Mortality and Morbidity among Farmers,Nonfarming Rural Men,and Urban Referents: A Prospective Population-Based Study

Abstract

A cohort of 1,220 farmers, 1,130 nonfarming rural men, and 1,087 urban referents from Sweden were monitored for 12 years. Farmers had lower mortality than urban referents for all causes of death (hazard ratio [HR] = 0.51; 95% confidence interval [CI], 0.37–0.71), cancer (HR = 0.44; 95% CI, 0.24–0.78) and cardiovascular diseases (HR = 0.60; 95% CI, 0.36–0.99). Nonfarming rural men had lower mortality than urban referents for all causes of deaths (HR = 0.81; 95% CI, 0.70–0.94). Farmers and nonfarming rural men had significantly lower morbidity risks of cancer and of psychiatric disorders than urban referents. Farmers had significantly lower risk of endocrine disorders, cardiovascular disorders, and respiratory disorders. In general, morbidity was lower among nonfarming rural men compared with urban referents and was even lower among farmers. Urban referents had, however, significantly less musculoskeletal disorder morbidity. An urban–rural factor and a farming occupational or lifestyle factor results in lower mortality and morbidity rates except concerning musculoskeletal disorders.     

Occupation and osteoarthrosis of the hip and knee: a register-based cohort study.

A register-based cohort study was performed to investigate if men and women in certain occupations with high physical workload had increased risks of developing severe symptomatic osteoarthrosis of the hip and knee, resulting in hospital care. The study population consisted of 250,217 people from the 1980 census, in blue-collar occupations, who had reported the same occupation in the 1960 and 1970 censuses. The study population was followed for hospital care for osteoarthrosis of the hip and knee during 1981-1983 by linkage to the Swedish Hospital Discharge Register. Different blue-collar occupations were classified as high or low with regard to exposure to forces acting on the hip and knee and the frequencies of the outcomes were compared. Male farmers, construction workers, firefighters and some food processing workers had an excess risk of hospitalization due to osteoarthrosis of the hip. Male farmers, construction workers and firefighters also had increased risks of osteoarthrosis of the knee. Female mail carriers had an excess risk of osteoarthrosis of the hip, and female cleaners, of osteoarthrosis of the knee. The findings support the hypothesis that heavy physical work load contributes to osteoarthrosis of the hip and knee.     

Hospitalizations among teachers in Denmark, 1981-1997

It is a common notion that teachers constitute a group at high risk of occupational stress, but the potential health consequences of the assumed high stress levels are still poorly illuminated. The aim of the present study was to investigate morbidity among Danish teachers. Cohorts of Danish teachers of primary, secondary and vocational schools, aged 20-59 years in 1981, 1986, 1991 and 1994, were formed to calculate age standardized hospitalization ratios (SHRs) and time trends (1981-1997) for a large variety of diagostic aggregations. Statistically significantly low SHRs for the major disease categories: neoplasms, diseases of the nervous, circulatory, respiratory. digestive and musculoskeletal systems were found both for men and women. We also found significantly low SHRs for the aggregated diagnostic group "injury and poisoning" in men and for diseases of the nervous system and sense organs in women. Age standardized hospitalization rates with respect to diseases observed in practically all systems and organs of the body were statistically significantly lower among teachers compared with other economically active people of Denmark.     

Health, life expectancy, and mortality patterns among immigrant populations in the United States

