Mortality and Morbidity in Agriculture in the United States – Policy Implications Risto H. Rautiainen, MS, Stephen J. Reynolds, PhD, CIH Great Plains Center for Agricultural Health,

Aims Characterize trends since Ag at Risk, 1998 in Agriculture Agricultural populations Prevalence and incidence of Fatal occupational injuries Non-fatal occupational injuries Work related diseases Conclusions Recommendations

Trends in Agriculture Rapid decrease in farms and farm workforce in early and mid part of the 20 th century Relatively slow changes since 1970’s Part time farming has increased Large scale farming has increased

Fatal Injuries in Agriculture

Sources of Information National Safety Council (NSC) NIOSH National Traumatic Occupational Fatalities (NTOF) Bureau of Labor Statistics (BLS), Census of Fatal Occupational Injuries (CFOI)

ROPS in Relation to SUV Tire Separation Problem ProblemTractor OverturnTire Tread Separation Fatalities150/y, >6,000 total174 total Number of units4.8M Tractors6.5M Tires SolutionROPSNew tires Cost per unit / total$500 / $2.4B (1.4B for remaining non-ROPS tractors) $100 / $0.65B Intervention initiated>40 years7 months % Corrected, Feb 0140%95%

Nonfatal Injuries Sources National Safety Council Bureau of Labor Statistics (workers on farms with >10 hired workers) California Workers Compensation (hired farm workers) Studies and surveys

Work Related Illness Definitions: Occupational disease Work related illness Work related symptoms Sources: Bureau of Labor Statistics (hired workers) National Safety Council

Work Related Illnesses BLS (NSC Injury Facts 2000) Workers on farms with >10 employees 30.9 illnesses / 10,000 workers 56% skin disorders 14% repeated trauma 13% respiratory disease 17% other

Respiratory Disease Thorne et al: swine confinement workers: occup. asthma 20%, chronic bronchitis 25%, ODTS 33% Reynolds et al: association with work exposure and respiratory symptoms in turkey barn workers Wilkins et al: cash grain farmers, chronic caugh 9%, phlegm 11%, dysphnea 16%, wheeze 8% NIOSH: fatalities from hypersensitivity pneumonitis Causes: organic dust, endotoxin, ammonia

Cancer Overall cancer rates are typically lower in agriculture compared to general population. PMRs: NIOSH 0.89, Finland 0.82, Sweden 0.80 Blair et al: overall cancer rate lower but certain cancers elevated: Hodgkin’s disease, multiple myeloma, leukemia, skin melanomas, and cancers of the lip, stomach, and prostate

Hearing Loss Becker et al, NY: 72% of farmers had high frequency hearing loss Mudipalli et al, IA: 50% of females, 86% of males with farming history had hearing loss, respectively 50% and 80% when no farm history; 47% of young males had hearing loss

Skin Disorders BLS: 17/10,000 workers in Finland 16/10,000 farmers in 1996 California: 2% contact dermatitis California, causes: plants (52%), chemicals (20%), food products (22%)

Zoonoosis Thomas et al, England. Antibodies found for: Q-fever (29.2%), toxoplasma (50.2%), lyme disease (0.2%), leptospira (0.2%), brucella (0.7%), hantavirus (seroprevalence 4.7%), orthopox virus (0.7%), parapox virus (4.5%), Bartonella spp. (2.0%), Ehrlichia Chaffeensis (0.2%), human granulocytic ehrlichiosis agent (2.0%), Echinococcus Granulosis (1.5%)

Stress US, some studies show higher Relative Risk for suicide for farmers (~1.1) Canada: lower risk for farmers Center for Epidemiologic Studies Depression Scale; Depressive symptoms –Ohio 8%, –Colorado 8% males, 11% females –IA, Keokuk County males 17%, females 25% Kidd et al, Thu et al: injury-stress association

Repeated Trauma BLS: second most common work related illness in farm workers California: back (24%), upper back (19%), wrist problems (18%) Musculoskeletal problems in dairy farmers: Sweden (82-86%), Australia (57%), Colorado (43%)

Ag at Risk Recommendations 1.Mandate reporting of diseases and injuries through state health departments. 2.Complete agricultural/rural National Health Interview and Examination Survey 3.Develop model surveillance programs for occupational disease and injuries 4.Complete National Occupational Hazard Survey for Agriculture. 5.Enhance NTOF database for causes of agricultural deaths. 6.Continue NSC survey to provide continuity to estimate traumatic deaths and injuries.

Conclusions No progress in fatalities No progress in tractor fatalities Some progress regionally Some progress in childhood fatalities Some progress in non-fatal injuries for employed workers No progress in surveillance Some progress in research based knowledge of injuries, illnesses, and risk factors

Recommendations 1.Develop a National database for non-fatal injuries and illnesses. 2.Enhance NTOF, CFOI fatality surveillance. 3.Expand in-depth FACE fatality investigations to most states and include agricultural fatalities as priority. 4.Include info on farm family members and farm residents in Census of Ag and labor surveys. 5.Utilize existing knowledge to develop a National Agricultural Injury and Illness Prevention Agenda