Chronic disease risk in central New York dairy farmers: results from a large health survey 1989-1999

Longitudinal dynamics of farmer and livestock nasal and faecal microbiomes and resistomes

Globally, half a billion people are employed in animal agriculture and are directly exposed to the associated microorganisms. However, the extent to which such exposures affect resident human microbiomes is unclear. Here we conducted a longitudinal profiling of the nasal and faecal microbiomes of 66 dairy farmers and 166 dairy cows over a year-long period. We compare farmer microbiomes to those of 60 age-, sex- and ZIP code-matched people with no occupational exposures to farm animals (non-farmers). We show that farming is associated with microbiomes containing livestock-associated microbes; this is most apparent in the nasal bacterial community, with farmers harbouring a richer and more diverse nasal community than non-farmers. Similarly, in the gut microbial communities, we identify more shared microbial lineages between cows and farmers from the same farms. Additionally, we find that shared microbes are associated with antibiotic resistance genes. Overall, our study demonstrates the interconnectedness of human and animal microbiomes.

Lessons from Dairy Farmers for Occupational Allergy and Respiratory Disease

PURPOSE OF REVIEW

Exposure to bioaerosols at dairies has long been associated with allergy, respiratory disease, and decreases in lung function. Recent advancements in exposure assessments have aided our understanding on the size distribution and composition of these bioaerosols, but investigations focusing solely on exposures may overlook important intrinsic factors impacting worker's susceptibility to disease.

RECENT FINDINGS

In our review, we discuss the most recent studies examining the exposures and genetic factors that contribute to occupational disease in dairy work. We also review more recent concerns in livestock work associated with zoonotic pathogens, antimicrobial resistant genes, and the role of the human microbiome. The studies highlighted in this review demonstrate the need for further research to better understand bioaerosol exposure-response relationships in the context of extrinsic and intrinsic factors, antibiotic-resistant genes, viral pathogens, and the human microbiome to help inform effective interventions that improve respiratory health among dairy farmers.

Prevalence and risk factors of asthma in dairy farmers: Ancillary analysis of AIRBAg

BACKGROUND

Prolonged occupational agricultural exposure is associated with an increase in asthma diagnosis. This study aimed to identify the prevalence and risk factors for asthma in dairy farmers.

METHODS

AIRBAg was a cross-sectional study including 1203 representative dairy farmers. They completed a self-administered questionnaire and underwent a health respiratory check-up. Referral to a pulmonologist was made for any participant with wheezing, dyspnoea, chronic bronchitis, a chronic cough or a FEV₁/FEV₆ ratio<80%. They underwent further examinations such as spirometry with a reversibility test. Controls (non-asthmatic dairy farmers and non-farm employees) were matched to each asthma case for sex and age (±5 years). The odds ratios (OR) between asthma and different risk factors were estimated using conditional multivariate logistic regression models.

RESULTS

Active asthma was diagnosed in 107 (8.9%) farmers. Compared with control dairy farmers, there was a positive association with family history of allergy (OR = 8.68; 95% CI [4.26-17.69]), personal history of eczema (OR = 3.39; 95% CI [1.61-7.13]), hay manipulation (OR = 5.36, 95% CI [1.59-18.01]), and a negative association with farm area (OR = 0.92; 95% CI [0.85-0.99]) and handling treated seeds (OR = 0.47; 95% CI [0.23-0.95]). Compared with control non-farm employees, there was a positive association between asthma and family history of allergy (OR = 95.82, 95% CI [12.55-731.47]).

CONCLUSIONS

The prevalence of active asthma in dairy farmers was somewhat higher than the rate observed in the general population but may be controlled by reducing exposure to airborne organic contaminants through occupational adaptions on farms.

Healthy Lifestyle Counseling by Healthcare Practitioners: A Time to Event Analysis

INTRODUCTION

Medical societies have heavily prioritized preventive care, as evidenced by numerous best practice guidelines supporting counseling patients on lifestyle factors. This report examines preventive counseling by healthcare providers in a rural healthcare system. We utilized electronic medical records to determine whether patient characteristics and chronic conditions were predictors of preventive counseling, and what the average time-interval was before a patient received this counseling.