BACKGROUND: The US immigrant population has grown considerably in the last three decades, from 9.6 million in 1970 to 32.5 million in 2002. However, this unprecedented population rise has not been accompanied by increased immigrant health monitoring. In this study, we examined the extent to which US- and foreign-born blacks, whites, Asians, and Hispanics differ in their health, life expectancy, and mortality patterns across the life course. METHODS: We used National Vital Statistics System (1986-2000) and National Health Interview Survey (1992-1995) data to examine nativity differentials in health outcomes. Logistic regression and age-adjusted death rates were used to examine differentials. RESULTS: Male and female immigrants had, respectively, 3.4 and 2.5 years longer life expectancy than the US-born. Compared to their US-born counterparts, black immigrant men and women had, respectively, 9.4 and 7.8 years longer life expectancy, but Chinese, Japanese, and Filipino immigrants had lower life expectancy. Most immigrant groups had lower risks of infant mortality and low birthweight than the US-born. Consistent with the acculturation hypothesis, immigrants' risks of disability and chronic disease morbidity increased with increasing length of residence. Cancer and other chronic disease mortality patterns for immigrants and natives varied considerably, with Asian Immigrants experiencing substantially higher stomach, liver and cervical cancer mortality than the US-born. Immigrants, however, had significantly lower mortality from lung, colorectal, breast, prostate and esophageal cancer, cardiovascular disease, cirrhosis, diabetes, respiratory diseases, HIV/AIDS, and suicide. INTERPRETATION: Migration selectivity, social support, socio-economic, and behavioural characteristics may account for health differentials between immigrants and the US-born.     

Mortality among male farmers in Finland during 1979-1983

In this study the cause-specific mortality of male farmers in Finland was compared with the mortality of all economically active men. Mortality was also examined by size of farm, by type of farm production, and by geographic area. It was shown that, compared to the mortality of all economically active men, that of the farmers was generally low. The only exception was mortality due to respiratory diseases, for which the mortality rate of the farmers was about 40-50% higher than that of all economically active men. The rate ratio, which was higher for those men with small farms, was almost independent of the cause of death. The rate ratio was highest for farmers in eastern and northern Finland. Assessed by type of farm production, the differences in mortality were small. It was supposed that the high rate ratio of respiratory deaths among farmers was, at least partly, work-related. The high mortality of the men with a small farm was shown to be associated with the higher proportion of smokers among this group of farmers.     

A follow-up study found that cardiovascular risk in middle age predicted mortality and quality of life in old age

OBJECTIVE: Cardiovascular risk reduction, while saving lives, may prolong the time with disability and impair the quality of life in survivors. We compared the consequences of middle age cardiovascular risk in old age. STUDY DESIGN AND SETTING: In 1974, risk was low in 593 (low-risk group) and high in 610 men (high-risk group). At baseline, all were healthy with similar age and socioeconomic status. Lifestyle and clinical factors, including quality of life (RAND-36), were surveyed with a questionnaire in 2000, and mortality was determined up to 2002. RESULTS: During the follow-up, 303 men died, with mortality 54% higher in the high-risk group (P=.001). In the 2000 survey, high-risk men still had significantly greater BMI, higher blood glucose, higher prevalence of smoking, and more sedentary lifestyle, and they reported more both cardiovascular and noncardiovascular diseases. All the RAND-36 scales were worse in the high-risk group; of the two component summary scores, physical (PCS), but not mental (MCS) score, was significantly lower in the high-risk group. CONCLUSION: Low cardiovascular risk in middle age was associated with lower mortality, morbidity, and better quality of life in old age 26 years later. The results may support the theory of compression of morbidity.     

Psychosocial job characteristics and risk of mortality in a Japanese community-based working population: the Jichi Medical School Cohort Study

We prospectively investigated the association between psychosocial job characteristics according to the job demand-control model and the risk of mortality in a Japanese community-based working population. A baseline examination conducted from 1992 to 1995 determined the socioeconomic, behavioural, and biological risks in addition to the psychosocial job characteristics of 3178 male and 3331 female workers aged 65 and under and free from cancer and cardiovascular diseases. During the 9-year follow-up study, 157 men and 64 women died. In the follow-up, the results of Cox proportional hazards regression analysis revealed that men with concurrent high job demands and high job control (an active job) had the lowest risk of mortality from all causes. Compared with the low demand and high control job category, the multivariate relative risk of an active job was 0.53 (95% confidence interval: 0.31, 0.89). This finding appeared largely attributable to a reduction in cancer mortality. Job characteristics were not associated with cardiovascular diseases or external causes of mortality. For women, no significant associations were observed. The findings suggest that an active job has a beneficial effect on the health of Japanese male workers. Investigating of the effect of psychosocial job characteristics on cancer might therefore provide valuable insights into the health of workers.     

