National Health Interview Survey (NHIS) Mortality among US Farmers and Pesticide Applicators
-
Upload
philip-hebert -
Category
Documents
-
view
20 -
download
3
description
Transcript of National Health Interview Survey (NHIS) Mortality among US Farmers and Pesticide Applicators
National Health Interview Survey (NHIS)
Mortality among US Farmers and Pesticide Applicators
Orlando Gomez-Marin, Fangchao Ma , Lora E. Fleming, David Lee
Dept of Epidemiology and Public Health
University of Miami School of Medicine
Miami, FL
Outline
• Background
• Objectives
• Methods
• Results
• Conclusions
• Recommendations
Background: Pesticides & Health
• Pesticides & Human Health– Acute Disease– Chronic Disease??
• Occupational Exposed Groups– Manufacturers– Farmers– Pesticide Applicators
Background: Mortality Risks
Farmers & Pesticide Applicators Mortality Tobacco & Ethanol Diseases
– Cardiovascular disease– COPD
Accidents Neurologic Diseases Respiratory & Infectious Diseases
Background: Cancer Risk
Farmers• Skin• Stomach• Brain• Prostate• Multiple Myeloma• Leukemia
Pesticide Applicators• Skin• Stomach• Brain• Testicular • Soft Tissue Sarcoma• Non Hodgkins Lymphoma
Background: Methodologic Issues
Farmers & Pesticide Applicators
• Healthy Worker Effect
• Small sample sizes
• Variable populations by geography
• Inadequate exposure assessment
• Variable exposures
Background
National Health Interview Survey (NHIS)
• Multi-purpose household survey
• Probability sampling
• US civilian non-institutionalized population
• Conducted Annually since 1957
• 95-98% Response rate
Background
National Health Interview Survey (NHIS)
• Annual national estimates on disease, injury, impairment, disability, and related issues on a uniform basis for the entire US population
Background
National Health Interview Survey (NHIS)
• Aggregate Morbidity Data
– Cross-Sectional Study & Trend Analysis
• Periodic Supplements on subpopulations
• Mortality Follow Up through 1995
– Longitudinal Mortality Data
– Retrospective Cohort Study
Objectives
Use the NHIS Mortality Follow Up to Assess Overall & Cause-Specific Mortality
• Farmers & Pesticide Applicators vs Other US Workers
• Farmers vs Pesticide Applicators
MethodsNational Health Interview Survey (NHIS)• Probability sampling of the US Population• 1986-1994: > 450,000 US workers > 18 yrs • Employment status during the 2 weeks prior
to interview for all persons > 18 years • Standardized Occupational & Industry Codes
• Farmers and Pesticide Applicators• Morbidity & Mortality (ICD 9)
– Acute & Chronic Conditions
Methods
National Health Interview Survey (NHIS)• Mortality Follow Up through
– National Death Index (NDI) linkage – January 1, 1986 through December 31, 1995– Computerized Linkage algorithm
• Match class & score• 97% complete• > 18 yrs
V ariablesIden tification:• N CHS Pe rsonal iden ti fier• B asi c (statistical) we ightD emograph ics:• Gen de r• M on th/Ye ar of B irth• M ain racial back groun d• Hispan ic OriginL ocation:• Geograph ic Re gion• T ype of Res idence (Urb an/ru ral)S ocio-Econ omic• E du cation years com pleted• Fam ily In com eHealth :• Heal th status• Height• We igh t• A ctivity lim itation• Re stri cte d activity• B e d days• D octor vi s its• Hospital s tays• A cute an d Ch ronic con dition s (associated wi th disabil ity days, doctor vi s its an d/or hospitali zation s)Occu pation :• E m ploym ent status in p ast 2 week s• C lass of work er• Occu pation (with recode s)• W ork-loss days in p ast 2 week s• A t work at time of accident/injuryVi tal S tatus:• Pe rsonal Iden tifier for lin kage• Qu ality of m atchin g score• Assum ed Al ive/Dead• M on th/year of death• Un de rlyin g cau se of death• Oth er con ditions
