A Systematic Review of Reported Risk Factors for Agricultural Injury Rohan Jadhav PhD 1, Chandran Achutan PhD 1, Shireen Rajaram PhD 2, Gleb Haynatzki PhD 3 and Risto Rautiainen PhD 1,4 1 Department of Environmental, Agricultural and Occupational Health, 2 Department of Health Promotion, Social and Behavioral Health, 3 Department of Biostatistics, 4 Central States Center for Agricultural Safety and Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE aa INTRODUCTION METHODS RESULTS Of the 25 selected risk factors that were evaluated, seventeen increased the risk of injury while one decreased the risk. The pooled odds ratio estimates ranged from 0.76 to Two out of the 18 significant risk factors were derived from single reports. All pooled estimates remained stable in sensitivity analysis, comparing results from all studies vs. highest quality studies only. Correlation between age and risk of injury was weak, although statistically significant (Pearson’s correlation p-value=0.03, r-square=0.21). Other significant factors included education, native language, race, on-farm residence, sleep, perceived injury risk, social conditions, farm size, sales, income, livestock production, number of workers employed, cooperation between farms, unsafe practices, poor maintenance, computer and/or internet use, and accidental exposure to pesticides or chemicals. Injury was not significantly associated with marital status, experience, principal occupation, alcohol use, smoking, and safety training. CONCLUSION Agriculture is one of the most hazardous industries in the United States. The Bureau of Labor Statistics reported 24.1 fatalities per 100,000 full-time equivalent (FTE) workers in agriculture compared to 3.3 per 100,000 FTE workers in all industries 1. The incidence rate of non-fatal injuries was 5.7 per 100 FTE employees in agriculture compared to 3.5 per 100 FTE workers in all industries in Farmers perform a variety of tasks that demand vigilance 3. Failure to employ safe behaviors can lead to injuries 4. A wide range of demographic and work-related risk factors have been identified in some studies 5. While studies have been conducted addressing these risk factors for injury, it is difficult to understand their role, particularly when studies may show conflicting results. Objective: To conduct a systematic review and meta-analysis to evaluate common and emerging risk factors for agricultural injury. Selection criteriaNumber of studies identified Search in Google Scholar (n=285) and in PubMed (n=451) 736 Study focused on agricultural injury outcomes 210 Study reported adjusted or unadjusted OR or RR for at least one of the 25 risk factors 84 Study met Newcastle-Ottawa Scale (NOS) quality assessment 38 A literature search for studies addressing risk factors for agricultural injuries was conducted from two electronic databases: Google Scholar and PubMed using the following inclusion criteria: 1. The study must focus on agricultural injury outcomes and report injury occurrences 2. The study must report adjusted or unadjusted point estimates for injury risk factors. Meta-analysis was conducted summarizing point estimates reported in the selected studies. Pooled OR estimates were calculated for 21 risk factors reported in these studies. Age was assessed separately in correlation analysis due to inconsistent use of age categories in source studies. Study quality was assessed using the Newcastle-Ottawa Scale. Table1. Selection process for identification of studies for systematic review We found evidence that older age, higher education, Finnish (vs. Swedish) as native language, non-Caucasian race, on-farm residence, inadequate sleep, high perceived injury risk, challenging social conditions, large farm size, high sales, high income from farming, animal production, large number of hired workers, high cooperation between farms, engaging in unsafe practices, poorly maintained machinery, use of computer and/or internet and accidental exposure to pesticides and/or chemicals to the skin were risk factors for injury. To enhance cost effectiveness, interventions should be targeted to these agricultural populations at elevated risk. Also, co-occurring effects of risk factors should be investigated. Further expertise from multiple areas such as agriculture, engineering, medicine, veterinary medicine, industrial hygiene, public health education and counseling is required to design specific interventions for identified populations at risk. Figure 1. Reported risk estimates (OR) of agricultural injury by age weighted by study size. Author Correspondence: Rohan M Jadhav REFERENCES 1. National census of fatal occupational injuries in 2013 (preliminary results). Bureau of Labor Statistics. Available at Incidence rates of nonfatal occupational injuries and illnesses by case type and ownership, selected industries, Bureau of Labor Statistics. Available at Updated Pickett, W., Chipman, M. L., Brison, R. J., & Holness, D. L. (1996). Medications as risk factors for farm injury. Accident Analysis and Prevention, 28(4), Van den Broucke, S., & Colemont, A. (2011). Behavioral and nonbehavioral risk factors for occupational injuries and health problems among Belgian farmers. Journal of Agromedicine, 16(4). 5. Karttunen, J. P., & Rautiainen, R. H. (2013). Occupational injury and disease incidence and risk factors in Finnish agriculture based on 5-year insurance records. Journal of Agromedicine, 18(1), Table 2. Results of the meta-analysis for selected risk factors *- P-value of reflected very small, undetermined value. Observations 103 Correlation