Morbidity among self-employed farmers in Norway

A health survey among 923 self-employed Norwegian farmers was carried out in 1982 to investigate the state of non-hospital morbidity in the agricultural community. 85% of the nation-wide representative sample of active farmers answered the questionnaire. A disease was recorded, according to the International Classification of Diseases (ICD, 8th revision), when the farmer had been confined to bed/had reduced activity, or had consulted a medical practitioner, or used medication, all during the last 14 days. Congenital diseases were also recorded. The following findings were elicited: 56% of all morbidity came under the three headings cardiovascular diseases, musculoskeletal diseases, injuries; the incidence of cardiovascular diseases is rising in spite of the reduced average age of the agricultural population; within agriculture the following groups have the highest work-related morbidity: full-time farmers, grain-growing farmers, those farmers who have the greatest daily work load, and farmers who are physically exhausted at the end of the day.     

A prospective study of morbidity and mortality rates among farmers and rural and urban nonfarmers

Farmers are known to have lower morbidity and mortality rates than the mean for other occupational groups in the general population. Whether this is due to the urban-rural health gradient or to occupational factors related to farming is not clear. To explore this issue, we conducted a prospective study of farmers and matched rural and urban referents. Official hospital admission and mortality data for the years 1989-1996 were obtained. The relative risk of being admitted to hospital were 10% higher among rural and urban referents than among the farmers. The biggest differences were seen for mental and cardiovascular disorders. The odds of dying during follow-up did not differ between the two rural groups but were doubled among urban referents. In conclusion, the lower morbidity and mortality rates among farmers are partly due to the urban-rural health gradient but in addition salutogenic factors linked to farming seem to be active.     

Self-reported dermatitis and skin cancer in California farm operators

BACKGROUND: High rates of skin diseases and higher non-melanoma skin cancer rates have been reported in farmers. METHODS: Self-report of dermatitis and skin cancer was among the information collected from 1947 California farm operators, mostly men, in a telephone survey. The majority of the farmers cultivated fruits, nuts, or other field crops. RESULTS: Dermatitis was reported by 8.9% of men and 15.8% of women during the previous 12 months. In a logistic regression model, female gender (OR 2.0, 95% confidence interval 1.3-3.0) and respiratory atopy (OR 1.4, 1.01-1.90) were the only significant independent risk factors for reported dermatosis. There was significantly less reporting of skin cancer among field farmers when compared to others. Regular sunscreen use was reported significantly more often by women (42%) as compared to men (11%). CONCLUSIONS: More in-depth studies are needed to get information on the role of agrochemicals as risk factors for dermatitis and skin cancer.     

Dietary habit of smokers in a Chinese population

The objective of this study is to determine whether smokers have unhealthy dietary habits with respect to cardiovascular diseases and cancer. An age and sex stratified random sample of the Hong Kong Chinese population aged 25 to 74 years (500 men, 510 women) was recruited. A dietary assessment using a food frequency method over a 7 day period, together with a lifestyle questionnaire was administered by a trained interviewer. Approximately half the men were smokers, while only 19/510 women smoked. Smoking was related to lower education level. Male smokers had a lower mean daily consumption of fruits, lower carbohydrate and carbohydrate percentage calorie intake, higher fat and fat percentage calorie intake, and higher vitamin D intake compared with non-smokers. However, the differences were small compared with reported differences in Caucasian populations. No difference in dietary pattern was noted between female smokers and non-smokers. Although there is a tendency for male smokers to have an unhealthy dietary pattern with respect to cardiovascular disease and cancer, the differences between smokers and non-smokers are small, and together with the favourable health features of the Chinese diet, this difference is unlikely to add to the risk of these diseases in smokers or be a confounding factor in examining the aetiology of smoke-related diseases in this population.     

