1
|
Lebov JF, Hooper SR, Pugh N, Becker-Dreps S, Bowman NM, Brown LM, MacDonald PD, Lakshmanane P, Jadi R, Bucardo F, Chevez T, Rodriguez AH, Aleman Rivera TDJ. Neurological and neuropsychological sequelae of Zika virus infection in children in León, Nicaragua. Rev Panam Salud Publica 2022; 46:e90. [PMID: 35875321 PMCID: PMC9299389 DOI: 10.26633/rpsp.2022.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/16/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives. To describe the presence and persistence of neurological and neuropsychological sequelae among children with acquired Zika virus infection and assess whether those sequelae were more common in children infected with Zika virus compared to uninfected children. Methods. We conducted a prospective cohort study of children with and without Zika virus infection in León, Nicaragua, using a standard clinical assessment tool and questionnaire to collect data on symptoms at three visits, about 6 months apart, and a battery of standardized instruments to evaluate neurocognitive function, behavior, depression, and anxiety at the last two visits. Results. Sixty-two children were enrolled, with no significant differences in demographics by infection group. Children infected with Zika virus had a range of neurological symptoms, some of which persisted for 6 to 12 months; however, no consistent pattern of symptoms was observed. At baseline a small percentage of children infected with Zika virus had an abnormal finger-to-nose test (13%), cold touch response (13%), and vibration response (15%) versus 0% in the uninfected group. Neurocognitive deficits and behavioral problems were common in both groups, with no significant differences between the groups. Children infected with Zika virus had lower cognitive efficiency scores at the 6-month visit. Anxiety and depression were infrequent in both groups. Conclusions. Larger studies are needed to definitively investigate the relationship between Zika virus infection and neurological symptoms and neurocognitive problems, with adjustment for factors affecting cognition and behavior, including mood and sleep disorders, home learning environment, history of neuroinvasive infections, and detailed family history of neuropsychological problems.
Collapse
Affiliation(s)
- Jill F. Lebov
- RTI International, Research Triangle Park, NC, United States of America
| | | | - Norma Pugh
- RTI International, Research Triangle Park, NC, United States of America
| | | | | | - Linda M. Brown
- RTI International, Research Triangle Park, NC, United States of America
| | | | | | - Ramesh Jadi
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Filemon Bucardo
- National Autonomous University of Nicaragua-León, León, Nicaragua
| | - Tatiana Chevez
- National Autonomous University of Nicaragua-León, León, Nicaragua
| | | | | |
Collapse
|
2
|
Lebov JF, Arias JF, Balmaseda A, Britt W, Cordero JF, Galvão LA, Garces AL, Hambidge KM, Harris E, Ko A, Krebs N, Marques ETA, Martinez AM, McClure E, Miranda-Filho DB, Moreira MEL, Mussi-Pinhata MM, Ochoa TJ, Osorio JE, Scalabrin DMF, Schultz-Cherry S, Seage GR, Stolka K, Ugarte-Gil CA, Vega CMV, Welton M, Ximenes R, Zorrilla C. Correction to: International prospective observational cohort study of Zika in infants and pregnancy (ZIP study): study protocol. BMC Pregnancy Childbirth 2019; 19:423. [PMID: 31744466 PMCID: PMC6862798 DOI: 10.1186/s12884-019-2589-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Following publication of the original article [1], the author mentioned that two additional NIH staff were involved in the development of the protocol who did not receive recognition in the Acknowledgments section in their published article.