Analytic sample size of employed adults by Ethnicity/Race, Gender and Age Group - NHIS 1986-94
EthnicityStudy Year
FemalesAge Group
MalesAge Group
Total
Total MortalityFollow-up18-44 45-64 65+ Total 18-44 45-64 65+ Total
African-American1986198719881989199019911992199319941986-1994
158631493019276329282770279424912505
24005
544107411291001104310501032908
10008781
53119118118114
87116115105945
218343424266388240853907364235143610
33431
137026182478230923722181231920182054
19719
471927969871885873821746810
7373
6896
10587
114115
857265
671
190936413552326733713169322528362929
27899
409279837818714974567076716763506539
61630
400478187650696473016884692361666353
60063Aleut/Native Amer
1986198719881989199019911992199319941986-1994
87101134111122129147129154
1114
202541483839533756
357
153544535
35
108131178164164172205169215
1506
89132149125153162157139164
1270
344347493948724148
421
423342643
31
127177199177196212235184215
1722
235308377341360384440353430
3228
230300371331352371428345415
3143Cuban-American
1986198719881989199019911992199319941986-1994
559089727879966779
705
112935454739643634
340
165447
1032
42
67125129121129125170106115
1087
599593897771
1338185
783
335452406146
1052635
452
688
1137976
65
98157153140141124247114126
1300
165282282261270249417220241
2387
165278279254266242409210238
2341
Analytic sample size of employed adults by Ethnicity/Race, Gender and Age Group - NHIS 1986-94
EthnicityStudy Year
FemalesAge Group
MalesAge Group
Total
Total MortalityFollow-up18-44 45-64 65+ Total 18-44 45-64 65+ Total
African-American1986198719881989199019911992199319941986-1994
158631493019276329282770279424912505
24005
544107411291001104310501032908
10008781
53119118118114
87116115105945
218343424266388240853907364235143610
33431
137026182478230923722181231920182054
19719
471927969871885873821746810
7373
6896
10587
114115
857265
671
190936413552326733713169322528362929
27899
409279837818714974567076716763506539
61630
400478187650696473016884692361666353
60063Aleut/Native Amer
1986198719881989199019911992199319941986-1994
87101134111122129147129154
1114
202541483839533756
357
153544535
35
108131178164164172205169215
1506
89132149125153162157139164
1270
344347493948724148
421
423342643
31
127177199177196212235184215
1722
235308377341360384440353430
3228
230300371331352371428345415
3143Cuban-American
1986198719881989199019911992199319941986-1994
559089727879966779
705
112935454739643634
340
165447
1032
42
67125129121129125170106115
1087
599593897771
1338185
783
335452406146
1052635
452
688
1137976
65
98157153140141124247114126
1300
165282282261270249417220241
2387
165278279254266242409210238
2341
Number of Deaths and Person-Years Among Employed Adults by Ethnicity/Race/Gender - NHIS 1986-94
Deaths Person-Years*
EthnicityStudy Year
Females Males Total Females Males Total
African-American1986198719881989199019911992199319941986-1994
76125101
806838321614
550
138221167123129
77562912
952
214346268203197115884526
1502
19907357293097024351217541687313201
85075247
176539
1727829523254782032617860135591083767904246
145897
3718665252564474467739614304322403915298
9493322437
Aleut/Eskimo/Native Amer1986198719881989199019911992199319941986-1994
565230022
25
6137555232
48
111912785254
73
990106712931024875716698405306
7374
11561429144110921044
871803450314
8598
2146249727342116191915861501855619
15972Cuban-American
1986198719881989199019911992199319941986-1994
2021111109
688620702
39
88