Dietary habit of smokers in a Chinese population

The objective of this study is to determine whether smokers have unhealthy dietary habits with respect to cardiovascular diseases and cancer. An age and sex stratified random sample of the Hong Kong Chinese population aged 25 to 74 years (500 men, 510 women) was recruited. A dietary assessment using a food frequency method over a 7 day period, together with a lifestyle questionnaire was administered by a trained interviewer. Approximately half the men were smokers, while only 19/510 women smoked. Smoking was related to lower education level. Male smokers had a lower mean daily consumption of fruits, lower carbohydrate and carbohydrate percentage calorie intake, higher fat and fat percentage calorie intake, and higher vitamin D intake compared with non-smokers. However, the differences were small compared with reported differences in Caucasian populations. No difference in dietary pattern was noted between female smokers and non-smokers. Although there is a tendency for male smokers to have an unhealthy dietary pattern with respect to cardiovascular disease and cancer, the differences between smokers and non-smokers are small, and together with the favourable health features of the Chinese diet, this difference is unlikely to add to the risk of these diseases in smokers or be a confounding factor in examining the aetiology of smoke-related diseases in this population.     

Relation of cigarette smoking to 25-year mortality in middle-aged men with low baseline serum cholesterol: the Chicago Heart Association Detection Project in Industry

It has been suggested that smoking does not influence risk of cardiovascular diseases in populations with low serum cholesterol levels. To determine whether cigarette smoking is an independent risk factor among men with low levels of serum cholesterol, data on 25-year coronary, cardiovascular, and all-cause mortality for 8,816 middle-aged men screened between 1967 and 1973 by the Chicago Heart Association Detection Project in Industry were examined. With Cox multivariate proportional hazards regression, relative risks of coronary heart disease and cardiovascular disease mortality associated with smoking for the two subcohorts with favorable levels of serum total cholesterol, that is, less than 180 and 180-199 mg/dl, were of the same magnitude as those for men with elevated serum cholesterol, that is, 200-239 and 240 mg/dl. In the two lower strata of cholesterol, the absolute risk and absolute excess risk of mortality for current smokers at baseline were substantially higher compared with men who never smoked, with all-cause death rates of 423.0 and 428.0 per 1,000 and absolute excess rates of 209.8 and 225.7 per 1,000. These translate to estimated shorter life expectancies of 5.3 and 5.7 years, respectively. Adverse effects of smoking on risk of coronary, cardiovascular, and all-cause mortality prevail for men with lower as well as higher serum cholesterol levels.     

Occupation and smoking as risk determinants of lung cancer

The standardized incidence ratio (SIR) of lung cancer was determined for different occupational groups in Finland. The data on all cases of lung cancer diagnosed in Finland in age groups of 35-69 years in 1971-1975 were supplemented by information on occupation from the 1970 census (Central Statistical Office). The expected numbers of cases were based on the sex, age and occupation-specific numbers of person-years computed in the Central Statistical Office, and sex- and age-specific incidence rates of lung cancer among the economically active population (as defined 1 January 1971). Compared with the risk of the total economically active population, the relative risk of those not active (SIR) was 1.69 for men and 0.86 for women. Lower than expected relative risks were encountered among highly educated and white-collar male workers (religious, legal, pedagogical, medical, technical and administrative work), in sales work, transport service work and among farmers. High SIRs were found in mining and quarrying, forestry, woodworking (joiners), construction, painting and among unskilled workers. Among women the numbers of cases were small and only one significant SIR was obtained; the risk was lower than expected in farming. Data on the smoking habits of males in different main occupational categories in Finland show that variation between different occupational groups in the prevalence of smoking closely corresponds to that in the SIR for lung cancer (R = 0.96).     

General and oncologic morbidity in Moscow municipal transport drivers

A case study was undertaken to examine general and cancer mortality rates and cancer morbidity among municipal transport drivers in Moscow. The mortality and cancer morbidity in 1969 to 1988 were followed up among 2528 men and 212 women. In this period, male mortality rates due to malignant neoplasms, cardiovascular diseases and all causes taken together were statistically lower than the expected rates. Male cancer morbidity rates were also lower the expected ones. In the past decade 42 cases of gastric cancer were revealed in the cohort, which was statistically greater than the expected figures (29.8). In the first decade, prostatic cancer mortality was statistically significantly higher in bus drivers with length of service of over 20 years. Among women, there were only 12 deaths, with significantly decreased mortality rates. Esophageal cancer was detected in women who had worked as drivers for 20-29 years. The lower morbidity and mortality rates may be associated with the "healthy worker effect", i.e. with the fact that staff is strictly selected for this job.     