Collapse
Affiliation(s)
- Jill F Lebov
- Social, Statistical and Environmental Sciences, RTI International, Durham, NC, USA.
| | - Juan F Arias
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - Angel Balmaseda
- Centro Nacional de Diagnostico y Referencia, Complejo Nacional de Salud, Managua, Nicaragua
| | - William Britt
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - José F Cordero
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | | | - Ana Lucía Garces
- Fundación para la Alimentación y Nutrición de Centro América y Panamá (INCAP), Guatemala City, Guatemala
| | - K Michael Hambidge
- Section of Nutrition, Pediatrics, University of Colorado, Aurora, CO, USA
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA
| | - Albert Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.,Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Salvador, Brazil
| | - Nancy Krebs
- Section of Nutrition, Pediatrics, University of Colorado, Aurora, CO, USA
| | - Ernesto T A Marques
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.,Instituto Aggeu Magalhães, Department of Virology and Experimental Therapeutics, FIOCRUZ, Pernambuco, Brazil
| | | | - Elizabeth McClure
- Social, Statistical and Environmental Sciences, RTI International, Durham, NC, USA
| | - Democrito B Miranda-Filho
- Programa de Pós-Graduação em Ciências da Saúde (PPGCS) da Universidade de Pernambuco, Microcephaly Epidemic Research Group, Recife, Brazil
| | | | | | - Theresa J Ochoa
- Instituto de Medicina Tropical Alexander von Humboldt and Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jorge E Osorio
- Department of Pathobiological Sciences, University of Wisconsin, Madison, WI, USA
| | - Deolinda M F Scalabrin
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.,Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Salvador, Brazil
| | - Stacey Schultz-Cherry
- Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, TN, 38105, USA
| | - George R Seage
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, MA, USA
| | - Kristen Stolka
- Social, Statistical and Environmental Sciences, RTI International, Durham, NC, USA
| | - César Augusto Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt and Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Michael Welton
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA
| | - Ricardo Ximenes
- Departamento de Medicina Tropical da Universidade Federal de Pernambuco, Microcephaly Epidemic Research Group, Recife, Brazil
| | - Carmen Zorrilla
- Maternal-Infant Studies Center (CEMI), San Juan, Puerto Rico
| |
Collapse
|
3
|
Lebov JF, Arias JF, Balmaseda A, Britt W, Cordero JF, Galvão LA, Garces AL, Hambidge KM, Harris E, Ko A, Krebs N, Marques ETA, Martinez AM, McClure E, Miranda-Filho DB, Moreira MEL, Mussi-Pinhata MM, Ochoa TJ, Osorio JE, Scalabrin DMF, Schultz-Cherry S, Seage GR, Stolka K, Ugarte-Gil CA, Vega CMV, Welton M, Ximenes R, Zorrilla C. International prospective observational cohort study of Zika in infants and pregnancy (ZIP study): study protocol. BMC Pregnancy Childbirth 2019; 19:282. [PMID: 31391005 PMCID: PMC6686399 DOI: 10.1186/s12884-019-2430-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/26/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Until recently, Zika virus (ZIKV) infections were considered mild and self-limiting. Since 2015, they have been associated with an increase in microcephaly and other birth defects in newborns. While this association has been observed in case reports and epidemiological studies, the nature and extent of the relationship between ZIKV and adverse pregnancy and pediatric health outcomes is not well understood. With the unique opportunity to prospectively explore the full spectrum of issues related to ZIKV exposure during pregnancy, we undertook a multi-country, prospective cohort study to evaluate the association between ZIKV and pregnancy, neonatal, and infant outcomes. METHODS At research sites in ZIKV endemic regions of Brazil (4 sites), Colombia, Guatemala, Nicaragua, Puerto Rico (2 sites), and Peru, up to 10,000 pregnant women will be recruited and consented in the first and early second trimesters of pregnancy and then followed through delivery up to 6 weeks post-partum; their infants will be followed until at least 1 year of age. Pregnant women with symptomatic ZIKV infection confirmed by presence of ZIKV RNA and/or IgM for ZIKV will also be enrolled, regardless of gestational age. Participants will be tested monthly for ZIKV infection; additional demographic, physical, laboratory and environmental data will be collected to assess the potential interaction of these variables with ZIKV infection. Delivery outcomes and detailed infant assessments, including physical and neurological outcomes, will be obtained. DISCUSSION With the emergence of ZIKV in the Americas and its association with adverse pregnancy outcomes in this region, a much better understanding of the spectrum of clinical outcomes associated with exposure to ZIKV during pregnancy is needed. This cohort study will provide information about maternal, fetal, and infant outcomes related to ZIKV infection, including congenital ZIKV syndrome, and manifestations that are not detectable at birth but may appear during the first year of life. In addition, the flexibility of the study design has provided an opportunity to modify study parameters in real time to provide rigorous research data to answer the most critical questions about the impact of congenital ZIKV exposure. TRIAL REGISTRATION NCT02856984 . Registered August 5, 2016. Retrospectively registered.
