Behavioral and Nonbehavioral Risk Factors for Occupational Injuries and Health Problems Among Belgian Farmers

ABSTRACT

Preventive interventions to reduce occupational injuries and diseases among farmers require an appraisal of the relative importance of the various risk factors. This paper describes the results of a cross-sectional study investigating determinants of occupational health and injuries among 510 Belgian farmers, looking at health-related behaviors (machinery use, animal handling, fall prevention, and pesticide use), as well as nonbehavioral risk factors (demographic characteristics, farm characteristics, and participation in safety training). Education level and number of employees on the farm were identified as nonbehavioral risk factors for injuries, with highly educated farmers and working with one employee associated with a higher injury risk. In contrast, none of the nonbehavioral factors were related to occupational disease. Unsafe machinery use, animal handling, fall prevention, and pesticide use were behavioral risk factors for injuries, with unsafe pesticide use representing the highest risk. Unsafe machinery and pesticide use were also risks for disease. Significant differences in self-reported behavior were found for gender, age, number of employees, and the interaction between age and education. The study highlights the importance of behavioral factors as determinants of occupational injuries and diseases among farmers, and suggests that tailored preventive interventions should be developed to accommodate for differences in these behaviors among subgroups of farmers.     

Behavioral and nonbehavioral risk factors for occupational injuries and health problems among Belgian farmers

Preventive interventions to reduce occupational injuries and diseases among farmers require an appraisal of the relative importance of the various risk factors. This paper describes the results of a cross-sectional study investigating determinants of occupational health and injuries among 510 Belgian farmers, looking at health-related behaviors (machinery use, animal handling, fall prevention, and pesticide use), as well as nonbehavioral risk factors (demographic characteristics, farm characteristics, and participation in safety training). Education level and number of employees on the farm were identified as nonbehavioral risk factors for injuries, with highly educated farmers and working with one employee associated with a higher injury risk. In contrast, none of the nonbehavioral factors were related to occupational disease. Unsafe machinery use, animal handling, fall prevention, and pesticide use were behavioral risk factors for injuries, with unsafe pesticide use representing the highest risk. Unsafe machinery and pesticide use were also risks for disease. Significant differences in self-reported behavior were found for gender, age, number of employees, and the interaction between age and education. The study highlights the importance of behavioral factors as determinants of occupational injuries and diseases among farmers, and suggests that tailored preventive interventions should be developed to accommodate for differences in these behaviors among subgroups of farmers.     

Work injuries among Finnish farmers: a national register linkage study 1996-1997

BACKGROUND: Farming is one of the most injury-prone occupations in Finland as it is in other countries. Our goals were to describe work injuries of Finnish farmers and to compare occupational injury rates between various subgroups. METHODS: A national cohort of 69,629 full-time farmers and their 11,657 compensated injuries were identified from an insurance company database. Cohort data were merged with a population census and farm register. Relative incidence rates were calculated using Poisson regression. RESULTS: Men had higher injury rates than women, except with regard to injuries caused by animals. Dairy and hog farming were the riskiest activities, and injury rates increased with the number of dairy cows. CONCLUSIONS: One-half of insured farmers in Finland are full-time farmers, which may have lead to underestimation of risk in Finnish injury statistics. Dairy farming is of particular concern because it is both common and has a high injury rate.     

Risk Factors for Machinery-related Injury among Iowa Farmers: A Case-Control Study Nested in the Agricultural Health Study

Abstract

Farm machinery is a major cause of injury morbidity and mortality among farmers. This case-control study assessed risk factors for machinery-related injuries among Iowa farmers. A screener questionnaire sent to 6,999 farmers in 1998 identified 205 farmers who had machinery-related injuries requiring medical advice/treatment in the previous year. Possible risk factors for injury were assessed among these farmers compared with 473 farmers with no injury in the previous year. A multiple logistic regression analysis showed significant associations between machinery-related injury and hours per week spent on farmwork (OR = 2.02; 95% CI 1.38–2.94), fewer years of farming experience (OR = 1.79; 95% CI 1.14–2.79), wearing a hearing aid (OR = 4.37; 95% CI 1.55–12.25), and a high CAGE score suggesting problem drinking (OR = 2.49; 95% CI 1.00–6.19). This is the first study to show associations between machinery-related injury and hearing impairment, problem drinking, and fewer years of farming experience. These findings may be useful for future interventions to decrease injuries related to farm machinery.     