METHODS

Medical records from a cohort of 395 subjects participating in the 1999 Bassett Health Census Survey were reviewed for documented counseling with respect to smoking cessation, weight management, physical activity, and health condition-related diets (anti-hypertensive and diabetic diets).

RESULTS

Our analyses revealed extensive delays in counseling for smoking cessation among smokers (median time to counseling = 4.2 years), for weight management among the obese (median time = 4.8 years), and for physical activity for all subjects (median time = 10.9 years). For those with diabetes, a median time of 7.5 years passed before being counseled on a diabetic diet. Hypertensive diet counseling did not occur for more than 50% of hypertensives.

CONCLUSION

In this population, we did not find documentation of lifestyle counseling that was in compliance with current guidelines for any of the lifestyle factors. The measurement of actual delay times provides further support for the position that preventive efforts of health care providers need to be improved.

Prevalence of Sarcopenia in Community-Dwelling Older Adults According to Simplified Algorithms for Sarcopenia Consensus Based on Asian Working Group for Sarcopenia

Purpose

This study sought to identify the prevalence of sarcopenia in community-dwelling Korean older adults and validate two simplified diagnostic algorithms based on the Asian Working Group for Sarcopenia (AWGS) algorithm for identifying sarcopenia.

Patients and Methods

Patients (n = 338) aged ≥65 years participated in this cross-sectional study. Muscle strength was measured by hand grip strength, physical performance by gait speed, and muscle mass by the skeletal muscle mass index (SMI). Sarcopenia was assessed using the AWGS-recommended algorithm and two simplified algorithms (A and B). Algorithms A and B were validated with respect to the AWGS-recommended algorithm using the chi-square test, and the sensitivity and specificity were obtained.

Results

Sarcopenia prevalence, determined using the AWGS-recommended algorithm, was 40.3% and 41.3% in men and women, respectively. The overall prevalence of sarcopenia was 41.0% by the AWGS-recommended algorithm, 37.6% by algorithm A, and 37.6% by algorithm B; 111 participants were diagnosed with sarcopenia using all three methods (p = 0.157).

Conclusion

We established sarcopenia prevalence among rural community-dwelling adults in Korea and confirmed that the simplified algorithms were suitable for the identification of sarcopenia in rural community-dwelling older adults in Korea. Further studies are needed to assess whether these simplified algorithms are applicable to older Asian adults with functional and/or cognitive impairment and nursing home residents.

Characteristics of Agriculture Related Motor Vehicle Crashes in Rural New York State

Objective: The Centers for Disease Control and Prevention (CDC) data have shown that agriculture, forestry, and fishing as an occupational group have the third highest rate of work-related roadway crashes. Agriculture-related crashes have been explored in the Midwest and South; however, we know little about agriculture-related crashes in the Northeast, especially in New York.Methods: To better understand this, researchers obtained motor vehicle crash data from 2010 to 2012 from the New York State Department of Motor Vehicles (NYSDMV). These data were then filtered to agriculture-related cases by both vehicle registration type and vehicle body type.Results: We identified 203 agriculture-related vehicle crashes, involving 381 vehicles and 482 people. Of the agriculture incidents, 91.6% caused property damage, while 36.0% caused injury. The case fatality rate for roadway vehicle crashes was nearly five times as great (2.0/0.4 = 5.00) for agriculture versus non-agriculture crashes (p = 0.0003).Conclusion: Using these data as a supplement to the New York Center for Agricultural Medicine and Health's existing surveillance system provided information useful in setting priorities involving roadway safety.