Collapse
Affiliation(s)
- Jill F. Lebov
- Social, Statistical and Environmental Sciences, RTI International, Durham, NC USA
| | - Juan F. Arias
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, TN 38105 USA
| | - Angel Balmaseda
- Centro Nacional de Diagnostico y Referencia, Complejo Nacional de Salud, Managua, Nicaragua
| | - William Britt
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL USA
| | - José F. Cordero
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA USA
| | | | - Ana Lucía Garces
- Fundación para la Alimentación y Nutrición de Centro América y Panamá (INCAP), Guatemala City, Guatemala
| | | | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA USA
| | - Albert Ko
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT USA
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Salvador, Brazil
| | - Nancy Krebs
- Section of Nutrition, Pediatrics, University of Colorado, Aurora, CO USA
| | - Ernesto T. A. Marques
- School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
- Instituto Aggeu Magalhães, Department of Virology and Experimental Therapeutics, FIOCRUZ, Pernambuco, Brazil
| | | | - Elizabeth McClure
- Social, Statistical and Environmental Sciences, RTI International, Durham, NC USA
| | - Democrito B. Miranda-Filho
- Programa de Pós-Graduação em Ciências da Saúde (PPGCS) da Universidade de Pernambuco, Microcephaly Epidemic Research Group, Recife, Brazil
| | | | | | - Theresa J. Ochoa
- Instituto de Medicina Tropical Alexander von Humboldt and Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jorge E. Osorio
- Department of Pathobiological Sciences, University of Wisconsin, Madison, WI USA
| | - Deolinda M. F. Scalabrin
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT USA
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz/MS, Salvador, Brazil
| | - Stacey Schultz-Cherry
- Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, TN 38105 USA
| | - George R. Seage
- Department of Epidemiology, Harvard Chan School of Public Health, Boston, MA USA
| | - Kristen Stolka
- Social, Statistical and Environmental Sciences, RTI International, Durham, NC USA
| | - César Augusto Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt and Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Michael Welton
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA USA
| | - Ricardo Ximenes
- Departamento de Medicina Tropical da Universidade Federal de Pernambuco, Microcephaly Epidemic Research Group, Recife, Brazil
| | - Carmen Zorrilla
- Maternal-Infant Studies Center (CEMI), San Juan, Puerto Rico
| |
Collapse
|
4
|
Lebov JF, Brown LM, MacDonald PDM, Robertson K, Bowman NM, Hooper SR, Becker-Dreps S. Review: Evidence of Neurological Sequelae in Children With Acquired Zika Virus Infection. Pediatr Neurol 2018; 85:16-20. [PMID: 30343688 DOI: 10.1016/j.pediatrneurol.2018.03.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/01/2018] [Indexed: 12/30/2022]
Abstract
Limited information is available on health outcomes related to Zika virus infection acquired during childhood. Zika virus can cause severe central nervous system malformations in congenitally exposed fetuses and neonates. In vitro studies show the capacity of Zika virus to infect neural progenitor cells, induce central and peripheral neuronal cell deaths, and target different brain cells over the course of brain development. Studies of postnatally infected mice and nonhuman primates have detected degradation of neural cells and morphologic brain cell changes consistent with a broad neuroinflammatory response. In addition, case reports of central nervous system disease in adults and in adolescents secondary to Zika virus infection suggest that Zika virus may have a broader impact on neurological health beyond that observed in congenitally exposed newborns. Long-term neurological complications have been observed with other acquired flaviviral infections, with clinical symptoms manifesting for years after primary infection. The extent to which postnatal Zika virus infection in humans negatively affects the central and peripheral nervous systems and causes long-term neurological damage or cognitive effects is currently unknown. To better understand the potential for neurological sequelae associated with acquired Zika virus infection in children, we reviewed the biological, clinical, and epidemiologic literature and summarized the evidence for this link. First, we review biological mechanisms for neurological manifestations of Zika virus infection in experimental studies. Second, we review observational studies of congenital Zika virus infection and case studies and surveillance reports of neurological sequelae of Zika virus infection in adults and in children. Lastly, we discuss the challenges of conducting Zika virus-neurological sequela studies and future directions for pediatric Zika virus research.