10731812
48
6291045954750686256572249165
5305
90512851107
874762227831266180
6436
15342329206116241448483
1403515345
11741
Total Number of Employed Adults, Deaths and Person-Years by Occupation and Gender - NHIS 1986-94
Number Deaths Person-Years*
Occupation Female Male Total Female Male Total Female Male TotalExecutive, Administrative and Managerial 26408 37135 63543 264 854 1118 132231 191749 323981
Professional Specialty 35187 30930 66117 301 539 840 176917 157699 334615
Technicians and Related Support 8138 8109 16247 59 122 181 41250 40706 81956
Sales 26913 26386 53299 293 660 953 139308 134321 273629
Administrative Support, Including Clerical 58277 14735 73012 630 356 986 305104 75432 380536
Private Household 3347 157 3504 112 7 119 18134 860 18994
Protective Service 1299 6602 7901 15 173 188 6416 33323 39738
Service , Except Protective and Household 34343 16879 51222 542 483 1025 177430 85632 263062
Farming, Forestry and Fishing 2406 11399 13805 43 455 498 12691 59325 72016
Precision Production, Craft and Repair 4993 47968 52960 61 1039 1100 26322 252676 278997
Machine Operators, Assemblers and Inspectors 13982 19595 33577 201 419 620 75702 102775 178477
Transportation and Material Moving 1989 18154 20143 26 512 538 10156 94403 104559
Handlers, Equipment Cleaners, Helpers and Laborers 3693 14279 17972 41 315 356 19198 74530 93727
Unknown (includes New Workers) 6696 6627 13323 152 170 322 26169 23713 49882
Military 23 107 130 0 1 1 138 635 772
Example of Hypothesis
Pesticide Applicators & Farmers will have
Prostate Cancer Risk– Sample Size Sufficient– Detect Risk Ratio of 1.54 – At an Alpha level of 0.05, with 90% Power
S a m p le S ize o f Pesticide Applicators, d e a th s a n d p e rso n-y e a rs , b y G en d e r a n d S tu d y Y e ar - N H IS 1 9 86 -9 4
N um be r D e a ths P e rso n-Ye a rs *
S tu dyYe a r
F e m a le s M a le s T o ta l F e m a le s M a le s T o ta l F e m a le s M a le s T o ta l
P e s tic ideA p p lic a tio n
1 9 8 61 9 8 71 9 8 81 9 8 91 9 9 01 9 9 11 9 9 21 9 9 31 9 9 41 9 8 6-1 9 94
1 3 82 6 22 5 62 1 82 1 02 0 32 5 61 9 11 9 2
1 9 2 6
6 091 1 0 41 0 8 21 0 1 69 399 12
1 0 4 47 538 18
8 2 7 7
7 4 71 3 661 3 381 2 341 1 491 1 151 3 009 4 41 0 101 0 20 3
657464300
3 5
5 19 15 34 23 73 33 81 2
43 6 1
5 79 66 04 64 33 74 11 2
43 9 6
1 2 712 1 361 8 571 4 041 1 21
8 748 764 682 74
10 2 81
5 39 08 87 37 79 06 36 45 01 03 96 33 55 71 84 41 20 9
4 4 00 1
66 6 01 10 0 996 4 777 6 961 3 148 3 744 3 423 1 214 8 3
5 42 8 2
Statistical Methods• Create Database
– Exclude: Unemployed, <18 yrs, inadequate data– Link Annual Survey Data & Mortality Follow up
(1986-95)• Due to the multi-stage sampling design
– Adjustments for sample weights & design effects – SUDAAN Statistical Package – Further adjustment of sample weights for analysis of
data from combined survey years (Botman1995)• Mortality analyses
– Cox Regression models (SUDAAN Proc Survival)
Results
All Workers
• 450,540 persons > 18 yrs
• 8304 deaths
• 209,908 (46.6%) women
• Mean age+SD = 38.9+12.9 years.
Results
Farmers
N 4783
Deaths 250
Women 798 (16.7%)
Mean Age 49.7+15.4 **
Pest. Appltors All Other Workers
4790 440,967
128 7926
946 (19.8%) 208,164 (47.2%)
38.2+14.9** 38.8+12.8**
** p<0.001
ResultsOverall and Cause-specific Number
of Deaths by Occupation and Gender
Pesticide Farmers Other
M F M F M F
All Deaths 116 12 228 22 5372 2554
Infectious disease 4 0 2 0 316 75
Heart disease 36 6 105 7 1822 716
Respiratory Disease 2 0 8 1 252 131
Nervous System 1 0 1 0 43 24
MVA/Accidents 10 1 18 4 435 138
Results Cancer -specific Number of
