Pesticide exposure and end-stage renal disease risk among wives of pesticide applicators in the Agricultural Health Study.
BACKGROUND
Pesticide exposure has been found to cause renal damage and dysfunction in experimental studies, but epidemiological research on the renal effects of chronic low-level pesticide exposure is limited. We investigated the relationships between end-stage renal disease (ESRD) among wives of licensed pesticide applicators (N=31,142) in the Agricultural Health Study (AHS) and (1) personal pesticide use, (2) exposure to the husband's pesticide use, and (3) other pesticide-associated farming and household activities.


METHODS
AHS participants reported pesticide exposure via self-administered questionnaires at enrollment (1993-1997). ESRD cases were identified via linkage to the United States Renal Data System. Associations between ESRD and pesticide exposures were estimated with Cox proportional hazard regression models controlling for age at enrollment. Models of associations with farming and household factors were additionally adjusted for personal use of pesticides.


RESULTS
We identified 98 ESRD cases diagnosed between enrollment and 31 December 2011. Although women who ever applied pesticides (56% of cohort) were less likely than those who did not apply to develop ESRD (Hazard Ratio (HR): 0.42; 95% CI: 0.28, 0.64), among women who did apply pesticides, the rate of ESRD was significantly elevated among those who reported the highest (vs. lowest) cumulative general pesticide use (HR: 4.22; 95% CI: 1.26, 14.20). Among wives who never applied pesticides, ESRD was associated with husbands' ever use of paraquat (HR=1.99; 95% CI: 1.14, 3.47) and butylate (HR=1.71; 95% CI: 1.00, 2.95), with a positive exposure-response pattern for husband's cumulative use of these pesticides.


CONCLUSIONS
ESRD may be associated with direct and/or indirect exposure to pesticides among farm women. Future studies should evaluate indirect exposure risk among other rural populations.
Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA. Electronic address: jlebov@email.unc.edu.
Jill F
JF
Lebov
Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA. Electronic address: larry.engel@unc.edu.
Lawrence S
LS
Engel
Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA. Electronic address: david.richardson@unc.edu.
David
D
Richardson
Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC, USA. Electronic address: Susan_hogan@med.unc.edu.
Susan L
SL
Hogan
Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA. Electronic address: sandler@niehs.nih.gov.
Dale P
DP
Sandler
Department of Biological Sciences, Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA. Electronic address: jahoppin@ncsu.edu.
Jane A
JA
Hoppin
D000293:Adolescent; D000328:Adult; D000368:Aged; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis; D000067565:Farmers / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007484:Iowa / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000139:chemically induced / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010575:Pesticides / Q000032:analysis / Q000633:toxicity*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D018454:Spouses / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
D010575:Pesticides
Agricultural exposures; End-stage renal disease; Farm women; Pesticide exposure