Risk factors for injury in rural Iowa: round one of the Keokuk County Rural Health Study

BACKGROUND: Unintentional injuries represent a major cause of morbidity and mortality in rural communities. This study aimed to determine the distribution of injury risk factors in a rural Iowa community and to identify the rural subgroups at highest risk for injury. METHODS: We reported on 1583 participants, aged > or =25 years, from Round One of the Keokuk County Rural Health Study, a longitudinal panel study of a rural community. The self-reported data were collected during face-to-face interviews. RESULTS: Our data suggested that several risk factors for injury are not uniformly distributed among rural populations. Male farmers were significantly less likely to wear their seatbelts than townspeople or rural nonfarmers. However, farm women were as likely to wear seatbelts as other women. Both male and female farmers were more likely to use all-terrain vehicles than townspeople or rural nonfarmers. In contrast, townspeople were more likely to ride bicycles than either farmers or rural nonfarmers. Townspeople were less likely to have firearms in their homes than either farmers or rural nonfarmers. Farmers were most likely to have fired a gun in the last year. Male farmers aged <65 years were less than half as likely as other men the same age to report a history of alcohol abuse. Binge drinking was equally frequent among farmers, rural nonfarmers, and townspeople. CONCLUSIONS: These differences in risk behavior in a rural county suggest the possibility of targeting specific rural injury prevention interventions at those with the highest risk for dangerous behavior.     

Physical activity,cardiovascular morbidity and overall mortality: results from a 14-year follow-up of the German Health Interview Survey

The aim of this study was to analyze whether physically active persons have fewer cardiovascular diseases and lower overall mortality than sedentary persons and whether there is a benefit for persons performing vigorous physical activities compared to those reporting light or moderate levels. In 1984–1985, a population-based random sample of women and men aged 25–69 years was recruited for the National Health Interview Survey in Germany. Self-reported duration of sports and leisure-time physical activities at baseline were evaluated in relation to cardiovascular morbidity and overall mortality after 14 years of follow-up among participants free of cardiovascular diseases, cancer and obstructive pulmonary diseases at baseline. An inverse association of the duration of sports with cardiovascular morbidity was found for women (regular 1–2 h a week: odds ratio, 1.42, 95% CI: 0.75, 2.67; less than 1 h: odds ratio, 1.85, 95% CI: 1.06, 3.23) as well as for men (odds ratio, 2.47, 95% CI: 1.51, 4.05; odds ratio, 2.43, 95% CI: 1.58, 3.74), if compared to a reference, defined as regular sports for at least 2 h/week. Regarding overall mortality, an inverse association was also found. Women with 1–2 h of regular sports (odds ratio, 1.49, 95% CI: 0.53, 4.22) and less than 1 h (odds ratio, 3.31, 95% CI: 1.34, 8.14) as well as men (odds ratio, 1.27, 95% CI: 0.75, 2.14; odds ratio, 1.59, 95% CI: 1.04, 2.44) are under higher risk of dying compared to the reference. Similar results were found regarding the intensity of physical activities. We concluded that regular sports as well as regular physical activity are related to lower levels of cardiovascular diseases and overall mortality. An additional benefit was found for those reporting vigorous activities.     

