title: Pesticide use and fatal injury among farmers in the Agricultural Health Study.
abstract: OBJECTIVE
  To assess whether pesticide use practices were associated with injury mortality among 51,035 male farmers from NC and IA enrolled in the Agricultural Health Study.
  
  
  METHODS
  We used Cox proportional hazards models adjusted for age and state to estimate fatal injury risk associated with self-reported use of 49 specific pesticides, personal protective equipment, specific types of farm machinery, and other farm factors collected 1-15 years preceding death. Cause-specific mortality was obtained through linkage to mortality registries.
  
  
  RESULTS
  We observed 338 injury fatalities over 727,543 person-years of follow-up (1993-2008). Fatal injuries increased with days/year of pesticide application, with the highest risk among those with 60+ days of pesticide application annually [hazard ratio (HR) = 1.87; 95% confidence interval (CI) = 1.10, 3.18]. Chemical-resistant glove use was associated with decreased risk (HR = 0.73; 95% CI = 0.58, 0.93), but adjusting for glove use did not substantially change estimates for individual pesticides or pesticide use overall. Herbicides were associated with fatal injury, even after adjusting for operating farm equipment, which was independently associated with fatal injury. Ever use of five of 18 herbicides (2,4,5-T, paraquat, alachlor, metribuzin, and butylate) were associated with elevated risk. In addition, 2,4-D and cyanazine were associated with fatal injury in exposure-response analyses. There was no evidence of confounding of these results by other herbicides.
  
  
  CONCLUSIONS
  The association between application of pesticides, particularly certain herbicides, and fatal injuries among farmers should be interpreted cautiously but deserves further evaluation, with particular focus on understanding timing of pesticide use and fatal injury.
authors.affiliation: Division of Respiratory Disease Studies, NIOSH, CDC, DHHS, Morgantown, WV, USA.
authors.forename: Jenna K
authors.initials: JK
authors.lastname: Waggoner
authors.forename: Paul K
authors.initials: PK
authors.lastname: Henneberger
authors.forename: Greg J
authors.initials: GJ
authors.lastname: Kullman
authors.forename: David M
authors.initials: DM
authors.lastname: Umbach
authors.forename: Freya
authors.initials: F
authors.lastname: Kamel
authors.forename: Laura E
authors.initials: LE
authors.lastname: Beane Freeman
authors.forename: Michael C R
authors.initials: MC
authors.lastname: Alavanja
authors.forename: Dale P
authors.initials: DP
authors.lastname: Sandler
authors.forename: Jane A
authors.initials: JA
authors.lastname: Hoppin
mesh_terms: D000062:Accidents, Occupational / Q000401:mortality* / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000383:Agriculture; D016001:Confidence Intervals; D017575:Gloves, Protective; D006306:Health Surveys; D006801:Humans; D007484:Iowa / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D016273:Occupational Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D010575:Pesticides / Q000009:adverse effects*; D016016:Proportional Hazards Models; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D010575:Pesticides