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The AGRIculture and CANcer (AGRICAN) cohort study: Enrollment and causes of death for the 2005-2009 period

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... Farmers have lower overall cancer and mortality rates compared with the general population. [1][2][3][4] Nevertheless, the rates of certain cancers, including lymphohaematopoietic cancers (LHCs), have been reported to be higher among farmers. 5 6 Reasons for these elevated rates remain unclear, and may be due to a variety of exposures, including pesticides, allergens (eg, mites), endotoxins, bacteria and viruses. ...
... AGRICOH is an international consortium of agricultural cohort studies established to examine the associations between health outcomes and agricultural exposures. 15 We used data from three prospective cohort studies that had relevant data available on animal production and cancer incidence, including the Agricultural Health Study (AHS) 16 from the USA, the AGRIculture and CANcer (AGRICAN) study 3 from France and the Cancer in the Norwegian Agricultural Population (CNAP) study 4 from Norway. A detailed summary of study design and participant details for this project, including inclusion criteria, has been published. ...
... Subjects who had been diagnosed with cancer before the date of enrolment and those who did not live in either Iowa or North Carolina were excluded, leaving 51 167 farmers. Incident cases were identified through linkage to state cancer registries from the date of enrolment (1993)(1994)(1995)(1996)(1997) 3 At enrolment, farmers and farm workers were asked if they had ever worked with each of the following types of animal: cattle, sheep or goat, pigs, horses, poultry and other animals. For each type of animal, they reported the tasks performed. ...
Article
Objectives Animal farming entails a variety of exposures to infectious agents, endotoxins and pesticides, which may play a role in the aetiology of lympho-hematopoietic cancers. The aim of this investigation was to assess lymph-hematopoietic cancers risk in association with raising animals on farms. Method Self–reported animal production (cattle, hogs, sheep/goats, poultry) were collected in the US Agricultural Health Study, French Agriculture and Cancer Study, and Cancer in the Norwegian Agricultural Population cohorts. Associations with risk of lymph-hematopoietic cancers, including 18 cancer outcomes, were evaluated using Cox proportional hazard models, adjusted for sex, pesticides and other confounders. The referent category consisted of farmers who didn’t produce the animal species being evaluated. Cohort-specific hazard ratios (HR) were combined using random effects meta-analysis. Among 316,270 farmers, 3,282 lymph-hematopoietic cancers were diagnosed between 1993–2011. Results 60%, 35%, 33%, and 27%, of farmers raised cattle, hogs, poultry and sheep/goats, respectively, although the prevalence varied by cohort. Raising cattle was not associated with overall non-Hodgkin lymphoma (meta-HR=1.04; 95% Confidence Interval (CI): 0.93–1.16; I2 = 13%), but was associated with follicular lymphoma (meta-HR = 1.43; 95% CI: 1.02–2.01; I2 = 21%). The risk of myelodysplastic syndromes was significantly reduced in farmers who raised sheep/goats (meta-HR = 0.66; 95% CI: 0.46–0.95; I2 = 0%), as was the risk of „marginal-zone lymphoma among farmers who raised hogs (meta-HR = 0.57; 95% CI: 0.33–0.99; I2 = 0%), with the majority of exposed cases coming from two cohorts. We observed no meta-association between raising poultry and any lymph-hematopoietic cancer subtypes. It should be noted that differences in raising animals between countries and years might have influenced relevant exposures and therefore HR estimates for lymph-hematopoietic cancer sub-types might vary by cohort for specific animals. Conclusions This study suggests specificity of associations between specific animals raised and lymph-hematopoietic cancer sub-types. These associations will be investigated further considering number of animals raised and farmers producing single species.
... Farmers have lower overall cancer and mortality rates compared with the general population. [1][2][3][4] Nevertheless, the rates of certain cancers, including lymphohaematopoietic cancers (LHCs), have been reported to be higher among farmers. 5 6 Reasons for these elevated rates remain unclear, and may be due to a variety of exposures, including pesticides, allergens (eg, mites), endotoxins, bacteria and viruses. ...
... AGRICOH is an international consortium of agricultural cohort studies established to examine the associations between health outcomes and agricultural exposures. 15 We used data from three prospective cohort studies that had relevant data available on animal production and cancer incidence, including the Agricultural Health Study (AHS) 16 from the USA, the AGRIculture and CANcer (AGRICAN) study 3 from France and the Cancer in the Norwegian Agricultural Population (CNAP) study 4 from Norway. A detailed summary of study design and participant details for this project, including inclusion criteria, has been published. ...
