Mortality and Morbidity in Agriculture in the

United States – Policy Implications

Risto H. Rautiainen, MS,

Stephen J. Reynolds, PhD, CIH

Great Plains Center for Agricultural Health,

Aims

Characterize trends since Ag at Risk, 1998 in • Agriculture• Agricultural populations• Prevalence and incidence of

• Fatal occupational injuries• Non-fatal occupational injuries• Work related diseases

Conclusions

Recommendations

Trends in Agriculture

• Rapid decrease in farms and farm workforce in early and mid part of the 20th century

• Relatively slow changes since 1970’s

• Part time farming has increased

• Large scale farming has increased

Number of Farms and Farm Workers in the United States. Sources: USDA NASS, BLS CPS

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

Year

1949

1952

1955

1958

1961

1964

1967

1970

1973

1976

1979

1982

1985

1988

1991

1994

1997

Num

ber

in th

ousa

nds

Workers

Farms

Fatal Injuries in Agriculture

Sources of Information

• National Safety Council (NSC)

• NIOSH National Traumatic Occupational Fatalities (NTOF)

• Bureau of Labor Statistics (BLS), Census of Fatal Occupational Injuries (CFOI)

Figure 1. Agricultural Fatality Rate in the United States in 1992-98. Source: NCS Injury Facts, 2000. (based on CFOI)

0

5

10

15

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25

30

1992 1993 1994 1995 1996 1997 1998 1999

Fa

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/ 1

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ork

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Comparison of Occupational Fatality Rates

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5

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15

20

25

USA Ag USA Other Canada Ag Finland Ag

Fa

talit

ies/

10

0,0

00

Tractor Fatality Rate in 1988-98. Source: NSC Injury Facts 2000.

0

2

4

6

8

10

12

1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998

Fa

talit

ies/

10

0,0

00

Tra

cto

rs

ROPS in Relation to SUV Tire Separation Problem

Problem Tractor Overturn Tire Tread Separation

Fatalities 150/y, >6,000 total 174 total

Number of units 4.8M Tractors 6.5M Tires

Solution ROPS New tires

Cost per unit / total $500 / $2.4B

(1.4B for remaining non-ROPS tractors)

$100 / $0.65B

Intervention initiated >40 years 7 months

% Corrected, Feb 01 40% 95%

Iowa Agricultural Fatality Rate 1990-99. Sources: IDPH SPRAINS (Injuries), ISU (Farm Population)

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

40.00

45.00

50.00

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Fat

aliti

es/1

00,0

00 P

erso

ns

Nonfatal Injuries

Sources

• National Safety Council

• Bureau of Labor Statistics (workers on farms with >10 hired workers)

• California Workers Compensation (hired farm workers)

• Studies and surveys

Incidence of Nonfatal Occupational Injuries.Source: BLS, Survey of Occupational Injuries and Illnesses,

Monthly Labor Review, 122:(8)94

0

2

4

6

8

10

12

14

1985 1990 1995 1996 1997

Inju

ries/

100

FT

Wor

kers

Ag, Foretry, Fishing

Total Private Industry

Rate of Hospitalized Injuries in Iowa 1990-99. Sources: IDPH SPRAINS (Injuries), ISU (Farm Population)

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1.80

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Inju

ries/

100

Per

sons

Work Related Illness

Definitions:• Occupational disease• Work related illness• Work related symptoms

Sources:• Bureau of Labor Statistics (hired workers)• National Safety Council

Work Related Illnesses

BLS (NSC Injury Facts 2000)

• Workers on farms with >10 employees

• 30.9 illnesses / 10,000 workers

• 56% skin disorders

• 14% repeated trauma

• 13% respiratory disease

• 17% other

Respiratory Disease• Thorne et al: swine confinement workers:

occup. asthma 20%, chronic bronchitis 25%, ODTS 33%

• Reynolds et al: association with work exposure and respiratory symptoms in turkey barn workers

• Wilkins et al: cash grain farmers, chronic caugh 9%, phlegm 11%, dysphnea 16%, wheeze 8%

• NIOSH: fatalities from hypersensitivity pneumonitis

• Causes: organic dust, endotoxin, ammonia

Cancer

Overall cancer rates are typically lower in agriculture compared to general population. PMRs: NIOSH 0.89, Finland 0.82, Sweden 0.80

• Blair et al: overall cancer rate lower but certain cancers elevated: Hodgkin’s disease, multiple myeloma, leukemia, skin melanomas, and cancers of the lip, stomach, and prostate

Hearing Loss

• Becker et al, NY: 72% of farmers had high frequency hearing loss

• Mudipalli et al, IA: 50% of females, 86% of males with farming history had hearing loss, respectively 50% and 80% when no farm history; 47% of young males had hearing loss

Skin Disorders

• BLS: 17/10,000 workers in 1999.

• Finland 16/10,000 farmers in 1996

• California: 2% contact dermatitis

• California, causes: plants (52%), chemicals (20%), food products (22%)

Zoonoosis

Thomas et al, England. Antibodies found for:• Q-fever (29.2%), toxoplasma (50.2%), • lyme disease (0.2%), leptospira (0.2%),• brucella (0.7%), • hantavirus (seroprevalence 4.7%), • orthopox virus (0.7%), parapox virus (4.5%),

Bartonella spp. (2.0%), • Ehrlichia Chaffeensis (0.2%), • human granulocytic ehrlichiosis agent (2.0%),• Echinococcus Granulosis (1.5%)

Stress

• US, some studies show higher Relative Risk for suicide for farmers (~1.1)

• Canada: lower risk for farmers• Center for Epidemiologic Studies Depression

Scale; Depressive symptoms – Ohio 8%, – Colorado 8% males, 11% females – IA, Keokuk County males 17%, females 25%

• Kidd et al, Thu et al: injury-stress association

Repeated Trauma

• BLS: second most common work related illness in farm workers

• California: back (24%), upper back (19%), wrist problems (18%)

• Musculoskeletal problems in dairy farmers: Sweden (82-86%), Australia (57%), Colorado (43%)

Ag at Risk Recommendations1. Mandate reporting of diseases and injuries

through state health departments. 2. Complete agricultural/rural National Health

Interview and Examination Survey3. Develop model surveillance programs for

occupational disease and injuries4. Complete National Occupational Hazard

Survey for Agriculture. 5. Enhance NTOF database for causes of

agricultural deaths.6. Continue NSC survey to provide continuity to

estimate traumatic deaths and injuries.

Conclusions

• No progress in fatalities• No progress in tractor fatalities• Some progress regionally • Some progress in childhood fatalities• Some progress in non-fatal injuries for

employed workers• No progress in surveillance• Some progress in research based knowledge

of injuries, illnesses, and risk factors

Recommendations

1. Develop a National database for non-fatal injuries and illnesses.

2. Enhance NTOF, CFOI fatality surveillance.3. Expand in-depth FACE fatality investigations to

most states and include agricultural fatalities as priority.

4. Include info on farm family members and farm residents in Census of Ag and labor surveys.

5. Utilize existing knowledge to develop a National Agricultural Injury and Illness Prevention Agenda