological variables to thermal stress associated with death among sugarcane cutters

Os cortadores de cana-de-açúcar exercem atividade muito pesada e em condições precárias de trabalho. Além disso, fatores ambientais podem ser um importante agravante à sobrecarga térmica desses trabalhadores. Neste artigo, analisa-se a condição atmosférica no dia da morte de 14 trabalhadores do corte de cana-de-açúcar no Estado de São Paulo, Brasil. Compara-se valores estatísticos históricos da temperatura, umidade, vento e radiação com os valores destas variáveis meteorológicas observadas no dia de cada óbito. Os dados atmosféricos foram obtidos da reanálise do National Center for Environmental Prediction/National Center for Atmospheric Research (NCEP/NCAR). Em 10 dos 14 casos analisados, as temperaturas observadas nos dias dos óbitos foram maiores ou iguais à média somada ao desvio-padrão. Em seis desses casos o valor da temperatura atingiu ou ficou muito próxima do recorde histórico. Constatou-se que a condição atmosférica pode ser um fator importante a ser considerado na análise das condições gerais de trabalho dos cortadores de cana-de-açúcar.

Sugarcane cutters perform heavy work under adverse conditions. Environmental factors can be an aggravating factor for thermal stress among these workers. This study analyzed the atmospheric conditions on the day of death of 14 sugarcane cutters in São Paulo State, Brazil. Historical data for temperature, humidity, wind, and sunlight were compared with the same meteorological variables on the days the deaths that occurred. The meteorological data were obtained from a reanalysis of the National Center for Environmental Prediction/National Center for Atmospheric Research (NCEP/NCAR). In 10 of the 14 cases, the temperature on the day of death was higher than or equal to the mean plus the standard deviation. In six of these cases, the temperature reached or came close to record levels. These findings suggest that atmospheric conditions can be an important factor in the analysis of overall work conditions for sugarcane cutters.

Mortality patterns of Australian male farmers and farm managers.

OBJECTIVE: To compare the all-cause and specific-cause death rates of Australian male farmers and farm managers aged 25-74 years, with other Australian men. METHODS: Data were extracted from the Australian Bureau of Statistics Death Registration Collection covering the calendar years of 1999-2002. Denominator data for male farmers and farm managers were drawn from the 2001 Australian Population Census. Direct age-standardized death rates were calculated and compared with the general Australian male population. RESULTS: The 4025 male farmers or farm managers who died in this period represented 3.35% of all male deaths in the 25-74 year age range. The all-cause death rate for farmers and farm managers (730/100,000) was 33% higher than that of the Australian male population of the same age (549/100,000) (standardized mortality ratio (SMR)=1.33). Causes of death related to neoplasms (SMR=1.37), circulatory disease (SMR=1.40) and all external causes (SMR=1.37), were all statistically higher than the comparison population. Within these groupings, ischaemic heart disease (SMR=1.39), other circulatory disease (SMR=1.42), prostate cancer (SMR=2.40), lymphohaematopoietic cancer (SMR=1.80) and transport injuries (SMR=2.06), were all significantly higher. CONCLUSION: These data indicate that Australian male farmers and farm managers are a disadvantaged group in terms of health status. The elevated rates of all-cause and specific-cause mortality compared with the Australian comparison population, illustrate both the need and scope for further investigation of these issues.

[Comparison of the leukaemia incidence in two cohorts of farmers and traders in the Vercelli province of Italy, 2002-2009]. / Confronto delle incidenze di leucemia di due coorti d'agri- coltori e di commercianti della provincia di Vercelli dal 2002 al 2009.

This study aims to investigate the incidence of leukaemia between 2002 and 2009 (ICDIX 204-208) among farmers active in the Vercelli province (North West Italy), during the period: 1962-1991. The farmer cohort (14397 subjects, 78 cases) was compared with a retail trader cohort (4565 subjects, 11 cases) who were Vercelli province residents as well, but not exposed to the risk factors associated with professional farming. A proportional hazard Cox model shows among the farmers, an approximately double leukaemia incidence with respect to traders (Hazard Ratio = 1,90 P-value 0,043 IC95% 1,00-3,60). Moreover men's incidence appears approximately to double that of women (Hazard Ratio = 1,92 P-value 0,003 IC95% 1,25-2,95).

Mortality and cancer incidence among British agricultural pesticide users.

BACKGROUND: Although the acute effects of pesticides in humans are well known, uncertainty still exists about the health effects of chronic low-level exposure to pesticides. AIMS: To compare mortality and cancer incidence experienced by a cohort of British pesticide users to that of the Great Britain (GB) population. METHODS: The Pesticide Users Health Study (PUHS) comprises users of agricultural pesticides who have Certificates of Competence under the Control of Pesticides Regulations 1986. Participants were followed up between 1987 and 2004 (cancer incidence) or 2005 (mortality). Standardized mortality ratios (SMRs) and Standardized incidence ratios (SIRs) were estimated for outcomes of interest identified from the literature. RESULTS: Altogether, 62,960 pesticide users were followed up for 829,709 person-years (to 31 December 2005). Most participants were male (94%) and based in England (86%). All-cause mortality was lower for both men [SMR 0.58, 95% confidence interval (CI) 0.55-0.60] and women (SMR 0.71, 95% CI 0.52-0.98) compared to the GB population. Mortality and incidence were below those expected for all cancers combined among men (SMR 0.71, 95% CI 0.66-0.77; SIR 0.85, 95% CI 0.81-0.90), particularly for cancers of the lip, oral cavity and pharynx, digestive organs and respiratory system. The incidence of testicular cancer, non-melanoma skin cancer and multiple myeloma were above expected. Mortality from injury by machinery was significantly above expected for men (SMR 4.21, 95% CI 2.11-8.42). CONCLUSIONS: This study suggests that pesticide users in the PUHS are generally healthier than the national population but may have excesses of non-melanoma skin cancer, testicular cancer and multiple myeloma.

