Farm residence and lymphohematopoietic cancers in the Iowa Women's Health Study

The Health and Well-Being of Women in Farming: A Systematic Scoping Review

OBJECTIVES

Health and well-being have long been identified as key issues for investigation within agricultural communities. While myriad studies have been conducted to investigate causation, impact, outcomes and interventions among farming populations, the overall emphasis has been disproportionately weighted away from the experiences of women. This systematic scoping review determines the prevalence of topics, identifies the target populations and geographical locations of studies, outlines methodological approaches to the subject area, and summarizes the key findings and conclusions of the available literature.

METHODS

With the guidance of the Arksey and O'Malley framework for conducting a scoping review, a single database search for publications focusing on the health and well-being of women in farming (including primary farmers, members of farm households, and farmworkers), in the Global North, published between 1990 and 2023, was conducted. Data were organized, thematically coded, critically appraised and analyzed using the systematic review online tool CADIMA.

RESULTS

In total, 93 studies met the inclusion criteria for full review. The majority of studies were conducted in the United States, with the number of publications steadily increasing since the 1990s. Of studies, 68% were wholly quantitative in nature, and 23% wholly qualitative. Key findings suggest women are at particular risk from certain illnesses associated with some aspects of agricultural work and face a number of stressors (including gender-specific issues) that can lower well-being, but evidence is scarce in a number of areas. Clear gaps in research exist in relation to reproductive health, caring responsibilities, or help-seeking and support. Women primary farmer and farmworkers are particularly neglected as study cohorts.

CONCLUSION

Numbers of studies related to the health and well-being of women in farming are still relatively small in comparison with the wider body of related literature, and there exists an obvious need for further studies with a specific emphasis on particular cohorts, issues pertaining to the contemporary climate, and issues specific to women, as well as greater geographical reach. By emphasizing such research gaps, opportunities exist to improve the health and well-being situation of women in agriculture through more explicit studies with the intention of developing more effective, targeted solutions.

Evaluating the accuracy of satellite-based methods to estimate residential proximity to agricultural crops

BACKGROUND

Epidemiologic investigations increasingly employ remote sensing data to estimate residential proximity to agriculture as a means of approximating individual-level pesticide exposure. Few studies have examined the accuracy of these methods and the implications for exposure misclassification.

OBJECTIVES

Compare metrics of residential proximity to agricultural land between a groundtruth approach and commonly-used satellite-based estimates.

METHODS

We inspected 349 fields and identified crops in current production within a 0.5 km radius of 40 residences in Idaho. We calculated the distance from each home to the nearest agricultural field and the total acreage of agricultural fields within a 0.5 km buffer. We compared these groundtruth estimates to satellite-derived estimates from three widely used datasets: CropScape, the National Land Cover Database (NLCD), and Landsat imagery (using Normalized Difference Vegetation Index thresholds).

RESULTS

We found poor to moderate agreement between the classification of individuals living within 0.5 km of an agricultural field between the groundtruth method and the comparison datasets (53.1-77.6%). All satellite-derived estimates overestimated the acreage of agricultural land within 0.5 km of each home (average = 82.8-148.9%). Using two satellite-derived datasets in conjunction resulted in substantial improvements; specifically, combining CropScape or NLCD with Landsat imagery had the highest percent agreement with the groundtruth data (92.8-93.8% agreement).

SIGNIFICANCE

Residential proximity to agriculture is frequently used as a proxy for pesticide exposure in epidemiologic investigations, and remote sensing-derived datasets are often the only practical means of identifying cultivated land. We found that estimates of agricultural proximity obtained from commonly-used satellite-based datasets are likely to result in exposure misclassification. We propose a novel approach that capitalizes on the complementary strengths of different sources of satellite imagery, and suggest the combined use of one dataset with high temporal resolution (e.g., Landsat imagery) in conjunction with a second dataset that delineates agricultural land use (e.g., CropScape or NLCD).

Incidence and Risk Factors of Acute Leukemias in Armenia: A Population-Based Study

OBJECTIVE

Leukemia represents a serious public health concern as the incidence is increasing worldwide. In this study we aimed to describe the epidemiological profile of acute lymphoblastic (ALL) and myeloid (AML) leukemia, identify disease clusters and find association with possible risk factors.