Deaths by Occupation and Gender Pesticide Farmers Other M F M F M F
Overall cancer 41 3 71 9 1713 1131 Nervous system 2 0 2 2 72 35 Digestive 9 0 18 2 460 211 Respiratory 10 0 20 0 294 264 Breast
0 0 0 1 1 263 Prostate 9 -- 8 -- 120 -- Genital 9 1 8 0 122 124 Urinary 0 0 3 0 71 17 Lymphatic&Hematopoietic 3 1 10 2 182 100
Results Pesticide Exposed vs Other
Age Adjusted RR (95% CI)
Disease Male Female Total
Overall Mortality 1.0 (0.9-1.1) 0.8 (0.6-1.2) 1.0 (0.9-1.1)
Infectious 0.5 (0.2-1.1) * 0.4 (0.2-1.0)
Heart 0.9 (0.8-1.2) 1.0 (0.6-1.7) 0.9 (0.8-1.1)
Respiratory 0.6 (0.3-1.1) 0.4 (0.1-2.8) 0.5 (0.3-1.0)
Nervous System 0.6 (0.2-2.7) * 0.6 (0.1-2.5)
MVA/Accidents 1.8 (1.3-2.6) 3.9 (1.6-9.4) 2.0 (1.4-2.8)
Results Pesticide Exposed vs Other
Age Adjusted RR (95% CI)
Disease Male Female Total
Overall Cancer 0.9 (0.7-1.1) 0.6 (0.3-1.1) 0.9 (0.7-1.0)
Nervous 0.9 (0.3-2.8) 2.8 (0.7-11.4) 1.2 (0.5-2.8)
Digestive 0.7 (0.5-1.0) 0.4 (0.1-1.7) 0.7 (0.5-1.0)
Respiratory 0.7 (0.5-1.0) * 0.6 (0.4-0.9)
Breast * 0.2 (0.1-1.6) *
Prostate 1.1 (0.6-2.0) * *
Genital 1.1 (0.6-2.0) * 1.3 (0.8-2.2)
Urinary 0.8 (0.2-3.2) * 0.7 (0.2-3.0)
Lymphatic/Hemato 1.3 (0.7-2.3) 1.6 (0.5-5.2) 1.3 (0.8-2.2)
ResultsFarmers vs Pesticide Applicators
Age Adjusted RR (95% CI)
Disease Male Female Total
Overall Mortality 0.8 (0.6-1.0) 1.0 (0.5-2.1) 0.8 (0.6-1.0)
Infectious 0.3 (0.1-1.2) * 0.3 (0.1-1.2)
Heart 1.0 (0.7-1.5) 0.6 (0.2-2.1) 0.9 (0.6-1.4)
Respiratory 1.6 (0.3-8.7) * 2.1 (0.4-11.1)
Nervous System 0.2 (0.0-3.9) * 0.3 (0.0-4.5)
MVA/Accidents 0.8 (0.4-1.9) 2.9 (0.3-31.4) 1.0 (0.5-2.2)
Results Farmers vs Pesticide Applicators
Age Adjusted RR (95% CI)
Disease Male Female Total
Overall Cancer 0.7 (0.5-1.2) 1.7 (0.5-5.7) 0.8 (0.5-1.2)
Nervous 0.9 (0.1-11.4) * 1.5 (0.2-11.3)
Digestive 0.8 (0.3-2.1) * 0.9 (0.4-2.3)
Respiratory 0.7 (0.3-1.6) * 0.7 (0.3-1.6)
Breast * * *
Prostate 0.4 (0.1-1.1) -- --
Genital 0.4 (0.1-1.1) * 0.4 (0.1-1.1)
Urinary * * *
Lymphatic/Hemato 0.9 (0.3-3.5) 1.8 (0.2-14.6) 1.1 (0.3-3.4)
Limitations• Healthy worker effect
• Lack of individual exposure measures – Confounding– Pesticide exposure
• Relatively small numbers of deaths
However, use of the US worker pop. as the major comparison population is appropriate for issues of the healthy worker effect and other biases
Conclusions
NHIS population-based sample of US workers
• Farmers & Pesticide Applicators vs Other Workers Cardiovascular disease Tobacco-related diseases Infectious diseases Motor vehicles & accidents
• Farmers vs Pesticide Applicators Aging Farmers
Conclusions
All Pesticide Exposed Workers
• Men Motor vehicles & accidents Lymphocytic/Hematopoietic Cancer
• Women Motor vehicles & accidents Lymphocytic/Hematopoietic Cancer Nervous system
ConclusionsFarmers vs Pesticide Applicators• Age adjustment• Pesticide applicators
Infectious & Nervous system diseases disease Respiratory, Male genital, Prostate cancer mortality
• Farmers Respiratory disease Nervous system cancer mortality
• Women Farmers Motor vehicles & accidents Lymphocytic/Hematopoietic Cancer
Recommendations
National Health Interview Survey (NHIS): Research Potential
• Probability sampling of the US Population
• Mortality Follow Up– Pesticide-exposed worker Example
• Aggregate Morbidity Data
• Supplemental surveys
Acknowledgments• Data
– Inter-University Consortium for Political & Social Research
– US Dept of Health & Human Services – National Center for Health Statistics
• Funding– National Institute of Occupational Safety & Health
(NIOSH)-funded Deep South Agricultural Center (University of South Florida)