Mortality among a Cohort of Banana Plantation Workers in Costa Rica

Lung Cancer in the French West Indies: Role of Sugarcane Work and Other Occupational Exposures

OBJECTIVE

Our aim was to study the role of occupational exposures in lung cancer risk in the French West Indies, with special attention to some specific activities, such as sugarcane work, that can only be studied in a limited number of populations.

METHODS

We used data from a population-based case-control study that included 147 incident lung cancer cases and 405 controls. Smoking histories and detailed occupational histories with descriptions of tasks and substances were collected by questionnaire during face-to-face interviews. Odds ratios (OR) adjusted for sex, age, region, smoking status, and cigarette pack-years and 95% confidence intervals (95% CI) were estimated by unconditional logistic regression.

RESULTS

Significantly increased risks of lung cancer were found in sugarcane farm workers (OR = 2.7; 95% CI 1.1-6.6) and more generally in the sugarcane-growing sector (OR = 2.5; 95% CI 1.0-6.3) and to a lesser extent in rum production. Elevated risks of lung cancer were also observed among other agricultural workers, painters, warehouse porters, labourers, and maintenance and motor vehicle repair workers. Exposure to herbicides in sugarcane cultivation was associated with an increased risk of lung cancer (OR = 2.6; 95% CI 0.9-7.6).

CONCLUSION

These results show that occupational exposures contributed to lung cancer risk in the French West Indies, and highlighted the role of exposures related to sugarcane work.

A cohort study of banana plantation workers in the French West Indies: first mortality analysis (2000-2015)

Chlordecone, an organochlorine insecticide, was widely used in the French West Indies banana plantations. We set up a cohort of banana plantation workers who worked between 1973 and 1993, the period of authorized use of chlordecone. Vital status and causes of death were collected from French national registries. Workers were followed up from 1 January 2000 to 31 December 2015. Cause-specific mortality in the cohort was compared to that of the general population of the French West Indies by computing standardized mortality ratios (SMRs). A total of 11,112 workers (149,526 person-years, 77% men) were included in the mortality analysis, and 3647 deaths occurred over the study period. There was a slight deficit in all-cause mortality, which was statistically significant in men (SMR = 0.93, 95% CI 0.89-0.96), but not in women (SMR = 0.96, 95% CI 0.89-1.04). All-cancer mortality did not differ significantly from that of the general population (men: SMR = 0.96, 95% CI 0.90-1.03; women: SMR = 1.04, 95% CI 0.89-1.21). Significant excesses of deaths were observed for stomach cancer in women (SMR = 1.94, 95% CI 1.24-2.89) and pancreatic cancer in women farm owners (SMR = 2.31, 95% CI 1.06-4.39). Mortality from prostate cancer was similar to that of the general population in the whole cohort (SMR = 1.00; 95% CI 0.89-1.13) and non-significantly elevated among farm workers (SMR = 1.10, 95% CI 0.87-1.36). Non-significant increases in mortality were also observed for lung cancer in women, leukemia in men, and non-Hodgkin lymphoma in both genders.

Occupational pesticide use and Parkinson's disease in the Parkinson Environment Gene (PEG) study

OBJECTIVE

To study the influence of occupational pesticide use on Parkinson's disease (PD) in a population with information on various occupational, residential, and household sources of pesticide exposure.

METHODS

In a population-based case control study in Central California, we used structured interviews to collect occupational history details including pesticide use in jobs, duration of use, product names, and personal protective equipment use from 360 PD cases and 827 controls. We linked reported products to California's pesticide product label database and identified pesticide active ingredients and occupational use by chemical class including fungicides, insecticides, and herbicides. Employing unconditional logistic regression, we estimated odds ratios and 95% confidence intervals for PD and occupational pesticide use.

RESULTS

Ever occupational use of carbamates increased risk of PD by 455%, while organophosphorus (OP) and organochlorine (OC) pesticide use doubled risk. PD risk increased 110-211% with ever occupational use of fungicides, herbicides, and insecticides. Using any pesticide occupationally for >10years doubled the risk of PD compared with no occupational pesticide use. Surprisingly, we estimated higher risks among those reporting use of personal protective equipment (PPE).

CONCLUSIONS

Our findings provide additional evidence that occupational pesticide exposures increase PD risk. This was the case even after controlling for other sources of pesticide exposure. Specifically, risk increased with occupational use of carbamates, OPs, and OCs, as well as of fungicides, herbicides, or insecticides. Interestingly, some types of PPE use may not provide adequate protection during pesticide applications.

Parkinson's disease and pesticide exposure--a new assessment

Parkinson's disease (PD) is an idiopathic disease and its pathological feature is a loss of pigmented neurons in the substantia nigra. Some commonly used pesticides possess neurotoxicity, and exposure to such compounds may trigger mechanisms similar to those in the development of idiopathic PD. We conducted a systematic review of epidemiological studies, aiming at a critical evaluation of the association between the development of PD and pesticide exposure. Reported effect sizes (ES) in the relevant studies were pooled into the meta-analysis to derive summary ES. The summary ES suggested a significantly positive association between PD and overall pesticide use (non-occupational and/or occupational pesticide use) [1.42; 95% confidence interval (CI) 1.32 to 1.52, the fixed-effects model], as well as between PD and occupational pesticide exposure (1.49 with a 95% CI of 1.34-1.66). Both occupational herbicide and occupational insecticide exposure showed a significant association with PD. The results of the meta-analysis reported in this study suggest the existence of a statistically positive association between PD and pesticide exposure. The majority of the studies that were pooled in the meta-analysis were case-control design with very few cohort studies and most with poor exposure characterization thus, any further case-control studies using similar methodologies are unlikely to have a significant impact or understanding on the currently-reported association between pesticide exposure and the development of idiopathic PD. Therefore, we believe that if further epidemiological studies are going to be conducted in the area, they should be prospective cohort studies that will include accurate exposure assessment.

