Farming activity and risk of treated thyroid disorders: Insights from the TRACTOR project, a nationwide cohort study

BACKGROUND

Epidemiological data regarding thyroid diseases are lacking, in particular for occupationally exposed populations.

OBJECTIVES

To compare the risk of hypothyroidism and hyperthyroidism between farming activities within the complete population of French farm managers (FMs).

METHODS

Digital health data from retrospective administrative databases, including insurance claims and electronic health/medical records, was employed. This cohort data spanned the entirety of French farm managers (FMs) who had undertaken work at least once from 2002 to 2016. Survival analysis with the time to initial medication reimbursement as timescale was used to examine the association (hazard ratio, HR) between 26 specific farming activities and both treated hypothyroidism and hyperthyroidism. A distinct model was developed for each farming activity, comparing FMs who had never engaged in the specific farming activity between 2002 and 2016 with those who had. All analyses were adjusted for potential confounders (e.g., age), and sensitivity analyses were conducted.

RESULTS

Among 1088561 FMs (mean age 46.6 [SD 14.1]; 31% females), there were 31834 hypothyroidism cases (75% females) and 620 hyperthyroidism cases (67% females), respectively. The highest risks were observed for cattle activities for both hyperthyroidism (HR ranging from 1.75 to 2.42) and hypothyroidism (HR ranging from 1.41 to 1.44). For hypothyroidism, higher risks were also observed for several animal farming activities (pig, poultry, and rabbit), as well as fruit arboriculture (HR = 1.22 [1.14-1.31]). The lowest risks were observed for activities involving horses. Sex differences in the risk of hypothyroidism were observed for eight activities, with the risk being higher for males (HR = 1.09 [1.01-1.20]) than females in viticulture (HR = 0.97 [0.93-1.00]). The risk of hyperthyroidism was two times higher for male dairy farmers than females.

DISCUSSION

Our findings offer a comprehensive overview of thyroid disease risks within the FM community. Thyroid ailments might not stem from a single cause but likely arise from the combined effects of various causal agents and triggering factors (agricultural exposome). Further investigation into distinct farming activities-especially those involving cattle-is essential to pinpoint potential risk factors that could enhance thyroid disease monitoring in agriculture.

Does prenatal exposure to multiple airborne and tap-water pollutants increase neonatal thyroid-stimulating hormone concentrations? Data from the Picardy region, France

OBJECTIVE

Systematic screening for congenital hypothyroidism by heel-stick sampling has revealed unexpected heterogeneity in the geographic distribution of newborn thyroid-stimulating hormone concentrations in Picardy, France. We explored a possible relationship with environmental pollutants.

METHODS

Zip code geolocation data from mothers of newborns without congenital hypothyroidism born in 2021 were linked to ecological data for a set of airborne (particulate matter with a diameter of 2.5 μm or less [PM2.5] or 10 μm or less [PM10]) and tap-water (nitrate and perchlorate ions and atrazine) pollutants. Statistical associations between mean exposure levels during the third trimester of pregnancy and Thyroid-stimulating hormone (TSH) concentrations in 6249 newborns (51 % male) were investigated using linear regression models.

RESULTS

Median neonatal TSH concentration (interquartile range, IQR) was 1.7 (1-2.8) mIU/L. An increase of one IQR in prenatal exposure to perchlorate ions (3.6 μg/L), nitrate ions (19.2 mg/L), PM2.5 (3.7 μg/m3) and PM10 (3.4 μg/m3), were associated with increases in TSH concentrations of 2.30 % (95 % CI: 0.95-3.66), 5.84 % (95 % CI: 2.81-8.87), 13.44 % (95 % CI: 9.65-17.28) and 6.26 % (95 % CI: 3.01-9.56), respectively.

CONCLUSIONS

Prenatal exposure to perchlorate and nitrate ions in tap water and to airborne PM over the third trimester of pregnancy was significantly associated with increased neonatal TSH concentrations.

Cohort profile for development of machine learning models to predict healthcare-related adverse events (Demeter): clinical objectives, data requirements for modelling and overview of data set for 2016-2018

PURPOSE

In-hospital health-related adverse events (HAEs) are a major concern for hospitals worldwide. In high-income countries, approximately 1 in 10 patients experience HAEs associated with their hospital stay. Estimating the risk of an HAE at the individual patient level as accurately as possible is one of the first steps towards improving patient outcomes. Risk assessment can enable healthcare providers to target resources to patients in greatest need through adaptations in processes and procedures. Electronic health data facilitates the application of machine-learning methods for risk analysis. We aim, first to reveal correlations between HAE occurrence and patients' characteristics and/or the procedures they undergo during their hospitalisation, and second, to build models that allow the early identification of patients at an elevated risk of HAE.