... Subjects who had been diagnosed with cancer before the date of enrolment and those who did not live in either Iowa or North Carolina were excluded, leaving 51 167 farmers. Incident cases were identified through linkage to state cancer registries from the date of enrolment (1993)(1994)(1995)(1996)(1997) 3 At enrolment, farmers and farm workers were asked if they had ever worked with each of the following types of animal: cattle, sheep or goat, pigs, horses, poultry and other animals. For each type of animal, they reported the tasks performed. ...
Article
Objective: Animal farming entails a variety of potential exposures, including infectious agents, endotoxins and pesticides, which may play a role in the aetiology of lymphohaematopoietic cancers (LHCs). The aim of this study was to assess whether farming specific animal species is associated with the risk of overall LHC or its subtypes. Methods: Data from three prospective cohort studies in the USA, France and Norway which are part of the Agricultural Cohort consortium and which collected information about animal farming and cancer were used. Analyses included 316 270 farmers and farm workers. Adjusted Cox models were used to investigate the associations of 13 histological subtypes of LHC (n=3282) with self-reported livestock (cattle, pigs and sheep/goats) and poultry (ever/never and numbers raised) farming. Cohort-specific HRs were combined using random-effects meta-analysis. Results: Ever animal farming in general or farming specific animal species was not meta-associated with overall LHC. The risk of myeloid malignancies decreased with increasing number of livestock (p trend=0.01). Increased risk of myeloproliferative neoplasms was seen with increasing number of sheep/goats (p trend <0.01), while a decreased risk was seen with increasing number of livestock (p trend=0.02). Between cohorts, we observed heterogeneity in the association of type of animal farmed and various LHC subtypes. Conclusions: This large-scale study of three prospective agricultural cohorts showed no association between animal farming and LHC risk, but few associations between specific animal species and LHC subtypes were observed. The observed differences in associations by countries warrant further investigations.
... Details on the study have been previously published. 27 Briefly, a postal questionnaire was sent to the source population: all subjects (i) 18 years and over on January 1st, 2004; (ii) registered for at least 3 years by the health insurance for people involved in agriculture in France [Mutualit e Sociale Agricole (MSA)]; (iii) living in one of the 11 geographical areas covered by the study. The cohort included men and women, active or retired, workers and employers from agricultural or related sectors (including tertiary sector or other specific industries: cooperatives, sawmills, forestry. . ...
... Complete job calendars with lifetime history of farming types, including details on 13 crops (grassland, vineyard, corn, wheat and/or barley, peas, beet, sunflower, rape, tobacco, potato, fruits, greenhouse, other field-grown vegetable crops) and five types of animals (beef and/or dairy cattle, sheep and/or goats, pigs, horses, poultry) were collected at enrollment. 27 For each type of crop/animal, participants were invited to check all the appropriate boxes among lists of 2 to 5 main tasks (ever/never) and to indicate the dates of beginning and end (questionnaire available online as additional supporting information). Binary variables (ever/never) were considered for overall farming exposure, for each crop or animal grown, each task, and for self-reported pesticide poisoning. ...
... Indeed, in view of differences in clinical and epidemiological features of gliomas and meningioma, it is sound to hypothesize that they have different etiologies. 6,28 Another strength of the cohort is its representativeness as it targeted all individuals involved in agriculture, 27 independently of gender, age, or occupational status, and was not restricted to pesticide applicators. Moreover, as the cohort enrolled all individuals who worked for 3 years or more in agriculture at any time in their lives, including retirees and those who left the industry even a long time ago, we assume that selection bias related to health (Healthy Worker Effect) remained limited. ...
Article
Studies in farmers suggest a possible role of pesticides in the occurrence of Central Nervous System (CNS) tumors but scientific evidence is still insufficient. Using data from the French prospective agricultural cohort AGRICAN (Agriculture & Cancer), we investigated the associations between exposure of farmers and pesticide users to various kinds of crops and animal farming and the incidence of CNS tumors, overall and by subtypes. Over the 2005-2007, 181,842 participants completed the enrollment questionnaire that collected a complete job calendar with lifetime history of farming types. Associations were estimated using proportional hazards models with age as underlying timescale. During a 5.2 years average follow-up, 273 incident cases of CNS tumors occurred, including 126 gliomas and 87 meningiomas. Analyses showed several increased risks of CNS tumors in farmers, especially in pesticide users (hazard ratio=1.96; 95% confidence interval: 1.11-3.47). Associations varied with tumor subtypes and kinds of crop and animal farming. The main increases in risk were observed for meningiomas in pig farmers and in farmers growing sunflowers, beets and potatoes and for gliomas in farmers growing grasslands. In most cases, more pronounced risk excesses were observed among pesticide applicators. Even if we cannot completely rule out the contribution of other factors, pesticide exposures could be of primary concern to explain these findings. This article is protected by copyright. All rights reserved.