METHODS

Data on leukemia cases were provided by the National Institute of Health of the Republic of Armenia for the period of 2012-2018. Age-standardized incidence rate was calculated using Segi World Population. SaTScan purely spatial analysis was applied to find leukemia clusters. To find association between leukemia and agricultural and mining activities and demographic data Poisson regression model was used.

RESULTS

During the studied period 259 new cases of ALL and 478 AML were recorded. The age-standardized incidence rate was 1.5 and 1.9 per 100,000 inhabitants with male to female ratio of 0.97 and 1.1 for ALL and AML, respectively. No significant changes in ALL or AML incidence trends were found. For ALL significant cluster encompassing Shirak, Lori, Tavush and Armavir provinces of Armenia was identified, while Kotayk and Ararat was provinces with the highest incidence of AML. We found significant positive association of ALL with crop density, while no elevated risk estimates were found between AML and exposure variables.

CONCLUSION

Altogether, our results suggested that acute leukemias incidence in Armenia follows the pattern described for developing countries.

The spatial-temporal chemical footprint of pesticides in China from 1999 to 2018

The massive use of pesticides brings considerable environmental and human health impacts. This study conducted an overall assessment of the ecological impact of the extensive pesticide use in China from 1999 to 2018 through the Chemical Footprint (ChF) calculation. The results demonstrated that the primary ecological impacts caused by pesticides occurred in the most central and eastern regions in China, e.g., provinces of Shandong, Henan, Hubei, Anhui, and Jiangsu. The northeastern, some southern and central provinces, e.g., Heilongjiang, Jilin, Liaoning, Yunnan, Guangxi, Guangdong, Ningxia, and Shaanxi, got moderate impacts, whereas the northwest regions, e.g., Qinghai, Xinjiang, and Tibet, had much lighter impacts relatively. The agricultural soil in inland areas and surface sea waters in coastal provinces bore the major impacts of the pesticide pollution in China, shared above 80% of the ChF across all environmental compartments. Chlorpyrifos, pymetrozine, fenpropathrin, pyridaben, atrazine, etc., were the pesticides that had the greatest impacts on the ecosystem, which contributed over 95% of the total ChF of pesticides used in China, although the use amount of these pesticides accounted for less than 10% of the total use amount of all pesticides annually. The study also indicated that the overall ChF of pesticide use in China has been declining since 2010, which was corresponding with the control actions of highly hazardous pesticides, especially the elimination of high toxic organophosphorus insecticides during the past decade.

Pesticide use and risk of systemic autoimmune diseases in the Agricultural Health Study

BACKGROUND

Systemic lupus erythematosus (SLE) risk has been associated with pesticide use, but evidence on specific pesticides or other agricultural exposures is lacking. We investigated history of pesticide use and risk of SLE and a related disease, Sjögren's syndrome (SS), in the Agricultural Health Study.

METHODS

The study sample (N = 54,419, 52% male, enrolled in 1993-1997) included licensed pesticide applicators from North Carolina and Iowa and spouses who completed any of the follow-up questionnaires (1999-2003, 2005-2010, 2013-2015). Self-reported cases were confirmed by medical records or medication use (total: 107 incident SLE or SS, 79% female). We examined ever use of 31 pesticides and farm tasks and exposures reported at enrollment in association with SLE/SS, using Cox regression to estimate hazard ratios (HR) and 95% confidence intervals (CI), with age as the timescale and adjusting for gender, state, and correlated pesticides.

RESULTS

In older participants (>62 years), SLE/SS was associated with ever use of the herbicide metribuzin (HR 5.33; 95%CI 2.19, 12.96) and applying pesticides 20+ days per year (2.97; 1.20, 7.33). Inverse associations were seen for petroleum oil/distillates (0.39; 0.18, 0.87) and the insecticide carbaryl (0.56; 0.36, 0.87). SLE/SS was inversely associated with having a childhood farm residence (0.59; 0.39, 0.91), but was not associated with other farm tasks/exposures (except welding, HR 2.65; 95%CI 0.96, 7.35).

CONCLUSIONS

These findings suggest that some agricultural pesticides may be associated with higher or lower risk of SLE/SS. However, the overall risk associated with farming appears complex, involving other factors and childhood exposures.

