Agricultural exposures and chronic bronchitis: findings from the AGRICAN (AGRIculture and CANcer) cohort
Introduction
Farming is recognized as a risk factor for some respiratory diseases, including chronic bronchitis (CB) and impairment of lung function [1]. These disorders have been related to exposure to farm animals, especially swine and poultry, and in dairy farming compared with nonfarming control subjects [2], [3], [4]. These respiratory disorders have been associated with indoor air contaminants, such as gases, dusts, and/or endotoxins [5], [6], [7]. In North American grain workers, increased risk of CB symptoms and lung function impairment have been associated with exposure to grain dust [8]. In a few studies investigators have shown an increased prevalence of CB symptoms in crop farmers compared with the general population [2], [3], [9].
The findings from studies in which the authors compare the risks between specific farming activities via the use of internal reference groups are conflicting. Some studies have shown an increased risk of CB associated with animal production compared with crop production or a protective factor of crop production among cattle breeders [6], [10], [11], whereas others have shown that crop production is a risk factor for work-related respiratory symptoms [12], [13], [14]. However, these studies did not explore the role of specific crops. The European Farmers’ Study showed an increased risk of CB associated with oil plant, grain, and flower productions [15], [16], although the authors did not investigate associations with duration of work, cultivated surface, and agricultural tasks.
The French agricultural setting offers a good opportunity to study the respiratory health hazards because a large range of crops and animal exposures is covered. We present here the findings on farming activities associated with CB from the French agricultural cohort AGRICAN (AGRIculture and CANcer).
Section snippets
Study population
The AGRICAN cohort, a large prospective cohort of active and retired agricultural subjects, was initiated in France to assess cancer and noncancer health risks associated with occupational farming exposures. The eligible population consisted in all adults, men and women, active or retired, farm-owners and workers, affiliated to the Mutualité Sociale Agricole, the French Health insurance scheme in agriculture. To be included, individuals had to be 18 years old and over, to have paid at least 12
Characteristics of the population
A total of 14,441 subjects were included in the present analysis. Subjects were mainly men (56.3%) and ranged in age from 21 to 103 years (65.4 years [15.2]; mean [SD]). Half of them had completed an educational level of middle school or less (51%), 35.3% had completed high school, and 6.7% had an educational level above high school. Most of them had never smoked (59.4%). The prevalence of overweight and obesity, was respectively, 37.4% and 13.7%. Hay fever, asthma, and eczema were diagnosed
Discussion
Our first analysis showed an increased risk of CB associated with cattle raising (OR 1.24, 95% CI 1.03–1.48) and potato production (OR 1.33, 95% CI 1.13–1.57), independently of smoking status and asthma. This risk appeared more pronounced in smaller stocks (fewer than 20 animals) and in large-scale potato farms (surface over 20 hectares) among the longest exposed farmers (≥20 years). Pesticide poisoning and exposure to pesticides in potato production were positively related to CB risk.
An
Acknowledgments
We are indebted to S. Deant, M. Niez, and V. Tribouillard for processing data from the enrollment questionnaire and A. S. Lacauve, C. Meyer, and E. Niez for technical assistance. We thank M.A. Presles and J. Estru (MSA Loire Atlantique-Vendée), Y. Cosset (Caisse Centrale MSA), M. Delanoë (MSA Midi Pyrénées Nord), G. Gastinger (MSA Alsace), A. V. Guizard (Registre Général des Tumeurs du Calvados), C. Hernouet (Caisse Centrale MSA), B. Ladépêche (MSA Gironde), J. J. Laplante (MSA Franche Comté),
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