... It therefore seems essential not only to prevent occupational exposure in farmers, but also to fight against tobacco smoking, especially in those who are exposed to noxious occupational airborne contaminants [9]. The prevalence of smoking conceals large disparities between professional sectors [10], and it has previously been reported that farmers smoke less than non-farmers [11, 12]. In a recent report by the Institut National de Prévention et d'Education pour la Santé (INPES), the prevalence of active smoking in France was estimated to be about 17% in farmers, while it was 23% in managers and 40% in manual workers [13]. ...
... In a recent report by the Institut National de Prévention et d'Education pour la Santé (INPES), the prevalence of active smoking in France was estimated to be about 17% in farmers, while it was 23% in managers and 40% in manual workers [13]. In the French AGRICAN cohort ( " AGRIculture and CANcer " ) that included about 180,000 subjects working in the primary sector, the proportion of ever-smokers (either current or former smokers) was 58% in males and 24% in females [11]. In the general population, the INPES has reported a higher proportion of ever-smokers than that observed in farmers included in the AGRICAN cohort, with a prevalence of 64% in males and 51% in females [14]. ...
Article
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Background Farmers are exposed to multiple air contaminants that may interact with tobacco smoking in the development of respiratory diseases. Farmers are currently considered to smoke less than non-farmers, but precise data in different categories of age and farming activities are lacking. Methods Smoking habits were studied in a cross-sectional study involving 4105 farmers and 996 non-farming controls aged 40–74 years in 9 French departments between October 2012 and May 2013. Three age groups were defined (40–54, 55–64 and 65-74years). Farmers were divided into four activity groups, namely cattle breeders, livestock farmers working in confined spaces, crop farmers and others. Smoking prevalence was compared between farmers and controls, and odds ratios (ORs) for smoking adjusted for age were calculated. ResultsThe adjusted OR for ever-smoking was lower among farmers than among non-farmers in all age categories, but the ORs for current smoking were similar in farmers and controls. Smoking prevalence varied according to the type of farming activity, and was lower than in non-farming controls only among cattle breeders and confined livestock farmers. In farmers, the proportion of smokers was higher in the youngest age categories compared with the older age classes. Conclusions Our results confirm that the prevalence of ever-smokers is lower in farmers than in non-farmers. Nevertheless, our data show that active smoking prevalence is similar in farmers and in non-farmers. This suggests that farmers, just like non-farmers, should be targeted by primary prevention campaigns against smoking.
... [14,15] In contrast, farmers are typically physically active, [5][6][7] have access to fresh vegetables, [5][6][7]16] and are less likely to smoke. [17][18][19] There are currently no studies that have investigated the association between farm work and the duration of dependency on nursing care. We studied the association in a Japanese cohort of older adults. ...
... Our data were also consistent in that farm workers had a lower prevalence of current smoking [5,[17][18][19] and were more likely to exercise [7] than were the general population. In our study, the proportion of hospitalization among those who had farm work experience was significantly lower than that among those without. ...
Article
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With the advance of medical care, the duration of dependency on nursing care in later life has increased worldwide. There is a question of whether farm work could extend or shorten the dependency duration. We investigated the association between farm work experience and the duration of dependency on nursing support or care in late life. We randomly selected 600 adults aged ≥65 years, who were independent and not hospitalized, as part of the Yamanashi Healthy-Active Life Expectancy cohort and followed them for 13 years. We defined the duration of dependency as the time from reception of long-term care insurance benefits to death, and we adjusted for multiple covariates. We analyzed data from 225 adults (139 men and 86 women) who died during the follow-up period. Ninety four had received long-term care benefits. Mean age was 79.6 years (standard deviation [SD]: 6.3) in individuals with farm work experience and 80.1 years (SD: 7.2) in individuals without farm work experience. The estimated duration of dependency on long-term care was 1.3 years (standard error [SE]: 0.4) in individuals with farm work experience vs 2.1 years (SE: 0.5) in individuals without farm work experience (P = .01). The estimated duration of dependency in individuals with farm work experience and without farm work experience was 0.4 years (SE: 0.5) vs 1.3 years (SE: 0.6) in men respectively (P = .03) and 1.6 years (SE: 0.9) vs 2.4 years (SE: 0.9) in women, respectively (P = .16). The sensitivity analysis yielded an estimated duration of 1.2 years (SE: 0.5) in those with farm work experience and 2.3 years (SE: 0.5) in those without farm work experience (P = .004). Individuals with farm work experience required less long-term care prior to death, suggesting that agricultural and physical activities promote health. Policymakers focusing on preventing the need for nursing care in older populations could consider promoting farming or gardening.