Farm work-related asthma among US primary farm operators

The objective of this study was to estimate the prevalence of current asthma and the proportion of current asthma that is related to work on the farm among primary farm operators. The 2011 Farm and Ranch Safety Survey data were used to produce estimates and prevalence odds ratios. An estimated 5.1% of farm operators had asthma. Of these, 15.4% had farm work-related asthma. Among operators with farm work-related asthma, 54.8% (95% confidence interval [CI]: 41.8%-68.2%) had an asthma attack in the prior 12 months and 33.3% (95% CI: 21.2%-45.4%) had an asthma attack that occurred while doing farm work. Of those who had an asthma attack that occurred while doing farm work, 65.0% associated their asthma attack with plant/tree materials. This study provides updated information on asthma and the proportion of current asthma that is related to work on the farm and identifies certain groups of farm operators that might benefit from workplace asthma prevention intervention.

A comparison of health, health behavior, and access between farm and nonfarm populations in rural New York state

BACKGROUND

Recent technological and demographic changes in US agriculture raise questions about whether the previously observed benefits of the agricultural lifestyle persist.

METHODS

In 2009, researchers conducted a household survey of 9,612 adults (aged 20+) in a rural region of Upstate New York. Data on health status, health behaviors, and health care access among farmers and rural nonfarm residents were compared.

RESULTS

After adjustment for age, gender, education, and having a regular health care provider, male farmers had elevated prevalence of asthma (OR: 1.82, 95% CI: 1.05-3.16) and untreated chronic obstructive pulmonary disease (COPD) (OR: 3.17, 95% CI: 1.12-9.01). Farmers had significantly lower hypercholesterolemia (OR: 0.70, 95% CI: 0.50-0.99), but not lower prevalence of heart disease or stroke. Farmers had lower rates of smoking (OR: 0.60, 95% CI: 0.40-0.89) and higher rates of hard physical labor (OR: 2.61, 95% CI: 1.83-3.72) than nonfarmers, but they had notably worse health behavior prevalence relative to various types of screening, vaccinations, and having a regular medical care provider (OR: 0.53, 95% CI: 0.39-0.71).

CONCLUSIONS

The farm population is becoming more like the rural nonfarm population with regard to health outcomes and lifestyle, yet it remains notably poorer with regard to prevention. Targeted outreach is needed to increase prevention within the agricultural community.

Systematic review of respiratory health among dairy workers

The dairy industry is changing on a global scale with larger, more efficient operations. The impact of this change on worker health and safety, specifically, associations between occupational lung disease and inhalation exposures, has yet to be reported in a comprehensive review of the scientific literature. Therefore, a three-tier process was used to identify information using a keyword search of online databases of scientific literature. Of the 147 citations reviewed, 52 met initial screening criteria, and 30 were included in this review. Dairy workers experience lung conditions such as asthma, chronic obstructive pulmonary disease, hypersensitivity pneumonitis, chronic bronchitis, and cancer. Recent pulmonary function studies have identified obstructive lung changes among dairy farm workers. The increased scale of dairy production with significant changes in technology and work practices has altered inhalation exposure patterns among dairy workers. The inhalation exposure in the dairy work environment may elicit differing inflammatory responses in relation to timing of initial exposure as well as to repeated exposures. Few studies have measured inhalation exposure while simultaneously assessing the impact of the exposure on lung function of dairy farm workers. Even fewer studies have been implemented to assess the impact of aerosol control technology to reduce inhalation exposure. Future research should evaluate worker exposure to aerosols through a task-based approach while utilizing novel methods to assess inhalation exposure and associated inflammatory responses. Finally, potential solutions should be developed and tested to reduce inhalation exposure to inflammatory agents and respiratory diseases in the dairy farm work environment.

Respiratory disease in United States farmers

OBJECTIVES

Farmers may be at increased risk for adverse respiratory outcomes compared with the general population due to their regular exposures to dusts, animals and chemicals. However, early life farm exposures to microbial agents may result in reduced risk. Understanding respiratory disease risk among farmers and identifying differences between farmers and other populations may lead to better understanding of the contribution of environmental exposures to respiratory disease risk in the general population.

METHODS

We compared the prevalence of self-reported respiratory outcomes in 43548 participants from the Agricultural Health Study (AHS), a prospective cohort of farmers and their spouses from Iowa and North Carolina, with data from adult participants in the National Health and Nutrition Examination Survey (NHANES) over the same period (2005-2010).