Collapse
Affiliation(s)
- Jill F Lebov
- RTI International, Center for Applied Public Health Research, Durham, North Carolina.
| | - Linda M Brown
- RTI International, Center for Applied Public Health Research, Rockville, Maryland
| | - Pia D M MacDonald
- RTI International, Center for Applied Public Health Research, Berkeley, California
| | - Kevin Robertson
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Natalie M Bowman
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Stephen R Hooper
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Sylvia Becker-Dreps
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| |
Collapse
|
5
|
Lebov JF, Engel LS, Richardson D, Hogan SL, Sandler DP, Hoppin JA. Pesticide exposure and end-stage renal disease risk among wives of pesticide applicators in the Agricultural Health Study. Environ Res 2015; 143:198-210. [PMID: 26505650 PMCID: PMC4662544 DOI: 10.1016/j.envres.2015.10.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 09/30/2015] [Accepted: 10/01/2015] [Indexed: 05/08/2023]
Abstract
BACKGROUND Pesticide exposure has been found to cause renal damage and dysfunction in experimental studies, but epidemiological research on the renal effects of chronic low-level pesticide exposure is limited. We investigated the relationships between end-stage renal disease (ESRD) among wives of licensed pesticide applicators (N=31,142) in the Agricultural Health Study (AHS) and (1) personal pesticide use, (2) exposure to the husband's pesticide use, and (3) other pesticide-associated farming and household activities. METHODS AHS participants reported pesticide exposure via self-administered questionnaires at enrollment (1993-1997). ESRD cases were identified via linkage to the United States Renal Data System. Associations between ESRD and pesticide exposures were estimated with Cox proportional hazard regression models controlling for age at enrollment. Models of associations with farming and household factors were additionally adjusted for personal use of pesticides. RESULTS We identified 98 ESRD cases diagnosed between enrollment and 31 December 2011. Although women who ever applied pesticides (56% of cohort) were less likely than those who did not apply to develop ESRD (Hazard Ratio (HR): 0.42; 95% CI: 0.28, 0.64), among women who did apply pesticides, the rate of ESRD was significantly elevated among those who reported the highest (vs. lowest) cumulative general pesticide use (HR: 4.22; 95% CI: 1.26, 14.20). Among wives who never applied pesticides, ESRD was associated with husbands' ever use of paraquat (HR=1.99; 95% CI: 1.14, 3.47) and butylate (HR=1.71; 95% CI: 1.00, 2.95), with a positive exposure-response pattern for husband's cumulative use of these pesticides. CONCLUSIONS ESRD may be associated with direct and/or indirect exposure to pesticides among farm women. Future studies should evaluate indirect exposure risk among other rural populations.
Collapse
Affiliation(s)
- Jill F Lebov
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.
| | - Lawrence S Engel
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.
| | - David Richardson
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.
| | - Susan L Hogan
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC, USA.
