title: Risk and prognostic factors of inpatient mortality associated with unintentional insecticide and herbicide poisonings: a retrospective cohort study.
abstract: BACKGROUND
  Pesticide poisoning is an important public health problem worldwide. The study aimed to determine the risk of all-cause and cause-specific inpatient mortality and to identify prognostic factors for inpatient mortality associated with unintentional insecticide and herbicide pesticide poisonings.
  
  
  METHODS
  We performed a retrospective cohort study of 3,986 inpatients recruited at hospitalization between 1999 and 2008 in Taiwan. We used the International Classification of Disease, 9th ed., Clinical Modification external causes of injury codes to classify poisoning agents into accidental poisoning by insecticides and herbicides. Comparisons in mortality rates were made between insecticide poisoning patients and herbicide poisoning patients by using the Cox proportional hazards models to estimate multivariable-adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs).
  
  
  RESULTS
  There were 168 deaths during 21,583 person-days of follow-up evaluation (7.8 per 1,000 person-days). The major causes of mortality for insecticide poisonings were the toxic effect of organophosphate and coma, and the major causes of mortality for herbicide poisonings were the toxic effect of other pesticides and the toxic effect of organophosphate. The mortality for herbicide exposure was fourfold higher than that for insecticide exposure. The factors associated with inpatient mortality were herbicide poisonings (HR = 4.58, 95% CI 3.29 to 6.37) and receiving mechanical ventilation treatment (HR = 3.85, 95% CI 2.73 to 5.42).
  
  
  CONCLUSIONS
  We demonstrated that herbicides stand out as the dominant agent for poisoning-related fatalities. The control of and limiting access to herbicide agents and developing appropriate therapeutic regimens, including emergency care, should be priorities.
authors.affiliation: Department of Public Health, National Defense Medical Center, No. 161, Section 6, Neihu District, Taipei City, Taiwan, Republic of China.
authors.forename: Wu-Chien
authors.initials: WC
authors.lastname: Chien
authors.forename: Chi-Hsiang
authors.initials: CH
authors.lastname: Chung
authors.forename: Jouni J K
authors.initials: JJ
authors.lastname: Jaakkola
authors.forename: Chi-Ming
authors.initials: CM
authors.lastname: Chu
authors.forename: Senyeong
authors.initials: S
authors.lastname: Kao
authors.forename: Sui-Lung
authors.initials: SL
authors.lastname: Su
authors.forename: Ching-Huang
authors.initials: CH
authors.lastname: Lai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006540:Herbicides / Q000506:poisoning; D006801:Humans; D007306:Insecticides / Q000506:poisoning; D008297:Male; D008875:Middle Aged; D011041:Poisoning / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D006540:Herbicides; D007306:Insecticides