... In addition, the results obtained with Model 3 are consistent with the literature. Indeed, SPCs 'Farmers' and 'Other occupational activities' have a lower early background mortality (<65) ___________________________________________________________________________ than the overall mortality from the life table [41]; Farmers would be healthier than the general population [42,43]. The present study results showed that, before age 75 years, the working population had a lower background mortality than the overall mortality from the general population. ...
Preprint
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Background: Methods for estimating relative survival are widely used in population-based cancer survival studies. These methods are based on splitting the observed (the overall) mortality into excess mortality (due to cancer) and background mortality (due to other causes, as expected in the general population). The latter is derived from life tables usually stratified by age, sex, and calendar year but not by other covariates (such as the deprivation level or the socioeconomic status) which may lack though they would influence background mortality. The absence of these covariates leads to inaccurate background mortality, thus to biases in estimating the excess mortality. These biases may be avoided by adjusting the background mortality for these covariates whenever available. Methods: In this work, we propose a regression model of excess mortality that corrects for potentially inaccurate background mortality by introducing age-dependent multiplicative parameters through breakpoints, which gives some flexibility. The performance of this model was first assessed with a single and two breakpoints in an intensive simulation study, then the method was applied to French population-based data on colorectal cancer. Results: The proposed model proved to be interesting in the simulations and the applications to real data; it limited the bias in parameter estimates of the excess mortality in several scenarios and improved the results and the generalizability of Touraine’s proportional hazards model. Conclusion: Finally, the proposed model is a good approach to correct reliably inaccurate background mortality by introducing multiplicative parameters that depend on age and on an additional variable through breakpoints.
... In addition, the results obtained with Model 3 are consistent with the literature. Indeed, SPCs "Farmers" and "Other occupational activities" have a lower early background mortality (<65) ___________________________________________________________________________ than the overall mortality from the life table [41]; Farmers would be healthier than the general population [42,43]. The present study results showed that, before age 75 years, the working population had a lower background mortality than the overall mortality from the general population. ...
Preprint
Full-text available
Background : Methods for estimating relative survival are widely used in population-based cancer survival studies. These methods are based on splitting the observed (the overall) mortality into excess mortality (due to cancer) and background mortality (due to other causes, as expected in the general population). The latter is derived from life tables usually stratified by age, sex, and calendar year but not by other covariates (such as the deprivation level or the socioeconomic status) which may lack though they would influence background mortality. The absence of these covariates leads to inaccurate background mortality, thus to biases in estimating the excess mortality. These biases may be avoided by adjusting the background mortality for these covariates whenever available. Methods : In this work, we propose a regression model of excess mortality that corrects for potentially inaccurate background mortality by introducing age-dependent multiplicative parameters through breakpoints, which gives some flexibility. The performance of this model was first assessed with a single and two breakpoints in an intensive simulation study, then the method was applied to French population-based data on colorectal cancer. Results: The proposed model proved to be interesting in the simulations and the applications to real data; it limited the bias in parameter estimates of the excess mortality in several scenarios and improved the results and the generalizability of Touraine’s proportional hazards model. Conclusion: Finally, the proposed model is a good approach to correct reliably inaccurate background mortality by introducing multiplicative parameters that depend on age and on an additional variable through breakpoints.
... A low prevalence of asthma and atopy has been shown in farmers and agricultural workers, but a high prevalence of respiratory symptoms related to chronic bronchitis and COPD has been established [5,6]. Although farmers tend to smoke less often than the general population [7,8], a higher prevalence of COPD has been suggested in subjects exposed to farm animals, especially swine, poultry and cattle [5,[9][10][11]. However, a cross-sectional study of the risk of COPD in farmers using nonfarming working subjects as controls is still lacking, and there are conflicting data regarding the magnitude and determinants of COPD risk in farmers [5,9,10]. ...
Article
There are conflicting data regarding the magnitude and determinants of chronic obstructive pulmonary disease (COPD) risk in farmers.In a cross-sectional study of 917 nonfarming working controls and 3787 farmers aged 40-75 years, we assessed respiratory symptoms, tobacco exposure, job history (without direct exposure measurement) and lung function. COPD was defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criterion (post-bronchodilator forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC)<0.70) and by the Quanjer reference equation (post-bronchodilator FEV1/FVC<lower limit of normal (LLN)).The prevalence (95% CI) of COPD according to the GOLD criterion was 5.1% (4.4-5.8%) and 2.9% (1.8-4.0%) in farmers and controls, respectively (p=0.005), and 3.1% (2.5-3.6%) and 1.5% (0.7-2.3%), respectively, for the LLN criterion (p<0.01). For both COPD criteria after adjustment for age, sex and smoking status, COPD prevalence was similar in controls and crop farmers. Compared to controls, four job categories had a higher prevalence of COPD according to the GOLD criterion, namely, cattle breeders, swine breeders, poultry breeders and breeders of two or more livestock types. Among cattle breeders, only those from Franche-Comté had higher prevalence of COPD according to both GOLD and LLN criteria.The prevalence of COPD in farmers is higher than in nonfarming working controls, and depends on the farming activity, the region and the criterion used to define COPD.