PARTICIPANTS

143 865 adult patients hospitalised at Grenoble Alpes University Hospital (France) between 1 January 2016 and 31 December 2018.

FINDINGS TO DATE

In this set-up phase of the project, we describe the preconditions for big data analysis using machine-learning methods. We present an overview of the retrospective de-identified multisource data for a 2-year period extracted from the hospital's Clinical Data Warehouse, along with social determinants of health data from the National Institute of Statistics and Economic Studies, to be used in machine learning (artificial intelligence) training and validation. No supplementary information or evaluation on the part of medical staff will be required by the information system for risk assessment.

FUTURE PLANS

We are using this data set to develop predictive models for several general HAEs including secondary intensive care admission, prolonged hospital stay, 7-day and 30-day re-hospitalisation, nosocomial bacterial infection, hospital-acquired venous thromboembolism, and in-hospital mortality.

Hypergraph Based Data Model for Complex Health Data Exploration and Its Implementation in PREDIMED Clinical Data Warehouse

Within the PREDIMED Clinical Data Warehouse (CDW) of Grenoble Alpes University Hospital (CHUGA), we have developed a hypergraph based operational data model, aiming at empowering physicians to explore, visualize and qualitatively analyze interactively the complex and massive information of the patients treated in CHUGA. This model constitutes a central target structure, expressed in a dual form, both graphical and formal, which gathers the concepts and their semantic relations into a hypergraph whose implementation can easily be manipulated by medical experts. The implementation is based on a property graph database linked to an interactive graphical interface allowing to navigate through the data and to interact in real time with a search engine, visualization and analysis tools. This model and its agile implementation allow for easy structural changes inherent to the evolution of techniques and practices in the health field. This flexibility provides adaptability to the evolution of interoperability standards.

COVID-19 Geographical Maps and Clinical Data Warehouse PREDIMED

PREDIMED, Clinical Data Warehouse of Grenoble Alps University Hospital, is currently participating in daily COVID-19 epidemic follow-up via spatial and chronological analysis of geographical maps. This monitoring is aimed for cluster detection and vulnerable population discovery. Our real-time geographical representations allow us to track the epidemic both inside and outside the hospital.

Medico-administrative data combined with agricultural practices data to retrospectively estimate pesticide use by agricultural workers

This work is part of a global project aiming to use medico-administrative big data from the whole French agricultural population (~3 millions), collected through their mandatory health insurance system (Mutualité Sociale Agricole), to highlight associations between chronic diseases and agricultural activities. At the request of the French Agency for Food, Environmental and Occupational Health & Safety (ANSES), our objective was to estimate which pesticides were probably used by each agricultural worker, in order to include this information in our analyses and search for association with diseases. We selected five databases to achieve this objective: the Graphical Land Parcel Registration (RPG), the French Agricultural Census, "Cultivation Practice" surveys from the Agriculture ministry, the MATPHYTO crop-exposure matrix and the Compilation of Phytosanitary Indexes from the French Public Health Agency. A geographical grid was designed to use geographical location while maintaining worker anonymity, dividing France into square tracts of variable surface each containing a minimum of 1500 agricultural workers. We developed an automated algorithm to predict each individual potential exposure by crossing her/his occupational activity, the geographical grid and the RPG to deduce cultivation practices and use it as a gateway to estimate pesticides use. This approach allowed drawing, from administrative data, a list of substances potentially used by each agricultural worker throughout France. Results of the algorithm are illustrated at collective level (descriptive statistics for the whole population), as well as at individual level (some workers taken as examples). The generalization of this method in other national contexts is discussed. By linking this information with the health insurance databases, this approach could contribute to the agricultural workers health surveillance.

Cohort Creation and Visualization Using Graph Model in the PREDIMED Health Data Warehouse

Grenoble Alpes University Hospital (CHUGA) is currently deploying a health data warehouse called PREDIMED [1], a platform designed to integrate and analyze for research, education and institutional management the data of patients treated at CHUGA. PREDIMED contains healthcare data, administrative data and, potentially, data from external databases. PREDIMED is hosted by the CHUGA Information Systems Department and benefits from its strict security rules. CHUGA's institutional project PREDIMED aims to collaborate with similar projects in France and worldwide. In this paper, we present how the data model defined to implement PREDIMED at CHUGA is useful for medical experts to interactively build a cohort of patients and to visualize this cohort.