Occupational risk factors for testicular cancer: a registry-based case-control study in Rhineland Palatinate-Germany

Objectives: Testicular cancer affects mainly men below the age of 50. An association with occupation and social status has been suggested but risk factors are not well understood. A registry-based case-control study focusing on occupation was performed in Germany.

Methods: All 348 testicular cancer cases with available gainful occupational information registered between 2000 and 2005; as well as 564 suitable controls (from a pool of other cancers) were drawn from the Cancer Registry of Rhineland-Palatinate. Unconditional logistic regression was used to compute odds ratios (OR) and associated 95% confidence intervals (CI).

Results: Slightly elevated OR were observed for technicians and related professionals (OR 1.62, 95% CI 1.00–2.63) and for clerical support workers (OR 1.71, 95% CI 1.14–2.56). This increase was highest in the age group 20–50 for technicians (OR 2.02, 95% CI 1.23–3.33) and clerks (OR 2.00, 95% CI 1.30–3.09), respectively. An association with testicular cancer was observed for no other occupation.

Conclusion: An increased risk of testicular cancer was observed for technicians and related professionals and clerical support workers. This could be related to socioeconomic status or sedentary life style, two factors that were identified in previous studies. While the feasibility of a purely registry-based study was shown, missing occupational data and the choice of cancer controls represent challenges to the validity of this approach.

Occupational exposure to pesticides and Parkinson's disease: a systematic review and meta-analysis of cohort studies

OBJECTIVES

To systematically review available cohort studies and estimate quantitatively the association between occupational exposure to pesticides and Parkinson's disease (PD).

METHODS

Studies were identified from a MEDLINE search through 30 November 2011 and from the reference lists of identified publications. Relative risk (RR) estimates were extracted from 12 studies published between 1985 and 2011. Meta-rate ratio estimates (mRR) were calculated according to fixed and random-effect meta-analysis models. Meta-analyses were performed on the whole set of data and separate analyses were conducted after stratification for gender, exposure characterisation, PD cases identification, geographic location, reported risk estimator and cohort study design.

RESULTS

A statistically significant increased risk of PD was observed when all studies were combined (mRR=1.28; 95% confidence interval [CI]: 1.03-1.59) but there was a high heterogeneity and inconsistency among studies. The highest increased risks were observed for studies with the best design, i.e. reporting PD diagnosis confirmed by a neurologist (mRR=2.56; CI: 1.46-4.48; n=4), for cohort studies reporting incidence of PD (mRR=1.95; CI: 1.29-2.97; n=3) as well as for prospective cohorts (mRR=1.39; CI: 1.09-1.78; n=6). A significant increased risk was also seen for banana, sugarcane and pineapple plantation workers (mRR=2.05; CI: 1.23-3.42; n=2).

CONCLUSIONS

The present study provides some support for the hypothesis that occupational exposure to pesticides increases the risk of PD.

Pesticide use in banana and plantain production and risk perception among local actors in Talamanca, Costa Rica

The Talamanca County in Costa Rica has large-scale banana and small-scale plantain production, probably causing pesticide exposure in indigenous children. We explored to what extent different community actors are aware of children's pesticide hazards and how their awareness related to socio-economical and cultural conditions. Methods comprised eight focus groups with fathers and mothers separately, 27 semi-structured interviews to key actors, and field observations. As a whole, the indigenous plantain farmers and banana plantation workers had some general knowledge of pesticides concerning crop protection, but little on acute health effects, and hardly any on exposure routes and pathways, and chronic effects. People expressed vague ideas about pesticide risks. Inter-community differences were related to pesticide technologies used in banana and plantain production, employment status on a multinational plantation versus smallholder status, and gender. Compared to formalized practices on transnational company plantations, where workers reported to feel protected, pesticide handling by plantain smallholders was not perceived as hazardous and therefore no safety precautions were applied. Large-scale monoculture was perceived as one of the most important problems leading to pesticide risks in Talamanca on banana plantations, and also on neighboring small plantain farms extending into large areas. Plantain farmers have adopted use of highly toxic pesticides following banana production, but in conditions of extreme poverty. Aerial spraying in banana plantations was considered by most social actors a major determinant of exposure for the population living nearby these plantations, including vulnerable children. We observed violations of legally established aerial spraying distances. Economic considerations were most mentioned as the underlying reason for the pesticide use: economic needs to obtain the production quantity and quality, and pressure to use pesticides by other economic agents such as middlemen. Risk perceptions were modulated by factors such as people's tasks and positions in the production process, gender, and people's possibilities to define their own social conditions (more fatalistic perceptions among banana workers). The challenge for the future is to combine these insights into improved health risk assessment and management that is culturally adequate for each particular community and agricultural context.