Cancer and occupational exposure to pesticides: a bibliometric study of the past 10 years

Occupational exposure to pesticides has been identified as a major trigger of the development of cancer. Pesticides can cause intoxication in the individuals who manipulate them through either inhalation, ingestion, or dermal contact. Given this, we investigated the association between the incidence of cancer and occupational exposure to pesticides through a bibliometric analysis of the studies published between 2011 and 2020, based on 62 papers selected from the Scopus database. The results indicated an exponential increase in the number of studies published over the past decade, with most of the research being conducted in the USA, France, India, and Brazil, although a further 17 nations were also involved in the research on the association between cancer and pesticides. The principal classes of pesticides investigated in relation to their role in intoxication and cancer were insecticides, herbicides, and fungicides. The types of cancer reported most frequently were multiple myeloma, bladder cancer, non-Hodgkin's lymphoma, prostate cancer, leukemia, and breast cancer. Despite the known association between pesticides and cancer, studies are still relatively scarce in comparison with the global scale of the use of these xenobiotic substances, which is related to the increasing demand for agricultural products throughout the world.

Epidemiology of acute myeloid leukemia in Virginia: Excellent survival outcomes for patients in rural Appalachia

Background

Acute myeloid leukemia, the most common acute leukemia in adults, has a poor overall survival. Studies have suggested that certain socioeconomic factors such as living in a rural or farming area are associated with worse outcomes. Since 42% of acute myeloid leukemia patients seen in our academic center reside in a rural area, we have a unique opportunity to study outcomes of patients in rural versus urban settings.

Aim

This analysis evaluates the effect of geography and socioeconomic factors on the biology, treatment, and overall survival of patients with acute myeloid leukemia, with the goal of understanding health care disparities.

Methods and results

Patient characteristics, cytogenetic data, treatment history, and overall survival were collected and analyzed to identify differences between urban and rural residency. This cohort included 42% of patients who resided in a rural area at the time of acute myeloid leukemia diagnosis. There was no difference in overall survival between the cohorts. The 1 year overall survival for the entire cohort was 47.9%. There was no difference detected in rates of adverse cytogenetics between the rural and urban cohorts. Similar numbers of patients received induction chemotherapy or proceeded to allogeneic stem cell transplant between the cohorts.

Conclusions

This study highlights that similar outcomes can be achieved in rural and urban patients, suggesting that intensive efforts at telehealth, education, and collaboration with local oncology practices may be beneficial.

Challenging the concept of de novo acute myeloid leukemia: Environmental and occupational leukemogens hiding in our midst

Myeloid neoplasms like acute myeloid leukemia (AML) originate from genomic disruption, usually in a multi-step fashion. Hematopoietic stem/progenitor cell acquisition of abnormalities in vital cellular processes, when coupled with intrinsic factors such as germline predisposition or extrinsic factors such as the marrow microenvironment or environmental agents, can lead to requisite pre-leukemic clonal selection, expansion and evolution. Several of these entities have been invoked as "leukemogens." The known leukemogens are numerous and are found in the therapeutic, occupational and ambient environments, however they are often difficult to implicate for individual patients. Patients treated with particular chemotherapeutic agents or radiotherapy accept a calculated risk of therapy-related AML. Occupational exposures to benzene, dioxins, formaldehyde, electromagnetic and particle radiation have been associated with an increased risk of AML. Although regulatory agencies have established acceptable exposure limits in the workplace, accidental exposures and even ambient exposures to leukemogens are possible. It is plausible that inescapable exposure to non-anthropogenic ambient leukemogens may be responsible for many cases of non-inherited de novo AML. In this review, we discuss the current understanding of leukemogens as they relate to AML, assess to what extent the term "de novo" leukemia is meaningful, and describe the potential to identify and characterize new leukemogens.

Impact of residential mobility on estimated environmental exposures in a prospective cohort of older women

Longitudinal studies of environmental hazards often rely on exposure estimated at the participant's enrollment residence. This could lead to exposure misclassification if participants move over time.

Methods

We evaluated residential mobility in the Iowa Women's Health Study (age 55-69 years) over 19 years of follow-up (1986-2004). We assessed several environmental exposures of varying spatial scales at enrollment and follow-up addresses. Exposures included average nitrate concentrations in public water supplies, percent of agricultural land (row crops and pasture/hay) within 750 m, and the presence of concentrated animal feeding operations within 5 km. In comparison to gold standard duration-based exposures averaged across all residences, we evaluated the sensitivity and specificity of exposure metrics and attenuation bias for a hypothetical nested case-control study of cancer, which assumed participants did not move from their enrollment residence.