Mortality in the agricultural health study, 1993-2007.

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 (SMR(applicators) = 0.54, 95% confidence interval (CI): 0.52, 0.55; SMR(spouses) = 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.

Esophageal cancer among Brazilian agricultural workers: case-control study based on death certificates.

Several studies suggest that agricultural workers are at higher risk to develop and die by certain types of cancer. Esophageal cancer is not commonly listed among these types. However, some recent studies indicated that if there is an association between agricultural working and esophageal cancer, it s more likely to be observed among workers highly exposed to pesticides. In the present study, the magnitude of the association between agricultural working and esophageal cancer mortality was evaluated in a high pesticide use area in Brazil, through a death certificate-based case-control study. Cases were individuals from both genders, 30-59 years old, for whom basic cause of death was ascertained as cancer of the esophagus. For each case, one control was randomly selected from all possible controls for which the basic cause of death was ascertained as different from neoplasm and diseases of the digestive system. In addition, controls matched their cases by sex, age, year of death, and state of residence. Crude and adjusted odds ratios were then calculated to estimate the magnitude of the risk. Results showed that, in general, agricultural workers were at significantly higher risk to die by esophageal cancer, when compared to non-agricultural workers. Stratified analysis also revealed that the magnitude of such risk was slightly higher among illiterate agricultural workers, and simultaneous adjustment for several covariates showed that the risk was quantitatively higher among younger southern agricultural workers. These results suggest the esophageal cancer may be included among those types of cancer etiologically associated to agricultural working.

Disease prevalence and mortality among agricultural workers in Korea.

The aim of this paper was to provide an overview of mortality and disease prevalence related to occupational diseases among agricultural workers in Korea. We evaluated the age-standardized mortality rates and the prevalence of chronic diseases and compared them with those of other populations using death registration data from 2004 through 2008 and the 2005 Korean National Health and Nutrition Examination Survey. In addition, we conducted a literature review on published articles examining the health status of farmers in Korea. Agricultural workers have a significantly higher mortality of cancer, tuberculosis, chronic respiratory diseases, liver diseases, suicide, motor and non-motor vehicle accidents. Compared to other populations, farmers have higher prevalence rates of arthritis and intervertebral disc disorders. The literature review revealed a number of work-related diseases among farmers, such as musculoskeletal diseases, pesticide poisoning, infections, and respiratory and neurologic diseases. Korean farmers demonstrate a distinct pattern of mortality and disease prevalence compared to other populations. Although lifestyle factors remain important contributors to those deaths and diseases, our study suggests that occupation is a major determinant as well. Intensive programs such as surveillance systems, therefore, should be developed in order to identify and prevent work-related diseases among agricultural workers in Korea.

Pesticides and myocardial infarction incidence and mortality among male pesticide applicators in the Agricultural Health Study.

Acute organophosphate and carbamate pesticide poisonings result in adverse cardiac outcomes. The cardiac effects of chronic low-level pesticide exposure have not been studied. The authors analyzed self-reported lifetime use of pesticides reported at enrollment (1993-1997) and myocardial infarction mortality through 2006 and self-reported nonfatal myocardial infarction through 2003 among male pesticide applicators in the Agricultural Health Study. Using proportional hazard models, the authors estimated the association between lifetime use of 49 pesticides and fatal and nonfatal myocardial infarction. There were 476 deaths from myocardial infarction among 54,069 men enrolled in the study and 839 nonfatal myocardial infarctions among the 32,024 participants who completed the follow-up interview. Fatal and nonfatal myocardial infarctions were associated with commonly reported risk factors, including age and smoking. There was little evidence of an association between having used pesticides, individually or by class, and myocardial infarction mortality (e.g., insecticide hazard ratio (HR) = 0.91, 95% confidence interval (CI): 0.67, 1.24; herbicide HR = 0.74, 95% CI: 0.49, 1.10) or nonfatal myocardial infarction incidence (e.g., insecticide HR = 0.85, 95% CI: 0.66, 1.09; herbicide HR = 0.91, 95% CI: 0.61, 1.36). There was no evidence of a dose response with any pesticide measure. In a population with low risk for myocardial infarction, the authors observed little evidence of increased risk of myocardial infarction mortality or nonfatal myocardial infarction associated with the occupational use of pesticides.

Mortality and morbidity among farmers, nonfarming rural men, and urban referents: a prospective population-based study.

A cohort of 1,220 farmers, 1,130 nonfarming rural men, and 1,087 urban referents from Sweden were monitored for 12 years. Farmers had lower mortality than urban referents for all causes of death (hazard ratio [HR] = 0.51; 95% confidence interval [CI], 0.37-0.71), cancer (HR = 0.44; 95% CI, 0.24-0.78) and cardiovascular diseases (HR = 0.60; 95% CI, 0.36-0.99). Nonfarming rural men had lower mortality than urban referents for all causes of deaths (HR = 0.81; 95% CI, 0.70-0.94). Farmers and nonfarming rural men had significantly lower morbidity risks of cancer and of psychiatric disorders than urban referents. Farmers had significantly lower risk of endocrine disorders, cardiovascular disorders, and respiratory disorders. In general, morbidity was lower among nonfarming rural men compared with urban referents and was even lower among farmers. Urban referents had, however, significantly less musculoskeletal disorder morbidity. An urban-rural factor and a farming occupational or lifestyle factor results in lower mortality and morbidity rates except concerning musculoskeletal disorders.