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
| | - Jane A Hoppin
- Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA.
| |
Collapse
|
6
|
Strigo TS, Ephraim PL, Pounds I, Hill-Briggs F, Darrell L, Ellis M, Sudan D, Rabb H, Segev D, Wang NY, Kaiser M, Falkovic M, Lebov JF, Boulware LE. The TALKS study to improve communication, logistical, and financial barriers to live donor kidney transplantation in African Americans: protocol of a randomized clinical trial. BMC Nephrol 2015; 16:160. [PMID: 26452366 PMCID: PMC4600221 DOI: 10.1186/s12882-015-0153-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022] Open
Abstract
Background Live donor kidney transplantation (LDKT), an optimal therapy for many patients with end-stage kidney disease, is underutilized, particularly by African Americans. Potential recipient difficulties initiating and sustaining conversations about LDKT, identifying willing and medically eligible donors, and potential donors’ logistical and financial hurdles have been cited as potential contributors to race disparities in LDKT. Few interventions specifically targeting these factors have been tested. Methods/Design We report the protocol of the Talking about Living Kidney Donation Support (TALKS) study, a study designed to evaluate the effectiveness of behavioral, educational and financial assistance interventions to improve access to LDKT among African Americans on the deceased donor kidney transplant recipient waiting list. We adapted a previously tested educational and social worker intervention shown to improve consideration and pursuit of LDKT among patients and their family members for its use among patients on the kidney transplant waiting list. We also developed a financial assistance intervention to help potential donors overcome logistical and financial challenges they might face during the pursuit of live kidney donation. We will evaluate the effectiveness of these interventions by conducting a randomized controlled trial in which patients on the deceased donor waiting list receive 1) usual care while on the transplant waiting list, 2) the educational and social worker intervention, or 3) the educational and social worker intervention plus the option of participating in the financial assistance program. The primary outcome of the randomized controlled trial will measure potential recipients’ live kidney donor activation (a composite rate of live donor inquiries, completed new live donor evaluations, or live kidney donation) at 1 year. Discussion The TALKS study will rigorously assess the effectiveness of promising interventions to reduce race disparities in LDKT. Trial registration NCT02369354.
Collapse
Affiliation(s)
- Tara S Strigo
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, 27701, USA.
| | - Patti L Ephraim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Iris Pounds
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, 27701, USA.
| | - Felicia Hill-Briggs
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institution and Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Linda Darrell
- Department of Social Work, Morgan State University, Baltimore, MD, USA.
| | - Matthew Ellis
- Division of Nephrology, Duke University School of Medicine, Durham, NC, USA.
| | - Debra Sudan
- Division of Transplantation, Duke University School of Medicine, Durham, NC, USA.
| | - Hamid Rabb
- Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Dorry Segev
- Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Nae-Yuh Wang
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institution and Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Mary Kaiser
- Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Margaret Falkovic
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, 27701, USA.
| | - Jill F Lebov
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, 27701, USA.
| | - L Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, 27701, USA.
| |
Collapse
|
7
|
Lebov JF, Engel LS, Richardson D, Hogan SL, Hoppin JA, Sandler DP. Pesticide use and risk of end-stage renal disease among licensed pesticide applicators in the Agricultural Health Study. Occup Environ Med 2015; 73:3-12. [PMID: 26177651 DOI: 10.1136/oemed-2014-102615] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 06/22/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Experimental studies suggest a relationship between pesticide exposure and renal impairment, but epidemiological evidence is limited. We evaluated the association between exposure to 39 specific pesticides and end-stage renal disease (ESRD) incidence in the Agricultural Health Study, a prospective cohort study of licensed pesticide applicators in Iowa and North Carolina. METHODS Via linkage to the US Renal Data System, we identified 320 ESRD cases diagnosed between enrolment (1993-1997) and December 2011 among 55 580 male licensed pesticide applicators. Participants provided information on use of pesticides via self-administered questionnaires. Lifetime pesticide use was defined as the product of duration and frequency of use and then modified by an intensity factor to account for differences in pesticide application practices. Cox proportional hazards models, adjusted for age and state, were used to estimate associations between ESRD and: (1) ordinal categories of intensity-weighted lifetime use of 39 pesticides, (2) poisoning and high-level pesticide exposures and (3) pesticide exposure resulting in a medical visit or hospitalisation. RESULTS Positive exposure-response trends were observed for the herbicides alachlor, atrazine, metolachlor, paraquat, and pendimethalin, and the insecticide permethrin. More than one medical visit due to pesticide use (HR=2.13; 95% CI 1.17 to 3.89) and hospitalisation due to pesticide use (HR=3.05; 95% CI 1.67 to 5.58) were significantly associated with ESRD. CONCLUSIONS Our findings support an association between ESRD and chronic exposure to specific pesticides, and suggest pesticide exposures resulting in medical visits may increase the risk of ESRD. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT00352924.