Safety Practices Among Limited Resource Farmers in North Carolina

SUMMARY

The purpose of our NC Farm Safety Project is to reduce the incidence of farm injuries and illnesses among limited resource farmers in North Carolina by implementing an intervention program that stresses educational strategies. Limited resource farmers in the state are identified as farm families, who have a combined gross income of less-than $50,000 per year. A pilot-test was conducted to determine the educational safety programs needed by limited resource farmers in North Carolina. The target population in the pilot survey consisted of 2656 limited resource farmers representing 26 counties. Of this population, 335 were selected to participate in a farm injuries and illness telephone survey.

Some conclusions drawn are: (1) only a fourth of the farmers had medical insurance and they were mostly part-time farmers, (2) most of the farmers indicated that they were interested in participating in a farm machinery safety workshop, and (3) only a third of the farmers had first aid kits.     

Cost of Compensated Injuries and Occupational Diseases in Agriculture in Finland

Abstract

Although agriculture is one of the most hazardous industries, the costs of agricultural injuries and illnesses are not well known. This study aimed to determine the cost burden from compensated injuries and occupational diseases in Finnish agriculture using workers compensation records.

The incidence rates in 1996 were 7.4/100 for injuries and 0.61/100 for occupational diseases. Men had a higher risk of injury (RR = 1.89; 95% CI: 1.81-1.97), but a lower risk of an occupational disease (RR = 0.68; 95% CI: 0.60-0.78), compared to women. The total cost burden was €75 (Euros) per person in 1983, increasing to €215 in 1999. The total insurance cost in 1996 was €23.5 million consisting of medical care (16%), per diem (lost time compensation within one year from the incident) (37%), pension (lost time compensation after one year from the incident) (23%), survivors pension (3%), impairment allowance (7%), rehabilitation (6%), and other costs (9%). The total cost was 0.7% of the national gross farm income and 2.2% of the net farm income. The mean cost of 1996 cases was €1340 for injuries and €6636 for occupational diseases. Injuries represented 92% of the claims and 71% of the total costs. Occupational diseases represented 8% of the claims and 29% of the costs. Twenty percent of the most severe claims represented 79.5% of the total insurance costs.

Injuries and occupational diseases result in significant costs in agriculture. Lost time was the largest cost item. Overall, injuries were more costly than occupational diseases. This study indicates that the 20%-80% rule applies to agricultural injury and illness costs, and from the cost standpoint, it is important to focus prevention efforts on the most severe incidents.     

Cost of compensated injuries and occupational diseases in agriculture in Finland

Although agriculture is one of the most hazardous industries, the costs of agricultural injuries and illnesses are not well known. This study aimed to determine the cost burden from compensated injuries and occupational diseases in Finnish agriculture using workers compensation records. The incidence rates in 1996 were 7.4/100 for injuries and 0.61/100 for occupational diseases. Men had a higher risk of injury (RR = 1.89; 95% CI: 1.81-1.97), but a lower risk of an occupational disease (RR = 0.68; 95% CI: 0.60-0.78), compared to women. The total cost burden was 75 (Euros) per person in 1983, increasing to 215 in 1999. The total insurance cost in 1996 was 23.5 million consisting of medical care (16%), per diem (lost time compensation within one year from the incident) (37%), pension (lost time compensation after one year from the incident) (23%), survivors pension (3%), impairment allowance (7%), rehabilitation (6%), and other costs (9%). The total cost was 0.7% of the national gross farm income and 2.2% of the net farm income. The mean cost of 1996 cases was 1340 for injuries and 6636 for occupational diseases. Injuries represented 92% of the claims and 71% of the total costs. Occupational diseases represented 8% of the claims and 29% of the costs. Twenty percent of the most severe claims represented 79.5% of the total insurance costs. Injuries and occupational diseases result in significant costs in agriculture. Lost time was the largest cost item. Overall, injuries were more costly than occupational diseases. This study indicates that the 20%-80% rule applies to agricultural injury and illness costs, and from the cost standpoint, it is important to focus prevention efforts on the most severe incidents.     