Results

Among 41,650 participants, 32% moved at least once during follow-up. Mobility was predicted by working outside the home, being a former/current smoker, having a higher education level, using a public drinking water supply, and town size of previous residence. Compared with duration-based exposures, the sensitivity and specificity of exposures at enrollment ranged from 94% to 99% and 97% to 99%, respectively. A hypothetical true odds ratio of 2.0 was attenuated 8% for nitrate, 9%-10% for agricultural land, and 6% for concentrated animal feeding operation exposures.

Conclusions

Overall, we found low rates of mobility and mobility-related exposure misclassification in the Iowa Women's Health Study. Misclassification and attenuation of hypothetical risk estimates differed by spatial variability and exposure prevalence.

Pesticide exposures for residents living close to agricultural lands: A review

BACKGROUND

Residents living close to agricultural lands might be exposed to pesticides through non-occupational pathways including spray drift and volatilization of pesticides beyond the treated area.

OBJECTIVE

This review aimed to identify and analyze scientific literature measuring pesticide exposure in non-farmworker residents living close to agricultural lands, and to suggest practical implications and needs for future studies.

METHODS

A review was performed using inclusion criteria to identify original articles of interest published between 2003 and 2018.

RESULTS

From the 29 articles selected in this review, 2 belonged to the same study and were grouped, resulting in a total of 27 studies. Seven studies assessed exposure to pesticides using environmental samples, 13 collected biological samples and 7 analyzed both. Nine studies included a reference group of residents living far from agricultural lands while 11 assessed the influence of the spraying season or spray events on pesticide exposures. Studies included in this review provide evidence that residents living near to agricultural lands are exposed to higher levels of pesticides than residents living further away.

DISCUSSION AND CONCLUSION

This review highlights that the following study design characteristics may be more appropriate than others to measure pesticide spray drift exposure in non-farmworker residents living close to agricultural lands: inclusion of a non-agricultural control group, collection of both biological and environmental samples with repeated sampling, measurements at different periods of the year, selection of numerous study sites related to one specific crop group, and measurements of pesticides which are specific to agricultural use. However, few studies to date incorporate all these characteristics. Additional studies are needed to comprehensively measure non-occupational pesticide exposures in this population in order to evaluate health risks, and to develop appropriate prevention strategies.

An algorithm for quantitatively estimating non-occupational pesticide exposure intensity for spouses in the Agricultural Health Study

Residents of agricultural areas experience pesticide exposures from sources other than direct agricultural work. We developed a quantitative, active ingredient-specific algorithm for cumulative (adult, married lifetime) non-occupational pesticide exposure intensity for spouses of farmers who applied pesticides in the Agricultural Health Study (AHS). The algorithm addressed three exposure pathways: take-home, agricultural drift, and residential pesticide use. Pathway-specific equations combined (i) weights derived from previous meta-analyses of published pesticide exposure data and (ii) information from the questionnaire on frequency and duration of pesticide use by applicators, home proximity to treated fields, residential pesticide usage (e.g., termite treatments), and spouse's off-farm employment (proxy for time at home). The residential use equation also incorporated a published probability matrix that documented the likelihood active ingredients were used in home pest treatment products. We illustrate use of these equations by calculating exposure intensities for the insecticide chlorpyrifos and herbicide atrazine for 19,959 spouses. Non-zero estimates for ≥1 pathway were found for 78% and 77% of spouses for chlorpyrifos and atrazine, respectively. Variability in exposed spouses' intensity estimates was observed for both pesticides, with 75th to 25th percentile ratios ranging from 7.1 to 7.3 for take-home, 6.5 to 8.5 for drift, 2.4 to 2.8 for residential use, and 3.8 to 7.0 for the summed pathways. Take-home and drift estimates were highly correlated (≥0.98), but were not correlated with residential use (0.01‒0.02). This algorithm represents an important advancement in quantifying non-occupational pesticide relative exposure differences and will facilitate improved etiologic analyses in the AHS spouses. The algorithm could be adapted to studies with similar information.

Urban vs rural residency and allergy prevalence among adult women: Iowa Women's Health Study

Background

The association between residence and allergy has been well studied in children living on a farm; however, studies of this association in late adulthood are lacking.