... This is not consistent with the literature because farmers are known to have lower allcause mortality rates than all other occupational groups combined. 30 However, the effect was small (overall mortality Â1:1) and the confidence interval large. Besides, in the study data set, the number of missing data was important, and variable SPC was rather rough (only four categories with potential mortality rate differences into a category). ...
Article
Relative survival methods used to estimate the excess mortality of cancer patients rely on the background (or expected) mortality derived from general population life tables. These methods are based on splitting the observed mortality into the excess mortality and the background mortality. By assuming a regression model for the excess mortality, usually a Cox-type model, one may investigate the effects of certain covariates on the excess mortality. Some covariates are cancer-specific whereas others are variables that may influence the background mortality as well. The latter should be taken into account in the background mortality to avoid biases in estimating their effects on the excess mortality. Unfortunately, the available life table might not include such variables and, consequently, might provide inaccurate values of the background mortality. We propose a model that uses multiplicative parameters to correct potentially inaccurate background mortality. The model can be seen as an extension of the frequently used Estève model because we assume a Cox-type model for the excess mortality with a piecewise constant baseline function and introduce additional parameters that multiply the background mortality. The original and the extended model are compared, first in a simulation study, then in an application to colon cancer registry data.
... In a study assessing cancer risk in California farm workers from 1988 to 2010, less lung cancer was found in farm workers compared with a non-Hispanic White population assessed [38]. On the other hand, a study comparing farmers to nonfarmers in the Province of Vercelli in Italy, farmers had increased risk of numerous cancers including lung cancer (OR ¼ 1.59), with men having a higher lung cancer risk than women [39] The AGRICAN cohort study from France summarizing data collected from 2005 to 2009 reported no significant changes in lung cancer risk for farm owners and agriculture workers [40]. ...
Article
Purpose of review: Occupational exposures in the agricultural industry are associated with numerous lung diseases, including chronic obstructive pulmonary disease, asthma, hypersensitivity pneumonitis, lung cancer, and interstitial lung diseases. Efforts are ongoing to ascertain contributing factors to these negative respiratory outcomes and improve monitoring of environmental factors leading to disease. In this review, recently published studies investigating the deleterious effects of occupational exposures in the agricultural industry are discussed. Recent findings: Occupational exposures to numerous agricultural environment aerosols, including pesticides, fungi, and bacteria are associated with impaired respiratory function and disease. Increases in certain farming practices, including mushroom and greenhouse farming, present new occupational exposure concerns. Improved detection methods may provide opportunities to better monitor safe exposure levels to known lung irritants. Summary: In the agricultural industry, occupational exposures to organic and inorganic aerosols lead to increased risk for lung disease among workers. Increased awareness of respiratory risks and improved monitoring of agricultural environments are necessary to limit pulmonary health risks to exposed populations.
... Indeed, an analysis of the literature demonstrates the need for these new studies, both in the field of toxicology and in that of epidemiology, incorporating new exposure estimates which are as accurate as possible, based on agricultural data, and taking into account the realities on the ground. The Agrican cohort, established in 2006, has a privileged position in France on this issue, given the size of the population included (more than 180,000 people) and the diversity of agricultural sectors (Leveque-Morlais et al., 2014). The cohort answers many questions concerning the impact of pesticide exposure in the workplace in France and in the occurrence of cancerous, respiratory and neurological illnesses. ...
Chapter
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In the last decade, an extraordinary policy effort has been put in place to reduce the use of chemical plant protection products (PPPs) in French agriculture. This was done through a National Action Plan called Ecophyto which is the French response to the EU Framework Directive on the sustainable use of PPPs. The change in crop protection, required to meet the ambitious goal of Ecophyto, has generated three major research needs: first, exploration of new fields of knowledge (e.g., links between cropping systems, biodiversity and pest regulation), second, support of the unprecedented devices (e.g., pest monitoring system and farm network) put in place to accompany the transition phase, and third, reconsideration of issues related to pest management methods in the context of the changes of farming practices promoted by Ecophyto. To address these new research needs, Ecophyto has devoted a specific research and innovation (R&I) axis which prioritized relevant research questions covering eight thematic areas: (i) pest monitoring and decision-making, (ii) design of IPM solutions, (iii) diversification of pest control methods, (iv) durability and sustainability of these methods, (v) socio-economic aspects of the transition toward a low-input crop protection system, (vi) contribution of public policy for such a transition, (vii) development of indicators to assess the use and impacts of chemical PPPs, and (viii) effects on human health due to exposure to chemical PPPs. The resulting scientific program was disseminated through a diversity of calls for proposals which vastly mobilized public research, in partnership with agricultural experimentation networks and private research. This initiative has translated into dynamic and significant advances made by research which, in part, are already discernible. It will eventually produce a corpus of scientific knowledge and technical innovations which can contribute to the expected transition toward a low-input crop protection system, as long as farmers are associated in the design of sustainable IPM solutions and other concerned stakeholders of the sociotechnical system are mobilized.
