Agricultural Injury Surveillance in the United States and Canada: A Systematic Literature Review

INTRODUCTION

Agricultural injuries remain a major concern in North America, with a fatal injury rate of 19.5 deaths per 100,000 workers in the United States. Numerous research efforts have sought to compile and analyze records of agricultural-related injuries and fatalities at a national level, utilizing resources, ranging from newspaper clippings and hospital records to Emergency Medical System (EMS) data, death certifications, surveys, and other multiple sources. Despite these extensive efforts, a comprehensive understanding of injury trends over extended time periods and across diverse types of data sources remains elusive, primarily due to the duration of data collection and the focus on specific subsets.

METHODS

This systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, consolidates and analyzes agricultural injury surveillance data from 48 eligible papers published between 1985 and 2022 to offer a holistic understanding of trends and challenges.

RESULTS

These papers, reporting an average of 25,000 injuries each, were analyzed by database source type, injury severity, nature of injury, body part, source of injury, event/exposure, and age. One key finding is that the top source of injury or event/exposure depends on the chosen surveillance system and injury severity, underscoring the need of diverse data sources for a nuanced understanding of agricultural injuries.

CONCLUSION

This study provides policymakers, researchers, and practitioners with crucial insights to bolster the development and analysis of surveillance systems in agricultural safety. The overarching aim is to address the pressing issue of agricultural injuries, contributing to a safer work environment and ultimately enhancing the overall well-being of individuals engaged in agriculture.

Non-Fatal Work-Related Farm Injuries Occurring to Michigan Adults and Youths

Farming is one of the top industries in Michigan and has the highest fatality rate. National sources of non-fatal farm injuries underestimate the burden, especially among children. In this paper, we provide a more accurate estimate of non-fatal farm injuries in Michigan by using an ongoing multi-source surveillance system. Michigan's farm-injury surveillance system includes abstractions of hospital-based medical records, poison control center calls, ambulance runs, and workers' compensation claims for individuals with a farm-related injury. For this analysis, injury onset occurred in 2015 to 2021 and included all injuries regardless of age or occupation. We identified 4,306 injuries in adults and 336 injuries in youth. For those 0-13 years of age all but two were family members. For those 14-15 and 16-17 years of age, 19% and 45%, respectively were hired hands. For adults, 51% were owner/operators, 43% were hired hands, and 5% were family members. For all ages, the most frequent injury source was cattle. Lacerations/cuts/punctures were the most common type of injury for those < 14 years of age while for older individuals it was contusions/bruises. The plurality of injuries occurred in the summer months. Children working on a farm are in unique situation and tracking injuries and identifying injury sources provide necessary information to protect their health and well-being. Michigan's farm-injury surveillance system will continue to provide a comprehensive count of work-related injuries among Michigan's farming population. The information is used to direct public health intervention both at the individual and population level.

'It could have been a lot worse': the psychological effects of farm-related serious injury in Victoria

INTRODUCTION

The psychological response to injury is an important factor in recovery, and the development of psychological problems can result in a delay or inability to return to pre-injury function, including return to work. Farming is widely acknowledged as a stressful occupation, with non-injured farmers already at an increased risk of developing significant psychological problems, including high levels of stress and depression, and increased rates of suicide. This study aimed to investigate the psychological effects of serious farm-related injury on farmers, and how this influences their recovery.

METHODS

This was a qualitative study of 31 farmers in the state of Victoria, Australia, who sustained major trauma between 2007 and 2013. Participants were identified using the Victorian State Trauma Registry and underwent an in-depth, semi-structured telephone interview. Recruitment continued until data saturation was achieved, and thematic analysis was used to identify important themes from the data.

RESULTS

For many farmers, the traumatic circumstances and ongoing impact of their injury are life-changing. In this study, the psychological effects of sustaining a major farm-related injury varied between participants; however, four major interconnected themes were identified: importance of a pragmatic outlook; grief, helplessness and loss of independence; traumatic thoughts post-injury; and the importance of the support network and community. The findings of this study highlight both a reluctance for psychological assistance as well as the importance of psychological resilience and support networks to recovery.

CONCLUSION

Overall, a positive outlook was found to be the primary enabler in the farmers' recovery. It is recommended that injured farmers should be provided with additional psychological support and advice to aid in their recovery. Additionally, psychological support services should be extended to include both the family network and the broader farming community, as these were found to experience significant short- and long-term stress following farmers' injury.

Medical Emergencies in Farmers

BACKGROUND

Agricultural work involves hazards that may harm long-term well-being. We evaluated the risk of long-term disability and death for agricultural workers compared to construction workers with similar demographics. We hypothesized that delays to emergency care and subsequent long-term disability following injury might be worse for agricultural workers compared to those injured in construction.

METHODS

We evaluated all adults severely injured on farms or on construction sites in Ontario, Canada, between April 1, 2009, and March 31, 2012, according to the Ontario Trauma Registry. We excluded individuals living outside of the province, those missing a valid health card number, or youth less than 17 years old. Our primary outcome was death or the subsequent application for disability support.