Risk factors for machinery-related injury among Iowa farmers: a case-control study nested in the Agricultural Health Study

Farm machinery is a major cause of injury morbidity and mortality among farmers. This case-control study assessed risk factors for machinery-related injuries among Iowa farmers. A screener questionnaire sent to 6,999 farmers in 1998 identified 205 farmers who had machinery-related injuries requiring medical advice/treatment in the previous year. Possible risk factors for injury were assessed among these farmers compared with 473 farmers with no injury in the previous year. A multiple logistic regression analysis showed significant associations between machinery-related injury and hours per week spent on farmwork (OR = 2.02; 95% CI 1.38-2.94), fewer years of farming experience (OR = 1.79; 95% CI 1.14-2.79), wearing a hearing aid (OR = 4.37; 95% CI 1.55-12.25), and a high CAGE score suggesting problem drinking (OR = 2.49; 95% CI 1.00-6.19). This is the first study to show associations between machinery-related injury and hearing impairment, problem drinking, and fewer years of farming experience. These findings may be useful for future interventions to decrease injuries related to farm machinery.     

Pain, medication, and injury in older farmers

BACKGROUND: Agricultural work continues to be a dangerous occupation. Older farmers experience high risks for work-related injury. The purpose of this research was to determine if there is a relationship between medication use and injury among older male farmers in Alberta. METHODS: Using probabilistic linkage between an Alberta Agriculture government registry of farm operators and the Alberta Health Plan registry file, older farmers (aged 66 and older) were identified. Farm related injuries were identified using an E-code search of both hospitalization and emergency department separations for a 3-year period. Cases were matched to controls on age, geographic health region, and index injury date at a ratio of 1:5. Co-morbidity and medication use for each of the cases and controls were derived from population based health system utilization files. Conditional logistic regression was used to determine which medications were related to injury. RESULTS: Overall, a total of 282 farm related injuries were suffered by the linked group. Controlling for co-morbidity, farmers who had stopped taking narcotic pain killers (OR = 9.37 [95% CI:4.95, 17.72]) and non-steroidal anti-inflammatories (OR = 2.40 [95% CI:1.43, 4.03]) 30 days prior to the date of injury were at risk of injury. Those farmers taking sedatives up until the date of injury were also at risk (OR = 3.01 [95 CI:1.39, 6.52]). In addition, those suffering from incontinence/urinary tract disorders (OR = 2.95 [95% CI:1.30, 6.71]), and prior injury (OR = 1.42 [95% CI:1.04, 1.95]) were also at greater risk of injury. CONCLUSIONS: The relationship of medication use and injury in this population is different from those observed in studies of falls in older persons. We hypothesize that distraction from either pain or co-morbidity may play an important role in the etiology of injuries suffered in this active older working population. Further investigations in this area are required to confirm these findings.     

#65 Medication use,co-morbidity and injury in older male farmers

PURPOSE: The purpose of this research was to determine if there is a potentially causal relationship between medication use and injury among older male farmers in Alberta.METHODS: Using probabilistic linkage between an Alberta Agriculture government registry of farm operators and the Alberta Health Plan registry file, older farmers (aged 66 and older) were identified. Farm related injuries were identified using an E-code search of both hospitalization and emergency department separations for a 3-year period. Cases were matched to controls on age, geographic health region, and index injury date at a ratio of 5:1. Co-morbidity and medication use for each of the cases and controls were derived from population based health system utilization files. Conditional logistic regression was used to determine which medications were related to injury.RESULTS: Over a 3-year period, a total of 282 farm related injuries were suffered by the linked group. Controlling for co-morbidity, farmers who had stopped taking narcotic pain killers (OR = 9.85[95%CI:5.14,18.86]) and non-steroidal anti-inflammatories (OR = 2.36[95%CI:1.40,3.98]) 30 days prior to the date of injury were at increased risk. Those farmers taking sedatives and hypnotics right up until the date of injury were also at increased risk (OR = 3.12[95CI:1.41,6.89]).. In addition, those suffering from incontinence (OR = 3.71[95%CI:1.60,8.59]) and osteoporosis (OR = 4.78[95%CI:1.34,16.99]) were also at increased risk.CONCLUSION: The relationship of medication use and injury in this population is different from those observed in studies of falls in older persons. These data indicate that distraction from either pain or co-morbidity may play a factor in injuries suffered in this active older working population.     