... In addition, the results obtained with Model 3 are consistent with the literature. Indeed, SPCs 'Farmers' and 'Other occupational activities' have a lower early background mortality (< 65) than the overall mortality from the life table [41]; Farmers would be healthier than the general population [42,43]. The present study results showed that, before age 75 years, the working population had a lower background mortality than the overall mortality from the general population. ...
Article
Full-text available
Background Methods for estimating relative survival are widely used in population-based cancer survival studies. These methods are based on splitting the observed (the overall) mortality into excess mortality (due to cancer) and background mortality (due to other causes, as expected in the general population). The latter is derived from life tables usually stratified by age, sex, and calendar year but not by other covariates (such as the deprivation level or the socioeconomic status) which may lack though they would influence background mortality. The absence of these covariates leads to inaccurate background mortality, thus to biases in estimating the excess mortality. These biases may be avoided by adjusting the background mortality for these covariates whenever available. Methods In this work, we propose a regression model of excess mortality that corrects for potentially inaccurate background mortality by introducing age-dependent multiplicative parameters through breakpoints, which gives some flexibility. The performance of this model was first assessed with a single and two breakpoints in an intensive simulation study, then the method was applied to French population-based data on colorectal cancer. Results The proposed model proved to be interesting in the simulations and the applications to real data; it limited the bias in parameter estimates of the excess mortality in several scenarios and improved the results and the generalizability of Touraine’s proportional hazards model. Conclusion Finally, the proposed model is a good approach to correct reliably inaccurate background mortality by introducing multiplicative parameters that depend on age and on an additional variable through breakpoints.
Article
Background: Pesticide exposures are suspected to be implicated in the excess of central nervous system (CNS) tumours observed in farmers, but evidence concerning individual pesticides remains limited. Carbamate insecticides, used on a wide range of crops, have shown evidence of carcinogenicity in some experimental studies. In the cohort AGRICAN (AGRIculture & CANcer), we assessed the associations between potential exposures to carbamate insecticides and the incidence of CNS tumours, overall and by histological subtype. Methods: AGRICAN enrolled 181 842 participants involved in agriculture. Incident CNS tumours were identified by linkage with cancer registries from enrolment (2005-07) until 2013. Carbamate exposure was assessed by combining information on lifetime periods of pesticide use on crop or livestock and the French crop-exposure matrix PESTIMAT, individually for each of the 19 carbamate insecticides registered in France since 1950. Associations were estimated using proportional hazards models with age as the underlying time scale, adjusting for gender, educational level and smoking. Results: During a 6.9-year average follow-up, 381 incident cases of CNS tumours occurred, including 164 gliomas and 134 meningiomas. Analyses showed increased risks of CNS tumours with overall exposure to carbamate insecticides and linear trends with duration of use of each carbamate. Considering tumour subtypes, hazard ratios for gliomas ranged from 1.18 for thiofanox to 4.60 for formetanate, and for meningiomas from 1.51 for carbaryl to 3.67 for thiofanox. Conclusions: Findings reinforce carcinogenicity evidence for already suspected active ingredients and draw attention to additional active ingredients, notably used on fruit trees, vineyards, potatoes and beets.