Objective

This study examined the association between residence and allergy in 25,393 women aged 55–69 years in the large prospective Iowa Women’s Health Study (IWHS).

Methods

IWHS questionnaires collected information on socio-demographic and anthropometric characteristics, medical history, lifestyle behaviors, dietary intake, residence and allergy. Residence reported at baseline (1986) was categorized into 5 groups based on living on a farm, rural, or urban areas and population size. Allergy was determined from four self-reported questions about physician-diagnosed asthma, hay fever, skin allergy, and other allergy. Logistic regression was used to determine significant risk factors for allergy and prevalence odds ratios (OR) and 95% confidence intervals (CI) for allergy associated with residence.

Results

Compared to large city of >10,000 residents, those living on farm, rural and smaller urban areas had decreased odds ratios of overall, skin, and other allergy in age and multivariable-adjusted models. The multivariable ORs (95% CI) for farm versus large city were decreased for overall allergy: 0.72 (0.66, 0.78) and all allergy types including asthma: 0.87 (0.75, 1.00), hay fever: 0.77 (0.69, 0.88), skin: 0.76 (0.68, 0.86), and other allergy: 0.76 (0.68, 0.86).

Conclusion

This study supports a hypothesis that farm living is inversely associated with allergy, suggesting that environmental exposures may protect against allergy not only in childhood, but also in late adulthood.

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.

Ingested nitrate and nitrite, disinfection by-products, and pancreatic cancer risk in postmenopausal women

Nitrate and nitrite are precursors of N-nitroso compounds (NOC), probable human carcinogens that cause pancreatic tumors in animals. Disinfection by-products (DBP) exposures have also been linked with digestive system cancers, but few studies have evaluated relationships with pancreatic cancer. We investigated the association of pancreatic cancer with these drinking water contaminants and dietary nitrate/nitrite in a cohort of postmenopausal women in Iowa (1986-2011). We used historical monitoring and treatment data to estimate levels of long-term average nitrate and total trihalomethanes (TTHM; the sum of the most prevalent DBP class) and the duration exceeding one-half the maximum contaminant level (>½ MCL; 5 mg/L nitrate-nitrogen, 40 µg/L TTHM) among participants on public water supplies (PWS) >10 years. We estimated dietary nitrate and nitrite intakes using a food frequency questionnaire. We computed hazard ratios (HR) and 95% confidence intervals (CI) using Cox regression and evaluated nitrate interactions with smoking and vitamin C intake. We identified 313 cases among 34,242 women, including 152 with >10 years PWS use (N = 15,710). Multivariable models of average nitrate showed no association with pancreatic cancer (HR_{p95vs. Q1}  = 1.16, 95% CI: 0.51-2.64). Associations with average TTHM levels were also null (HR_{Q4vs. Q1}  = 0.70, 95% CI:0.42-1.18). We observed no trend with increasing years of exposure to either contaminant at levels >½ MCL. Positive associations were suggested in the highest dietary nitrite intake from processed meat (HR_{p95vs. Q1}  = 1.66, 95% CI 1.00-2.75;p_trend  = 0.05). We found no interactions of nitrate with known modifiers of endogenous NOC formation. Our results suggest that nitrite intake from processed meat may be a risk factor for pancreatic cancer.

Personal samplers of bioavailable pesticides integrated with a hair follicle assay of DNA damage to assess environmental exposures and their associated risks in children

Agriculture in the United States employs youth ages ten and older in work environments with high pesticide levels. Younger children in rural areas may also be affected by indirect pesticide exposures. The long-term effects of pesticides on health and development are difficult to assess and poorly understood. Yet, epidemiologic studies suggest associations with cancer as well as cognitive deficits. We report a practical and cost-effective approach to assess environmental pesticide exposures and their biological consequences in children. Our approach combines silicone wristband personal samplers and DNA damage quantification from hair follicles, and was tested as part of a community-based participatory research (CBPR) project involving ten Latino children from farmworker households in North Carolina. Our study documents high acceptance among Latino children and their caregivers of these noninvasive sampling methods. The personal samplers detected organophosphates, organochlorines, and pyrethroids in the majority of the participants (70%, 90%, 80%, respectively). Pesticides were detected in all participant samplers, with an average of 6.2±2.4 detections/participant sampler. DNA damage in epithelial cells from the sheath and bulb of plucked hairs follicles was quantified by immunostaining 53BP1-labled DNA repair foci. This method is sensitive, as shown by dose response analyses to γ radiations where the lowest dose tested (0.1Gy) led to significant increased 53BP1 foci density. Immunolabeling of DNA repair foci has significant advantages over the comet assay in that specific regions of the follicles can be analyzed. In this cohort of child participants, significant association was found between the number of pesticide detections and DNA damage in the papilla region of the hairs. We anticipate that this monitoring approach of bioavailable pesticides and genotoxicity will enhance our knowledge of the biological effects of pesticides to guide education programs and safety policies.