Risk factors for falls among Iowa farmers: a case-control study nested in the Agricultural Health Study

BACKGROUND: Farmers are at increased risk for fall-related injury compared with other occupations. Little is known about risk factors for non-fatal falls on the farm. This case-control study, nested within the Agricultural Health Study, aimed to assess risk factors for work-related falls among Iowa farmers. METHODS: A screener questionnaire sent to 6,999 farmers in 1998 identified 79 farmers who reported a fall-related farm injury that required medical advice or treatment in the previous year. Multivariable logistic regression analysis was used to assess several possible risk factors for injury among these farmers compared with 473 farmers with no injury in the previous year. RESULTS: There were significant associations between fall-related farm injury and age between 40 and 64 years (OR = 2.21; 95% CI = 1.20-4.07), doctor-diagnosed arthritis/rheumatism (OR = 2.05; 95% CI = 1.11-3.79), difficulty hearing normal conversation (even with a hearing aid, in the case of those who used one) (OR = 1.82; 95% CI = 1.07-3.08), and taking medications regularly (OR = 1.80; 95% CI = 1.02-3.18). CONCLUSIONS: Aging and health impairments, such as arthritis and hearing difficulties, are risk factors for which accommodations and preventive strategies can be devised to prevent fall-related injuries on the farm.     

Prevalence of Chronic Diseases and Occupational Injuries and their Influence on the Health-Related Quality of Life Among Farmers Working in Small-Farm Enterprises

Objectives: This study aimed to determine the prevalence of chronic diseases and occupational accidents and injuries, and to examine their association with the quality of life among a sample of Iranian farmers.

Methods: A cross-sectional study was conducted among 736 male farmers. Data on the prevalence of chronic diseases and occupational accidents and injuries was collected using an author-developed questionnaire, and the SF-36 questionnaire was used to obtain information on quality of life.

Results: The prevalence of chronic diseases was 96.1%. Musculoskeletal diseases (MSDs), eye diseases and neurology diseases were the most prevalent diseases. Almost half of the farmers (42.7%) had experienced an occupational accident during the last 12 months and cuts and fractures accounted for the most frequent injuries. Sick leave was reported by 28.2% of the farmers and from those with history of accidents, 21.4% were hospitalized. A significant association was found between age and education level with quality of life. Most of the chronic diseases showed a significant and inverse association with quality of life, however, the strongest association was found for MSDs and mental disorders. Furthermore, the most important injury associated with quality of life was cuts and fractures.

Conclusions: Based on the results, MSDs, mental disorders, and cut and fractures were the main determinants of the farmers’ quality of life. Hence, a better quality of life among farmers is especially dependent on eliminating ergonomics risk factors leading to developing musculoskeletal disorders, improving psychosocial work climate, and promoting occupational and personal safety culture.     

Risk Factors for Animal-related Injury Among lowa Large-livestock Farmers: A Case-control Study Nested in the Agricultural Health Study

CONTEXT: Although farmers are at risk for injuries from contact with large livestock, few previous studies have examined risk factors for animal-related injuries. PURPOSE: This case-control study, nested in the Agricultural Health Study, aimed to assess risk factors for animal-related injury among Iowa large-livestock farmers. METHODS: A screener questionnaire sent to 6999 farmers identified 116 farmers with large livestock who had an animal-related injury requiring medical advice/treatment in the previous year. Several possible risk factors for injury were assessed by comparing these farmers with 342 farmers who had livestock but were not injured in the previous year. FINDINGS: A multiple logistic regression analysis showed significant associations between animal-related injury and the use of a hearing aid (odds ratio [OR] = 5.4 [95% CI, 1.6 to 18.0]), doctor-diagnosed arthritis or rheumatism (OR = 3.0 [95% CI, 1.7 to 5.2]), education beyond high school (OR = 1.8 [95% CI, 1.1 to 2.8]), and a younger age. Farmers engaged in off-farm work were less likely to sustain animal-related injuries (OR = 0.4 [95% CI, 0.2 to 0.8]). CONCLUSIONS: This is the first study to show associations between animal-related injury and a younger age, hearing difficulties, and doctor-diagnosed arthritis. Hearing loss and arthritis, which are more common among farmers than among other workers, may be particularly important risk factors to address in future preventive studies.     