Article
La part des cancers attribuable à des expositions professionnelles représenterait au minimum 2 à 8 % des cas de cancer (soit 7000 à 28 000 cancers par année en France). La population agricole a été très peu étudiée en France en particulier en termes de survenue de cancer bien que les expositions professionnelles en exploitation agricole concernent plus de 1 million de personnes et que la France soit un des premiers pays utilisateurs de pesticides au monde. De plus, il est maintenant admis que certains cancers (hémopathies malignes, cancers cutanés, cancer de la prostate, tumeurs cérébrales, cancers gastriques…) sont retrouvés en excès dans cette population et plus particulièrement chez les utilisateurs de pesticides sans toutefois que des matières actives voire des familles chimiques de pesticides soient à ce jour formellement identifiées. La cohorte AGRICAN a été mise en place en 2005–2007 en France afin d’étudier la santé des agriculteurs dans 11 départements disposant d’un registre des cancers [1]. Elle a permis d’inclure plus de 180 000 affiliés au régime agricole (chefs d’exploitation et ouvriers agricoles principalement, en activité ou retraités, hommes et femmes). Les premiers résultats concernaient la comparaison de la mortalité et de l’incidence des cancers (plus de 11 000 cas incidents entre l’inclusion et décembre 2011) à celles de la population générale. Ils ont confirmé et renforcé les tendances observées au niveau international, à savoir des risques significativement plus faibles pour les cancers très liés au tabagisme (poumons, vessie, ORL et pancréas) et des risques significativement augmentés pour des cancers hématologiques (particulièrement les myélomes multiples), de la prostate et les mélanomes cutanés (chez les femmes uniquement). Les premières analyses internes sur les cancers les plus fréquents ont montré des risques augmentés de cancers de la prostate [2] chez les éleveurs de bovins (notamment lors de l’utilisation d’insecticides sur animaux), ou de cochons ou encore lors de la réalisation des foins ainsi que lors de l’exposition aux pesticides, qu’elle soit directe (traitements) ou secondaire (tâches de ré-entrée ou de récolte) sur différentes cultures (blé-orge, arboriculture, pommes de terre, tabac), plus particulièrement chez ceux n’ayant jamais porté de gants de protection lors de l’utilisation de pesticides. Notre étude montre par ailleurs une forte diminution du risque de cancer pulmonaire chez les éleveurs de bovins ou de chevaux, indépendante du statut tabagique, et qui ne concernerait que ceux ayant habité sur une ferme d’élevage bovin dans la petite enfance. Par contre, les cultivateurs de pois présenteraient un doublement du risque de cancer pulmonaire particulièrement lorsqu’ils étaient impliqués dans la moisson de cette culture. La première phase de suivi des expositions de cette cohorte a débuté en 2015 par l’envoi d’auto-questionnaires de suivi détaillés qui permettront d’approfondir les analyses sur des expositions professionnelles spécifiques et sur les habitudes de vie. Des analyses ont également été menées sur des maladies respiratoires (asthme [3], bronchite chronique [4]), d’autres sont actuellement en cours sur certaines localisations de cancers (hémopathies malignes, prostate, sein, tumeurs cérébrales) et sur des maladies neurologiques (maladie de Parkinson). Le croisement avec la matrice culture-exposition PESTIMAT [5] permettra l’analyse de risques associés à des familles chimiques ou à des molécules spécifiques. Ainsi, la cohorte AGRICAN représente aujourd’hui une des plus grandes études de cohorte menée en France et la cohorte agricole la plus vaste et la plus variée en termes de populations et d’activités au niveau international. Des travaux collaboratifs sont en cours avec d’autres cohortes agricoles dans le cadre du consortium international de cohortes agricoles (AGRICOH, http://agricoh.iarc.fr/ [6]), notamment, sur les facteurs de risque de cancers hématologiques (cohortes norvégienne et américaine [7]).
Article
Objective Several animal, fish and/or shellfish derived substances encountered in the workplace can initiate or exacerbate asthma. The aims of this study were: to produce a population-based estimate of the current prevalence of occupational exposure to animal, fish and/or shellfish derived asthmagens, to identify the main circumstances of exposures and to identify occupations with the highest proportions of exposed respondents. Methods We used data from the Australian Work Exposure Study-Asthma, a national telephone survey that investigated the current prevalence of occupational exposure to asthmagens among Australian workers. A web-based tool was used to collect job task information and assign exposure to asthmagens, including animal, fish and/or shellfish derived asthmagens. Prevalence ratios to determine risk factors for exposure were estimated using modified Poisson regression. Results Of the 4878 respondents, 12.4% were exposed to asthmagens derived from animals, fish and/or shellfish. Exposure to these asthmagens was significantly higher in workers residing in regional and remote areas, compared with major cities. The main circumstance of exposure to animal derived asthmagens was through cleaning up rat/mice infestations, while the main circumstance of exposure to fish and/or shellfish derived asthmagens was through preparing and cooking salmon. Occupational groups with the highest proportion of exposure to animal or fish and/or shellfish derived asthmagens were farmers/animal workers and food workers, respectively. Conclusions This is the first study investigating occupational exposure to animal, fish and/or shellfish derived asthmagens in a nationwide working population. The results of this study can be used to inform the direction of occupational interventions and policies to reduce work-related asthma.