The impact of Agent Orange exposure on prognosis and management in patients with chronic lymphocytic leukemia: a National Veteran Affairs Tumor Registry Study

Exposure to Agent Orange (AO) has been associated with the development of chronic lymphocytic leukemia (CLL). We performed a retrospective study of 2052 Vietnam veterans identified in the National VA Tumor Registry to assess the impact of AO exposure on CLL prognosis, treatment and survival. Prognostic factors did not differ based on exposure. Veterans exposed to AO were diagnosed younger (63.2 vs. 70.5 years, p < .0001) and had longer overall survival (median not reached vs. 91 months, p < .001). This prolonged survival was in the subgroups of patients aged 60-69 years (p< .0001) and those with 11q deletion (p < .0001). Those exposed to AO were more likely to be treated with fludarabine, chlorambucil and rituximab (38 vs. 21%, p < .001) and bendamustine plus rituximab (25 vs. 18%, p = 0.039) as first line therapy. Exposure to AO was not associated with either poor prognostic factors or shortened overall survival in our large veteran population with CLL.

Pesticide exposure assessed through agricultural crop proximity and risk of amyotrophic lateral sclerosis

BACKGROUND

Epidemiologic studies have raised the possibility that some pesticide compounds induce the neurodegenerative disease amyotrophic lateral sclerosis (ALS), though the available evidence is not entirely consistent.

METHODS

We conducted a population-based case-control study in two Italian populations to assess the extent to which residence in the vicinity of agricultural crops associated with the application of neurotoxic pesticides is a risk factor for ALS, using crop acreage in proximity to the residence as an index of exposure.

RESULTS

Based on 703 cases and 2737 controls, we computed an ALS odds ratio of 0.92 (95% confidence interval 0.78-1.09) for those in proximity to agricultural land. Results were not substantially different when using alternative exposure categories or when analyzing specific crop types, with the exception of a higher risk related to exposure to citrus orchards and olive groves in Southern Italy, though based on few exposed subjects (N = 89 and 8, respectively). There was little evidence of any dose-response relation between crop proximity and ALS risk, and using long-term residence instead of current residence did not substantially change our estimates.

CONCLUSIONS

Though our index of exposure is indirect and subject to considerable misclassification, our results offer little support for the hypothesis that neurotoxic pesticide exposure increases ALS risk.

Cancer risks in a population-based study of 70,570 agricultural workers: results from the Canadian census health and Environment cohort (CanCHEC)

BACKGROUND

Agricultural workers may be exposed to potential carcinogens including pesticides, sensitizing agents and solar radiation. Previous studies indicate increased risks of hematopoietic cancers and decreased risks at other sites, possibly due to differences in lifestyle or risk behaviours. We present findings from CanCHEC (Canadian Census Health and Environment Cohort), the largest national population-based cohort of agricultural workers.

METHODS

Statistics Canada created the cohort using deterministic and probabilistic linkage of the 1991 Canadian Long Form Census to National Cancer Registry records for 1992-2010. Self-reported occupations were coded using the Standard Occupational Classification (1991) system. Analyses were restricted to employed persons aged 25-74 years at baseline (N = 2,051,315), with follow-up until December 31, 2010. Hazard ratios (HR) and 95% confidence intervals (CI) were modeled using Cox proportional hazards for all workers in agricultural occupations (n = 70,570; 70.8% male), stratified by sex, and adjusted for age at cohort entry, province of residence, and highest level of education.