Prevalence of occupational injury and its contributing factors among rubber tappers in Galle,Sri Lanka

Background: Rubber tapping involves carrying heavy loads, navigating rough terrain, and using sharp tools. However, little is known about occupational injury among this vulnerable working population.

Objective: To assesses the prevalence, severity, and contributing factors associated with occupational injury among Sri Lankan rubber tappers and to identify possible interventions to improve occupational safety.

Methods: A questionnaire was administered to 300 Sri Lankan rubber tappers. The associations between tapper characteristics and injury within the last year were examined using log-binomial regression models. Short response answers were analyzed using qualitative content analysis.

Results: 300 tappers reported 594 injuries in the previous 12 months, and missed 1,080 days of work. The prevalence of one or more injuries was 49%. Factors associated with injury were being female, working an additional job, tapping with a two-handed approach, and depressive symptomology. Qualitative findings suggest three interventions to address injuries: (1) landscaping, (2) personal protective equipment, and (3) provision of eyeglasses.

Conclusions: Work-related injuries are common among Sri Lankan rubber tappers. These results highlight the importance of working with and including informal workers in the creation of Sri Lankan occupational health and safety regulations. We believe that the three interventions identified by respondents could help to reduce the risk of occupational injury among rubber tappers.     

Farm Activities Associated with Eye Injuries in the Agricultural Health Study

ABSTRACT

Farmers are at risk for work-related eye injuries, some of which can be very serious. This study describes the farm activities that were related to eye injury in a group of 36 Iowa farmers in the Agricultural Health Study who sustained 40 farmwork-related eye injuries requiring medical advice or treatment. Farm activities of grinding or cutting metal accounted for 11 (27.5%) of the eye injuries, welding for 3 (7.5%), and drilling for 2 (5%). The other 24 eye injuries were related to diverse farm activities. One injury was caused by an animal. Only one injury was caused by a chemical exposure. Foreign body in the eye was the most frequent type of eye injury overall, accounting for 32 (80%) of the eye injuries. Of those, 20 were metallic foreign bodies. Although none of the injuries required hospitalization, 10 eye injuries (25%) resulted in the farmer missing 1 to 5 days of work. At least three injuries occurred while farmers were wearing safety glasses/goggles. These results suggest that farmers are at risk for eye injury from activities such as grinding and cutting metal, welding, and drilling and from other diverse activities on the farm for which eye hazards may not have been anticipated. In addition, these findings have implications for use of appropriate eye protection during all farm activities.     

Health Indicators of a Cohort of Midwest Farmers: Health Outcomes of Participants in the Certified Safe Farm Program

Occupational illness, injury, and fatality rates for those working in production agriculture are higher than in any other industry. A potential risk factor contributing to occupational injuries across all industries is acute or chronic co-morbidity (e.g., obesity, high blood pressure, high cholesterol), and related health issues that increase the risk for an occupational injury or illness. These chronic health conditions have been associated not only with increased risk for injuries, but also higher health-care costs, and greater absenteeism. Certified Safe Farm (CSF) is a comprehensive intervention program aimed to reduce occupational health and safety hazards and to promote general health among farmers. Prior publications have described CSF program efforts to reduce hazardous exposures, disabling injuries, organic dust toxic syndrome, occupational health-care costs, and to increase positive occupational health behaviors. This paper reports on the general health indicators of a cohort of 438 Iowa farm owner/operators enrolled in the CSF program. Overall, this study found that the farming population in Iowa has higher body mass index (BMI), but lower total cholesterol, low-density lipoprotein (LDL), and lower prevalence of hypertension compared to the general population. There was evidence that the combination of high blood pressure, cholesterol, and BMI were related to increased injury rates. Poor self-reported health status was also related to increased injuries but was not related to clinical health indicators. The CSF intervention led to improvements on health outcomes, particularly among those in the 35 to 49 age group. Little research has focused on the individual’s general health status as a predictor of risk of occupational injury. This study suggests the need for additional research and interventions integrating occupational safety and health prevention along with health promotion.     