RESULTS

AHS participants had lower prevalences of respiratory diseases (asthma, adult-onset asthma, chronic bronchitis and emphysema), but higher prevalences of current respiratory symptoms (wheeze, cough and phlegm) even after controlling for smoking, body mass index and population characteristics. The overall prevalence of asthma in the AHS (7.2%, 95% CI 6.9 to 7.4) was 52% of that in NHANES (13.8%, 95% CI 13.3 to 14.3), although the prevalence of adult-onset asthma among men did not differ (3.6% for AHS, 3.7% for NHANES). Conversely, many respiratory symptoms were more common in the AHS than NHANES, particularly among men.

CONCLUSIONS

These findings suggest that farmers and their spouses have lower risk for adult-onset respiratory diseases compared with the general population, and potentially higher respiratory irritation as evidenced by increased respiratory symptoms.

New-onset asthma and the effect of environment and occupation among farming and nonfarming rural subjects

BACKGROUND

Many factors, including environmental exposures, have been related to the increase in the prevalence of asthma, but only few have been tested for in longitudinal studies.

OBJECTIVE

We studied farming students to determine whether their environment during childhood and as adults was a factor determining subsequent onset of asthma.

METHODS

From 1994 to 1998, new cases of asthma were identified by means of an annual posted questionnaire followed by a telephone interview in a prospective cohort consisting of 1964 farming-school students and 407 nonfarming subjects aged 16 to 26 years. For each case, we selected a control subject from the cohort with no asthma in a case-based design, and all underwent an interview and a clinical examination.

RESULTS

We found 122 new cases of asthma. In a multiple regression model the odds ratio for new asthma was 3.3 (95% CI, 1.7-6.3) for smoking; 3.4 (95% CI, 1.6-7.0), 2.5 (95% CI, 1.1-5.3), and 7.0 (95% CI, 1.2-41.6) for exposure to swine, dairy production, and welding, respectively; and 11.7 (95% CI, 2.4-56.4) for bronchial hyperresponsiveness at baseline. Being born and raised on a farm significantly reduced the risk odds ratio (0.5 [95% CI, 0.3-0.98]), whereas atopy had no influence.

CONCLUSION

Exposure to swine and dairy confinements, welding, smoking, and bronchial hyperresponsiveness are risk factors for nonallergic asthma, and being born and raised on a farm reduces the subsequent risk. These findings support the theory that immune and inflammatory responses can be influenced by environmental exposure to early childhood, reducing the risk of asthma later in life.

Body mass index, agricultural pesticide use, and cancer incidence in the Agricultural Health Study cohort

Obesity is associated with increased risks of several cancers including colon and female breast. Pesticide use in agricultural populations has also been linked with higher risks of various cancers. However, the interaction between obesity and pesticide use on cancer risk has not been well studied. Using data from the Agricultural Health Study, we examined the association between body mass index (BMI) and the risk of cancer at 17 sites and the interaction between BMI and pesticide use. Pesticide applicators residing in Iowa and North Carolina and their spouses were enrolled between 1993 and 1997 and given a self-administered questionnaire to obtain pesticide use and other information. This analysis included 39,628 men and 28,319 women with height and weight data who were cancer-free at enrollment. Among these participants, 4,432 were diagnosed with cancer between enrollment and 2005 and 64% were overweight or obese. BMI (per 1 kg/m(2)) was positively associated with colon cancer in men (hazard ratio (HR) 1.05, 95% confidence interval (CI) 1.02-1.09) and breast cancer in postmenopausal women (HR 1.03, 95% CI 1.01-1.06). In contrast, BMI was inversely associated with lung cancer in men, with a significant association in ever smokers (HR 0.92, 95% CI 0.88-0.97) and a null association in never smokers. The positive association between BMI and colon cancer in men was significant in those who ever used carbofuran (HR = 1.10, 95% CI 1.04-1.17; p-interaction = 0.04) or metolachlor (HR = 1.09, 95% CI 1.04-1.15; p-interaction = 0.02) but was null in non-users of these pesticides. Among male ever smokers, the inverse association between BMI and lung cancer was significant in non-users of carbofuran (HR = 0.87, 95% CI = 0.82-0.92) but was null in users of carbofuran (p-interaction = 0.02). These findings suggest that certain pesticides may modify the effects of BMI on the risks of colon and lung cancers.