RESULTS

In total, 353 patients were injured on a farm or construction site during the study period. Delays to emergency care exceeding 12 hours were more frequent for agricultural workers compared to construction workers (43% vs 23%, P <.001). After a 5-year follow-up, agricultural workers had a death or disability rate marginally higher than construction workers (23% vs 14%, P = .068), equivalent to a hazard ratio of 1.62 that was marginally statistically significant (95% confidence interval 0.96-2.75, P = .072). The risk of death and disability was greatest for patients who had the longest delays to emergency care.

INTERPRETATION

Agricultural workers experience a substantial delay in receiving emergency care and a marginally higher risk of death or disability in the years following injury compared to construction workers.

Injury risk factors to farm and ranch operators in the Central United States

BACKGROUND

This study focused on risk factors for serious injuries in farm and ranch operators in the central United States.

METHODS

The Central States Center for Agricultural Safety and Health, in collaboration with the National Agricultural Statistics Service, sent mail surveys to 6953, 6912, and 6912 farms/ranches in 2011-2013, respectively, covering seven Midwestern states.

RESULTS

The average survey response rate was 35%. The average annual incidence rate (injuries/100 workers) was 6.91 for all injuries and 2.40 for serious injuries. Univariate analyses determined several demographic and farm production-related risk factors for serious injury. Adjusted analysis showed a greater risk of serious injury for operators of age 45-54 years (vs. 65 and higher), those who worked 75-99% of their time (vs. less time), and those who operated larger land areas (vs. smaller).

CONCLUSION

The identified risk factors should be considered when targeting injury prevention programs.

Stress, Depression, and Occupational Injury among Migrant Farmworkers in Nebraska

Agriculture is one of the most dangerous industries in the United States. Farmworkers, including migrant farmworkers, are at risk for work-related injuries. This study explores the association between stress, depression, and occupational injury among migrant farmworkers in Nebraska. Occupational injury was hypothesized to significantly increase the odds of farmworkers being stressed and depressed. Two hundred migrant farmworkers (mean age = 33.5 years, standard deviation (SD) = 12.53; 93.0% men, 92.9% of Mexican descent) were interviewed. In bivariate analyses, results indicated that stress and depression were positively associated with occupational injury. Two logistic regression models were developed. Occupational injury was a significant factor for depression, but not for stress. Participants who had been injured on the job were over seven times more likely to be depressed. These results highlight the interconnection between the work environment and mental health. More must be done to foster well-being in rural, agricultural communities. Improving occupational health and safety information and training, integrating behavioral health services into primary care settings, and strengthening the protections of the Migrant and Seasonal Agricultural Worker Protection Act may improve conditions for migrant farmworkers in the rural Midwest.

The effects of arthritis, mobility, and farm task on injury among older farmers

The current study was conducted by performing secondary analysis of data drawn from a study of sustained work indicators of older farmers. The primary outcome variable was the reported occurrence or non-occurrence of injuries because of farm work in the past year. There were three explanatory variables of interest: (1) whether respondents reported ever having been diagnosed with arthritis/rheumatism by a medical doctor; (2) whether participants reported having mobility problems; and (3) a farm task injury risk index. Additional explanatory variables included the estimated number of days spent on farming activities in the past year, as well as demographic characteristics such as age, sex, and race. Institutional review board approvals were obtained for the original study prior to data collection, and for the current study prior to secondary analysis of data. Descriptive statistics were calculated for the outcome and explanatory variables. Initial multivariable longitudinal models for the occurrence of injuries were fitted with the explanatory variables. Odds ratios for the effects of interest were calculated using the final models. A longitudinal model was fitted using data in waves 1, 3, and 5, with a farm task injury risk index as outcome variable and wave, sex, age, race, and estimated number of days spent on farming activities in the past year as explanatory variables for exploration of the relationship between the farm task injury risk index and these variables. In this group of older farmers, aging was protective for injury, and was associated with decreased farm task injury risk index. Arthritis/rheumatism was associated in our study with occurrence of injury because of farm work across all four waves. Our results indicated that farmers with mobility problems were twice as likely to experience injuries because of farm work compared to farmers with no mobility problems. Increased farm task injury risk index was associated with a 40% increase in odds for the occurrence of injury due to farm work. In this study of older farmers, the type of work, and not the amount of work was significantly associated with injury risk. Implications for future studies of farm injury include the need for nurse researchers and others to incorporate objective validated measures of mobility and health care provider diagnoses of arthritis, and arthritis type. Nurse researchers should proceed with ongoing evaluation of the farm task injury risk index to determine its validity, reliability, and usefulness as a predictor of farm injuries. In the practice setting, nurses may apply findings from this study to provide injury prevention teaching to older farmers and their families. For example, discussions of the more risky farm tasks, injury prevention strategies, and treatment modalities including those that promote improved mobility should be targeted to older farmers with arthritis and actual or potential mobility issues. Ultimately, these nursing research and practice efforts may lead to preservation of function, and decreased injury risk and severity among older farmers.