Smoking,blood pressure and serum cholesterol-effects on 20-year mortality

BACKGROUND: To study the impact of smoking and blood pressure conditional on serum total cholesterol levels, we investigated the 20-year mortality risk associated with high systolic blood pressure (> or =140 mmHg) and smoking, at low (<5.2 mmol/Liter), medium (5.2-6.49mmol/Liter), and high (> or =6.5 mmol/Liter) serum total cholesterol levels. METHODS: The study population comprised a cohort of 50,000 men and women age 30-54 years, examined between 1974 and 1980, in five Dutch towns. The duration of follow-up averaged 20 years. Age-adjusted relative risks (RRs) for mortality from coronary heart disease (CHD), cardiovascular diseases (CVD) and all causes were estimated, for six risk profiles (based on levels of total cholesterol, systolic blood pressure and smoking), using Cox proportional hazards analysis. RESULTS: Given a low cholesterol level, smoking had a larger impact than elevated blood pressure on CHD, CVD and all-cause mortality. The combination of elevated blood pressure and smoking among persons with low cholesterol was associated with RRs of 3.0 for CHD, 6.0 for CVD and 4.1 for all-cause mortality in men, and 2.3, 3.6 and 2.6, respectively, in women. Among persons with high cholesterol, the combination of high blood pressure and smoking was associated with RRs of 9.7 for CHD, 13.9 for CVD and 5.7 for all-cause mortality in men, and 15.9, 9.3 and 4.3, respectively, in women. For each risk profile, the absolute number of CHD, CVD and total deaths was larger in men than in women. CONCLUSIONS: The results demonstrate the potential power of a multifactorial approach to risk factor reduction in the prevention of cardiovascular diseases and all-cause mortality.     

新疆和田地区60岁以上老年人急诊疾病谱分析

目的研究新疆和田地区老年急诊疾病谱的特点,为合理利用医疗资源提供依据。方法选择新疆和田地区人民医院急诊室登记的2010年1月1日～12月31日的老年（60岁以上）患者983例。采用SPSS17.0统计软件对患者的年龄、性别、民族、职业、疾病诊断等进行数据整理分析,了解不同年龄段、不同民族、不同性别及农民与城区居民急诊疾病构成的差异。结果 983例老年患者中,维吾尔族患者887例（90.2%）,其中男483例,女404例;汉族96例（9.8%）,其中男54例,女42例。农民618例（62.9%）,城区居民365例（37.1%）。（1）急诊病因按系统依次为心血管急症（34.8%）,神经系统急症（26.0%）,呼吸系统急症（22.7%）,消化系统急症（7.1%）。心脑血管及呼吸系统急症占83.2%。（2）随年龄增长,呼吸系统急症比例增加。与该地区汉族老年患者比较,维吾尔族老年患者神经系统急症与呼吸系统急症所占比例高;维吾尔族男性和女性以及汉族男性呼吸系统急症均较高,维吾尔族男性和女性略高于汉族男性,明显高于汉族女性,但差异无统计学意义。农民老年患者脑血管急症的比例明显高于城区老年患者（P=0.001）,城区居民心血管急症略高于农民,呼吸系统急症比例相近。出血性卒中高于缺血性卒中,出血性与缺血性比约为1.5：1。结论应针对该地区心脑血管及呼吸系统急症发病率高,采取有效措施提高急诊救治水平,同时进一步提高该地区,尤其是边远农村高血压的知晓率和控制率。     

Smoking and lipid cardiovascular risk factors in Vietnamese refugees in Australia

BACKGROUND: The effects of smoking and sex on lipid risk factors for cardiovascular disease were examined among Vietnamese people newly arrived in Australia. METHODS: Immigrants recruited through Refugee Screening had anthropometric data recorded and blood collected to measure total cholesterol (TC), high-density lipoprotein cholesterol (HDL), and triglyceride (TG) by Reflotron; apolipoprotein A-1 (apo A-1) and apolipoprotein B-100 (apo B) by immunoturbidimetric analyses (Turbitimer); and lipoprotein (a) (LP (a)) by ELISA. A questionnaire determined behavioral variables known to influence cardiovascular risk and Statview, Minitab, and SPSS were employed for data analysis. RESULTS: Lipoprotein profiles of men (n = 242) and women (n = 159) were compared. Crude TC and apo B were similar; HDL, apo A-1, and LP (a) were higher in women, TG was higher in men. After adjustment (age, BMI, WHR, years of smoking, and drinks per week), only apo A-1 and LP (a), were higher in women. "At risk" levels of TC or apo B did not differ by gender; risk of low apo A-1 was higher among men. Smokers had a significant risk (crude and adjusted) of low HDL, low apo A-1, and high LP (a). The sex difference in HDL was removed by a single adjustment for smoking; male smokers had higher LP (a) than male nonsmokers. CONCLUSION: Male and female Vietnamese immigrants had similar adjusted lipid profiles. Smoking had a marked detrimental effect on lipids.