Prevalence and changes in chronic diseases among South Korean farmers: 1998 to 2005

Background

Epidemiologic studies have suggested a unique pattern of disease among farmers in Western countries, but limited information is available about the magnitude of disease prevalence and their changes over time in Asian farmers. The aim of this study was to compare the prevalence and changes in chronic diseases among farmers with those of other occupational groups in South Korea.

Methods

Using data from three consecutive cross-sectional national surveys: the Korean National Health and Nutrition Examination Survey 1998 (n = 39,060), 2001 (n = 37,769), and 2005 (n = 34,145), we calculated age and gender-standardized prevalence of chronic diseases by the direct method and compared the prevalence changes from 1998 to 2005.

Results

Female farmers had significantly higher chronic disease prevalence than other occupational groups in all three surveys. Arthritis was the most prevalent chronic disease among farmers for both men and women. Compared with other populations, farmers demonstrated a higher prevalence of arthritis and intervertebral disc disorders. Farmers showed higher prevalence changes for intervertebral disc disorders than other occupational workers.

Conclusion

Our findings support that South Korean farmers have a distinct pattern of diseases prevalence from other populations. More detailed studies investigating the risk of musculoskeletal diseases and intensive intervention efforts to reduce the prevalence these diseases, particularly among female farmers, are required.

Ethnic, racial, and gender variations in health among farm operators in the United States

PURPOSE

The purpose of this study was to collect baseline prevalence data on the health problems faced by minority, white, and female farm operators.

METHODS

An occupational health survey of farm operators was conducted by the U.S. Department of Agriculture, National Agricultural Statistics Service between February and August 2000. A stratified random sample of farm operators from 50 U.S. states based on the 1997 Census of Agriculture was selected for telephone interview. Interviews were primarily conducted using a computer assisted telephone instrument system.

RESULTS

Population prevalences were calculated for 7137 farm operators. Prevalences were greatest for musculoskeletal discomfort, followed by respiratory problems, hearing loss, and hypertension. Generally, Latino and Asian American operators had lower prevalences for health problems than white non-Latino and white operators, respectively. African-American operators had greater prevalences for hypertension, and osteoarthritis, but lower prevalences for hearing loss, skin problems, heart problems, and cancer than white operators. American Indian or Alaska Native operators had higher prevalences for musculoskeletal problems, skin problems, and hypertension.

CONCLUSIONS

Prevalences for the different ethnicity and race groups are not the same. Studies that combine racial and ethnic groups, or study only white and non-Latino farm operators may overestimate or underestimate the prevalence of health conditions in the entire farm operator population.

Reduced risk of atopic sensitization among farmers: the Humboldt study

BACKGROUND

It needs to be clarified whether farming is associated with a reduced risk of atopy or allergic condition. There is a lack of consistent evidence for prevalences of atopy, respiratory allergy and asthma in adult farmers.

METHODS

A cross-sectional study of adults (n = 2,081) was conducted in the town of Humboldt, Sask. Allergy skin prick tests were conducted to determine atopic sensitization. Respiratory allergy and physician-diagnosed asthma were based on self-reporting. Logistic regression was used to assess the associations of atopy, respiratory allergy and asthma with farming practices, adjusting for other important variables.

RESULTS

Of 2,081 participants, 27.8% were farmers. Reduced risks of atopic sensitization, respiratory allergy and asthma were observed among farmers compared to non-farmers. After adjustment for sex and age, which are major confounders, the odds ratio for atopic sensitization was 0.79 (95% confidence interval: 0.65, 0.97) for farmers versus non-farmers. Asthma showed a similar trend; however, there was no statistically significant difference in either respiratory allergy or asthma rates observed between farmers and non-farmers.

CONCLUSIONS

The prevalence of atopy was lower in adult farmers than in non-farmers.