RESULTS

A total of 9515 incident cancer cases (7295 in males) occurred in agricultural workers. Among men, increased risks were observed for non-Hodgkin lymphoma (HR = 1.10, 95% CI = 1.00-1.21), prostate (HR = 1.11, 95% CI = 1.06-1.16), melanoma (HR = 1.15, 95% CI = 1.02-1.31), and lip cancer (HR = 2.14, 95% CI = 1.70-2.70). Decreased risks in males were observed for lung, larynx, and liver cancers. Among female agricultural workers there was an increased risk of pancreatic cancer (HR = 1.36, 95% CI = 1.07-1.72). Increased risks of melanoma (HR = 1.79, 95% CI = 1.17-2.73), leukemia (HR = 2.01, 95% CI = 1.24-3.25) and multiple myeloma (HR = 2.25, 95% CI = 1.16-4.37) were observed in a subset of female crop farmers.

CONCLUSIONS

Exposure to pesticides may have contributed to increased risks of hematopoietic cancers, while increased risks of lip cancer and melanoma may be attributed to sun exposure. The array of decreased risks suggests reduced smoking and alcohol consumption in this occupational group compared to the general population.

George DM, Loffredo CA, Amr S. Nonoccupational exposure to agricultural work and risk of urinary bladder cancer among Egyptian women

This study examined the associations between nonoccupational exposure to agricultural work, through husband or head of household (H/HH) occupation, and urinary bladder cancer risk among Egyptian women. A total of 1,167 women (388 bladder cases and 779 age- and residence-matched, population-based controls) from a multicenter case-control study were included in the analysis. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using logistic regression. Among married women, those who reported H/HH to be an agricultural worker were at increased risk for bladder cancer as compared to those with H/HH in other occupations, AOR = 1.54, 95% CI [1.09, 2.18]; among unmarried women the risk was not increased, AOR = 0.77, 95% CI [0.45, 1.32]. Nonoccupational exposure to agricultural work, defined as living with an agricultural worker, increased the risk for bladder cancer among married Egyptian women.

Relative Contributions of Agricultural Drift, Para-Occupational, and Residential Use Exposure Pathways to House Dust Pesticide Concentrations: Meta-Regression of Published Data

BACKGROUND

Increased pesticide concentrations in house dust in agricultural areas have been attributed to several exposure pathways, including agricultural drift, para-occupational, and residential use.

OBJECTIVE

To guide future exposure assessment efforts, we quantified relative contributions of these pathways using meta-regression models of published data on dust pesticide concentrations.

METHODS

From studies in North American agricultural areas published from 1995 to 2015, we abstracted dust pesticide concentrations reported as summary statistics [e.g., geometric means (GM)]. We analyzed these data using mixed-effects meta-regression models that weighted each summary statistic by its inverse variance. Dependent variables were either the log-transformed GM (drift) or the log-transformed ratio of GMs from two groups (para-occupational, residential use).

RESULTS

For the drift pathway, predicted GMs decreased sharply and nonlinearly, with GMs 64% lower in homes 250 m versus 23 m from fields (interquartile range of published data) based on 52 statistics from seven studies. For the para-occupational pathway, GMs were 2.3 times higher [95% confidence interval (CI): 1.5, 3.3; 15 statistics, five studies] in homes of farmers who applied pesticides more recently or frequently versus less recently or frequently. For the residential use pathway, GMs were 1.3 (95% CI: 1.1, 1.4) and 1.5 (95% CI: 1.2, 1.9) times higher in treated versus untreated homes, when the probability that a pesticide was used for the pest treatment was 1-19% and ≥ 20%, respectively (88 statistics, five studies).

CONCLUSION

Our quantification of the relative contributions of pesticide exposure pathways in agricultural populations could improve exposure assessments in epidemiologic studies. The meta-regression models can be updated when additional data become available. Citation: Deziel NC, Beane Freeman LE, Graubard BI, Jones RR, Hoppin JA, Thomas K, Hines CJ, Blair A, Sandler DP, Chen H, Lubin JH, Andreotti G, Alavanja MC, Friesen MC. 2017. Relative contributions of agricultural drift, para-occupational, and residential use exposure pathways to house dust pesticide concentrations: meta-regression of published data. Environ Health Perspect 125:296-305; http://dx.doi.org/10.1289/EHP426.