Collapse
Affiliation(s)
- Jill F Lebov
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lawrence S Engel
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David Richardson
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Susan L Hogan
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jane A Hoppin
- Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina, USA
| | - Dale P Sandler
- Epidemiology Branch/Chronic Disease Epidemiology Group, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
| |
Collapse
|
8
|
Lebov JF, Valladares E, Peña R, Peña EM, Sanoff SL, Cisneros EC, Colindres RE, Morgan DR, Hogan SL. A population-based study of prevalence and risk factors of chronic kidney disease in León, Nicaragua. Can J Kidney Health Dis 2015; 2:6. [PMID: 25926994 PMCID: PMC4414463 DOI: 10.1186/s40697-015-0041-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/31/2015] [Indexed: 01/13/2023] Open
Abstract
Background Recent studies have shown an excess of chronic kidney disease (CKD) among younger adult males in the Pacific coastal region of Nicaragua and suggest a non-conventional CKD etiology in this region. These studies have been conducted in small, non-representative populations. Objectives We conducted a large population-based cross-sectional study to estimate CKD prevalence in León, Nicaragua, and to evaluate the association between previously investigated risk factors and CKD. Methods Estimated glomerular filtration rate, derived using the MDRD equation, was assessed to determine CKD status of 2275 León residents. Multivariable logistic regression was used to estimate adjusted prevalence odds ratios. León CKD prevalence was also standardized to the demographic distributions of the León Health and Demographic Surveillance System and the León 2005 Census. Results CKD prevalence was 9.1%; twice as high for males (13.8%) than females (5.8%). In addition to gender, older age, rural zone, lower education level, and self-reported high blood pressure, more years of agricultural work, lija (unregulated alcohol) consumption, and higher levels of daily water consumption were significantly associated with CKD. Notably, self-reported diabetes was associated with CKD in adjusted models for females but not males. Conclusions Our findings are comparable to those found in regional studies and further support the hypothesis of a Mesoamerican Nephropathy. Electronic supplementary material The online version of this article (doi:10.1186/s40697-015-0041-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jill F Lebov
- UNC Kidney Center, 7024 Burnett-Womack CB # 7155, Chapel Hill, NC 27599-7155 USA
| | | | - Rodolfo Peña
- Centro de Investigaciones e Intervenciones en Salud, León, Nicaragua
| | - Edgar M Peña
- Centro de Salud Torre Ramona, Unidad Docente de Medicina Familiar y Comunitaria, Sector II, Zaragoza, España
| | | | | | - Romulo E Colindres
- UNC Kidney Center, 7024 Burnett-Womack CB # 7155, Chapel Hill, NC 27599-7155 USA
| | - Douglas R Morgan
- Department of Medicine, Vanderbilt University, Nashville, TN USA ; Department of Medicine, UNC Chapel Hill, NC USA
| | - Susan L Hogan
- UNC Kidney Center, 7024 Burnett-Womack CB # 7155, Chapel Hill, NC 27599-7155 USA
| |
Collapse
|