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2016 ; 73
(1
): 3-12
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Pesticide use and risk of end-stage renal disease among licensed pesticide
applicators in the Agricultural Health Study
#MMPMID26177651
Lebov JF
; Engel LS
; Richardson D
; Hogan SL
; Hoppin JA
; Sandler DP
Occup Environ Med
2016[Jan]; 73
(1
): 3-12
PMID26177651
show ga
OBJECTIVES: Experimental studies suggest a relationship between pesticide
exposure and renal impairment, but epidemiological evidence is limited. We
evaluated the association between exposure to 39 specific pesticides and
end-stage renal disease (ESRD) incidence in the Agricultural Health Study, a
prospective cohort study of licensed pesticide applicators in Iowa and North
Carolina. METHODS: Via linkage to the US Renal Data System, we identified 320
ESRD cases diagnosed between enrolment (1993-1997) and December 2011 among 55?580
male licensed pesticide applicators. Participants provided information on use of
pesticides via self-administered questionnaires. Lifetime pesticide use was
defined as the product of duration and frequency of use and then modified by an
intensity factor to account for differences in pesticide application practices.
Cox proportional hazards models, adjusted for age and state, were used to
estimate associations between ESRD and: (1) ordinal categories of
intensity-weighted lifetime use of 39 pesticides, (2) poisoning and high-level
pesticide exposures and (3) pesticide exposure resulting in a medical visit or
hospitalisation. RESULTS: Positive exposure-response trends were observed for the
herbicides alachlor, atrazine, metolachlor, paraquat, and pendimethalin, and the
insecticide permethrin. More than one medical visit due to pesticide use
(HR=2.13; 95% CI 1.17 to 3.89) and hospitalisation due to pesticide use (HR=3.05;
95% CI 1.67 to 5.58) were significantly associated with ESRD. CONCLUSIONS: Our
findings support an association between ESRD and chronic exposure to specific
pesticides, and suggest pesticide exposures resulting in medical visits may
increase the risk of ESRD. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov
NCT00352924.