Agricultural crop exposure and risk of childhood cancer: new findings from a case-control study in Spain

Background

Childhood cancer is the main cause of disease-related death in children in Spain. Although little is known about the etiology, environmental factors are potential explanations for a fraction of the cases. Previous studies have shown pesticides to be associated with childhood cancer. The difficulty of collecting personal environmental exposure data is an important limitation; this lack of information about pesticides motivates the development of new methods to subrogate this exposure. We developed a crop exposure index based on geographic information to study the relationship between exposure to different types of crops and risk of childhood tumors.

Methods

We conducted a population-based case–control study of childhood cancer covering 3350 cases and 20,365 controls in two Spanish regions. We used CORINE Land Cover to obtain data about agricultural land use. We created a 1 km buffer around every child and calculated the percentage of crop surface within the buffer (Global Crop Index) for total crops and for individual types of crops. We fitted mixed multiple unconditional logistic regression models by diagnostic group.

Results

We found excess of risk among children living in the proximity of crops. For total crops our results showed excesses of risk for almost all diagnostic groups and increasing risk with increasing crop index value. Analyses by region and individual type of crop also showed excess of risk.

Conclusion

The results suggest that living in the proximity of cultivated land could be a risk factor for several types of cancer in children.

Insecticide exposure and farm history in relation to risk of lymphomas and leukemias in the Women's Health Initiative observational study cohort

PURPOSE

Relationships of farm history and insecticide exposure at home or work with lymphohematopoietic (LH) neoplasm risk were investigated in a large prospective cohort of US women.

METHODS

In questionnaires, women self-reported history living or working on a farm, personally mixing or applying insecticides, insecticide application in the home or workplace by a commercial service, and treating pets with insecticides. Relationships with non-Hodgkin lymphoma (NHL), chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, plasma cell neoplasms, and myeloid leukemia were investigated using Cox proportional hazard models. Age and farming history were explored as effect modifiers.

RESULTS

The analysis included 76,493 women and 822 NHL cases. Women who ever lived or worked on a farm had 1.12 times the risk of NHL (95% confidence interval [CI] = 0.95-1.32) compared to those who did not. Women who reported that a commercial service ever applied insecticides in their immediate surroundings had 65% higher risk of CLL/SLL (95% CI = 1.15-2.38). Women aged less than 65 years who ever applied insecticides had 87% higher risk of DLBCL (95% CI = 1.13-3.09).

CONCLUSIONS

Insecticide exposures may contribute to risk of CLL/SLL and DLBCL. Future studies should examine relationships of LH subtypes with specific types of household insecticides.

Allergic diseases and risk of hematopoietic malignancies in a cohort of postmenopausal women: a report from the Iowa Women's Health Study

BACKGROUND

Allergic diseases signify immune dysregulation attributable to underlying genetics and environmental exposures. Associations between various allergies and hematopoietic cancers have been observed, albeit inconsistently; however, few prospective studies have examined the risk, and even fewer among older adults.

METHODS

We examined risk of incident hematopoietic cancers in those reporting allergic diseases in a population-based cohort of 22,601 older women (Iowa Women's Health Study). Self-reported allergic status, including asthma, hay fever, eczema, and/or other allergies, was determined via questionnaire in 1997 (mean age, 72 years; range, 63-81 years). Incident cancers were ascertained by linkage with the Iowa Cancer Registry from 1997 to 2011. Cox proportional hazards regression was performed to estimate multivariate-adjusted HR and 95% confidence intervals (CI) for myeloid (N = 177) and lymphoid (N = 437) malignancies, respectively.

RESULTS

Allergic diseases were not associated with risk of myeloid (HR, 1.00; 95% CI, 0.72-1.37) or lymphoid (HR, 0.99; 95% CI, 0.81-1.22) malignancies overall, or for most allergic and malignant subtypes examined. Self-reported asthma was positively associated with development of myelodysplastic syndrome (MDS; HR, 2.00; 95% CI, 0.93-4.32). In addition, there was a 30% to 40% decrease in risk of both lymphoid and myeloid cancers in those reporting rural residences but no association in those reporting urban residences; the interaction between residence and allergy was statistically significant for lymphoid malignancies (Pinteraction = 0.05).

CONCLUSIONS AND IMPACT

These results suggest that asthma may contribute to the pathogenesis of MDS, a finding consistent with the chronic antigen stimulation hypothesis. Susceptibility differences by location of residence are concordant with the hygiene hypothesis and merit additional exploration.