Incidence of farm-work–related acute injury in a defined population

To determine occurrence and sources of farm-work-related injury, we conducted a population-based, prospective study in a large clinic and hospital serving a defined rural area. The population at risk was identified through a unique demographic and medical records linkage system and a special agricultural census. Cases were 510 individuals who sought inpatient or outpatient care from May 1990 through April 1992 from a physician or chiropractor for harm resulting from acute exposure to energy. One per 31 farm residents was treated annually for a farm-work-related injury. Eight percent of these cases were hospitalized. Animals were the most frequent source of injury. Severity did not differ between cases associated with animals, machinery, falls, or chemicals. Thirty-eight percent of farm-work-related injury cases occurred in nonfarm residents. Injury risk was 2.5 times greater among dairy farm residents than among nondairy farm residents, 352.0 vs. 141.0 cases per 10,000 person-years, respectively. Adult male farm residents had 556.9 injuries per 10,000 person-years and 21.3 injuries per million hours of farm work.     

Risk factors for low back injury among farmers in Iowa: A case-control study nested in the agricultural health study

The aim of this study was to assess risk factors for low back injury requiring medical advice or treatment among Iowa farmers. Although farmers are at risk for low back injury, few studies have addressed risk factors for farm work-related low back injury. We screened 6999 participants in the Iowa portion of the Agricultural Health Study to identify 49 male farmers who reported farm work-related low back injury requiring medical advice or treatment in the previous year. We compared them with 465 uninjured male farmer controls. Multivariable modeling identified four risk factors significantly associated with low back injury: age less than 45 years (OR = 3.32; 95% CI 1.75-6.20), doctor-diagnosed asthma (OR = 4.26; 95% CI 1.49-12.10), education beyond high school (OR = 2.12; 95% CI 1.13-3.90), and difficulty hearing normal conversation (even with a hearing aid, in the case of those using one) (OR = 1.98; 95% CI 1.02-3.80). Although hearing difficulty may be a general risk factor for occupational injury, asthma may be a more specific risk factor for low back injury. Future research to assess the risk factors, asthma and difficulty hearing, may be particularly important, since farmers are at increased risk for hearing loss, and farmers come into contact with many inhaled agents that can cause asthma.     

Injury and Illness Costs in the Certified Safe Farm Study

CONTEXT: The Certified Safe Farm (CSF) intervention program aims to reduce occupational injuries and illnesses, and promote wellness to reduce health care and related costs to farmers, insurers, and other stakeholders. PURPOSE: To evaluate the cost effectiveness of CSF. METHODS: Farms (316) located in a 9-county area of northwestern Iowa were recruited and randomized into intervention and control cohorts. Intervention farms received occupational health screenings, health and wellness screening, education, on-farm safety reviews, and performance incentives. For both cohorts, quarterly calls over 3 years were used to collect self-reported occupational injury and illness information, including costs to the farmers and their insurers. FINDINGS: Annual occupational injury and illness costs per farmer paid by insurers were 45% lower in the intervention cohort ($183) than in the control cohort ($332). Although out-of-pocket expenses were similar for both cohorts, combined costs of insurance and out-of-pocket expenses were 27% lower in the intervention cohort ($374/year per farmer) compared to the control cohort ($512/year per farmer). Within the cohort of intervention farmers, annual occupational injury and illness cost savings were directly associated with on-farm safety review scores. Reported health care costs were $237 per farmer in the safest farms (those farms scoring in the highest tertile) versus $485 per farmer in the least safe farms (lowest tertile). CONCLUSIONS: Results suggest that farmers receiving the intervention had lower health care costs for occupational injuries and illnesses than control farmers. These cost savings more than cover the cost of providing CSF services (about $100 per farm per year).     

United Airway Disease Among Crop Farmers

Although there are observed relationships between agriculture and respiratory health problems, little attention has been given to relationship between lower and upper airway problems among farmers in the United States. The objective was to investigate the possible relationship between occupational risk factors and “united airway disease” among farmers in eastern North Carolina. Farmers and farm workers were selected from eastern North Carolina by using a cluster sampling method. A total of 180 farmers and farm workers completed the questionnaire. Data analyses were conducted to test associations and correlations between working conditions and symptoms. Lower airway symptom prevalence was 35%, and 66% had upper airway symptoms. Only 1% of farmers had physician-diagnosed rhinitis. Self-reported rhinitis and asthma symptoms were significantly correlated (r = .228, P = .003) among farmer/farm workers. Upper airway diseases are prevalent yet overlooked among farmer/farm workers. Early management of upper airway symptoms may prevent severe lower airway diseases, which will lead to increased productivity in the agricultural workforce.