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Objectives To compare mortality by cancer sites and by other specific causes of death, and the prevalence of risk behaviors in farmers and non-farmers in Spain. Methods Mortality by cause of death was calculated based on a longitudinal study with 10-years follow-up of 9.5 million men and 6 million women aged 20–64 years who were employed in 2001. The prevalence of risk behaviors was calculated from the 2001 National Health Survey in the 6464 employed men and 5573 employed women aged 20–64. The study subjects were grouped as farmers and non-farmers. For each cause of death, we estimated the ratio of age-standardized mortality rates, and for each risk behavior we estimated the age-standardized prevalence ratio in farmers versus non-farmers. Results In men, the mortality rate for most cancer sites did not differ significantly between farmers and non-farmers, except for cancers of the lip, oral cavity, stomach, larynx and skin epidermoid carcinoma—which was higher in farmers—and cancers of the liver, pancreas and mesothelioma—which was lower in farmers. In contrast, farmers had a higher rate of mortality from most other diseases and from external causes of death. In women, farmers showed lower mortality from lung cancer, breast cancer and chronic lower respiratory disease, and higher mortality from external causes. The prevalence of smoking, excessive alcohol consumption, physical inactivity and obesity was higher in farmers than in non-farmers, except smoking and excessive alcohol consumption in women where prevalence was lower in farmers. Conclusions Findings are different from those found in other studies. In men, greater exposure to the sun and the higher prevalence of risk behaviors in farmers could explain their excess mortality from some cancer sites and the other causes of death. However, other factors may be behind this excess risk of mortality from these causes, given that farmers did not show higher mortality from some cancers related to smoking. In women, no differences were observed in mortality rate for majority of causes of death between farmers and non-farmers.
Thesis
Introduction : La surveillance sanitaire et la vigilance (identification de nouveaux risques en particulier) représentent un enjeu majeur dans le champ santé-travail. En complément des études épidémiologiques classiques, l’analyse systématique, sans a priori, de données collectées en routine pourrait être un atout pour la détection précoce de pathologies en lien avec le travail. Dans ce contexte, la Mutualité Sociale Agricole (MSA), le régime de protection sociale dédié aux travailleurs agricoles français, a souhaité développer son activité de vigilance en exploitant ses données médico-administratives, utilisées pour le remboursement de prestations de santé. En partenariat avec l’Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail (Anses), un projet de fouille des données a donc été mis en place dans lequel ce travail de thèse s’inscrit. L’objectif de la thèse consiste plus précisément à tester, sans hypothèses préalables, l'existence ou non d'associations entre les activités agricoles et les pathologies reconnues en tant qu’affection de longue durée (ALD).Méthode : Les travaux présentés ont été menés sur la population de non-salariés (chefs d’exploitation ou d’entreprise) affiliés à la MSA, en disposant d’une part de données de cotisations, renseignant au niveau individuel, les activités professionnelles, caractéristiques démographiques et socio-économiques, et d’autre part, de données médico-administratives renseignant les déclarations de pathologies reconnues en ALD et informations associées dont la pathologie codée en CIM-10. Grâce à l’accord de la CNIL, un identifiant unique a été créé pour que, pour la première fois, ces données administratives et médico-administratives puissent être fusionnées et restructurées afin de permettre l’application de modèles. Des modèles de régression logistique ont été utilisés, en adaptant la sélection de variables pour chaque ALD et en utilisant la validation croisée afin de limiter le surajustement des modèles. Plusieurs méthodes ont été testées pour mieux prendre en compte les facteurs de confusion potentiels. Ces différents modèles ont ensuite été évalués via des mesures de robustesse et appliqués aux données à deux niveaux de précision pour la pathologie (ALD et CIM-10). Les associations statistiques entre chaque combinaison d’activité professionnelle et de pathologie ont été caractérisées par leur p-valeur, corrigées pour les tests multiples, et la valeur de l’odds ratio correspondant.Résultats : Le traitement des données a permis d’étudier une population constituée de 899 212 non-salariés affiliés entre 2006 et 2016. Au sein de cette population, il a été possible d’identifier 100 706 individus avec au moins une déclaration d’ALD sur la période d’observation. La méthodologie appliquée a mis en évidence 54 associations statistiquement significatives entre une activité professionnelle et une ALD, permettant à la fois de capturer des déterminants de santé déjà connus ou suspectés mais aussi de générer des hypothèses intéressantes. Après ajustement sur des facteurs de confusion, les secteurs agricoles les plus associés à des pathologies, faisant l’objet d’ALD chez les non-salariés, sont la viticulture, l’exploitation de bois, le paysagisme, et les entreprises de jardins ou de reboisement.Discussion : Ce travail de thèse apporte une première démonstration de la faisabilité et de la pertinence de l’analyse systématique des données collectées en routine à des fins assurantielles, sur l’ensemble de la population agricole, pour rechercher des risques sanitaires associés aux diverses activités professionnelles. Les « signaux » ainsi mis en évidence seront investigués à l’aide d’un groupe d’experts. D’autres modèles pourront être testés, au premier rang desquels les modèles de survie. Cette approche pourra ainsi constituer un outil précieux contribuant au dispositif de vigilance sanitaire des risques professionnels agricoles.
Article
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.ResultsAfter 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.
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