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JNIIV HEALTH CELL
The Rural Health Study: A Comparison of
Hospital Experience between Farmers and Nonfarmers in a
Rural Area of AAinnesota (1976-1977)
Uroh Biomedical Test Lab., Salt Lake City
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Prepared for
National Inst, for Occupational Safety and Health, Cincinnati, OH
Jul 78
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2.
I. Kryort Ni»,
BIBLIOGR/J’HIC DATA
SHEET
NIOSH 78-184
4. I idr and bulitidc
5. Kcpoft D.ite
July 1978________
Rural Health Study in Minnesota - 1976-1977
6.
7. Authot(s)
8. I’cilornun/; (h^ani.*jiion Kept.
No.
9. Pcrlctnnnf. Orfcan;;anon Nari.c c>nJ Adurcj.*.
10. I'tofcct/l Ask/U v:k Unit No.
John A. Burkart, Ph.D.; Christiane F. Egleston,
Rf ch.nrd J. Voss_________________________ _
Utah Biomedical Test Laboratory
University of Utah Research Institute
520 Wakara Way
Salt Lake City, UT 54108_________________________
11. Contruct/Grant Nu.
210-76-0153
17. bjK’nioiinf. (h^A.'iixAdon Nar-.c and Addica*
13. Type ©f Report A* Period
Coveted
National Institute for Occupational Safety and Health
4676 Columbia Parkway
Cincinnati, Ohio 45226
14.
15. Supplr..»cntAry Note*
16. Ab’.JiaCt*
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PB 297770
1
TECHNICAL REPORT
-F
RURAL HEALTH STUDY
in MINNESOTA 1976 -1977
MPMCUCtO fT
NATIONAL TECHNICAL
INFORMATION SERVICE
U.k MFAeiMfNT C# CO««(«ct
intuitu©, VK U1U
u. 5. DfKRTMfST or HKITH. IDUCATIOV AND WlHARf
Public Health ’‘entice
(enter Io* Diceace Control
Nabonai Institute lor Occupational Safrtv and Health
■nt
The Rural Health Study: A Comparison
of Hospital Experience between Fanners
and Nonfarmers in a Rural Area of Minnesota
John A. Burkart, Ph.D.
Christiane F. Egleston
Richard J. Voss
Utah Biomedical Test Laboratory
University of Utah Research Institute
520 Wakara Way
Salt Lake City, Utah 84108
Contract No. 210-76-015^
U. S. department of Health, Education, and Welfare
Public Health Service
Center for Disease Control
National Institute for Occupational Safety and Health
Division of Surveillance, Hazr.rd Evaluations A Fi.^ld Studies
Cincinnati, Ohio 45226
July 1978
Mtmss'sflrwwtw*-
DISCLAIMER
The contents of this report are reproduced herein as received
from the contractor.
The opinions^ findings and conclusions expressed herein are
not necessarily those of the National Institute for Occupational
Safety and Health, nor doer, mention of company names or products
constitute endorsement by the National Institute for Occupational
Safety and Health.
NIOSH Project Officer: Virginia Behrens
UBTL Project Director: John Burkart
DHEW (NIOSH) Publication No. 78-184
il
Abstract
The Rural Health Study was undertaken to use hospital records and
brief occupational histories as a means of identifying problem health
areas for agricultural workers and residents in a selected area of the
Midwest. A pcpulation-based analysis by place of residence for two
r-ral counties and a larger case-control analysis by years of agri
cultural exposure with data from six rural hospitals were utilized.
Overall, patients with an agricultural background seem to be as
healthy or slightly healthier than patients with no agricultural his
tory. Nevertheless, the following possible problem areas were identi
fied: Males and females both showed increased risks for diseases of the
blood and blood-forming organs, osteoarthritis, gall bladder disease,
hernia of the abdominal cavity, diseases of the veins and lymphatics,
and eye conditions. In addition, farm males showed increased risks for
beni*n prostatic hypertrophy and farm females had increased risks for
uterovaginal prolapse, acute myocardial infarctions, diseases of the
skin and subcutaneous tissue, and neoplasms. Females over 6S years of
age with 20 years or more of agricultural exposure were the only farm
group whose overall health was worse than the corresponding nonfarm
group.
Data on smoking histories, collected for adjustment purposes, corroborated national findings by giving evidence of relationships between
cigarette smoking and lung cancer, ulcers, and several circulatory and
respiratory problems.
ill
CONTENTS
Page no.
Hi
Abstract
List of Tables
v
List of Figures
vi
INTRODUCTION
1
METHODOLOGY
3
Initial Project Plans
3
Revised Project Plans
4
Study Variables . . .
S
Study Design
10
Statistical Methods .
15
THE USE OF HOSPITAL DATX IN EPIDEMIOLOGICAL RESEARCH . .
17
DATA COLLECTION
19
Questionnaire Administration
19
Coding and Receipt of Data.
19
Data Quality
20
Population Estimates. . . .
22
27
RESULTS AND DISCUSSION
1
J
Analysis of Population-Based Hospitals
27
Case-Control Analysis
34
Comparative Hospital Statistics
38
Comparison of Results with Published Statistics . .
47
CONCLUSIONS AND RECOMMENDATIONS
S3
Agricultural Health
53
Methodology . . . .
53
ACKNOWLEDGEMENTS
57
REFERENCES
59
APPENDICES
I.
Relative Risks for Population-Based Hospitals
II.
Case-Control Relative Risks
III. Relative Risks for Smoking and Selected Diagnoses
iv
1
*»«■»■'ST
LIST OF TABLES
Page No.
Table 1
Study Hospital Characteristics
6
Table 2
Population Characteristics of Study Counties
8
Table 3
Agricultural Characteristics of Study Counties
11
Table 4
Rural Health Study Cases - April 1976-March 1977
21
Table S
Rates of Errors and Inconsistencies
23
Table 6
Population by Age, Sex, and Residence - Estimated
1976
25
Table 7
Male Farm Workers by Age - Estimates 1976
26
Table 8
Patient Origin Study, November 1976, Kandiyohi
and Douglas Counties
28
Diagnostic Categories with Increased Relative Risks
for Farm Residents as Compared to Nonfarm
Residents - Males
30
Diagnostic Categories with Increased Relative Risks
for Farm Residents as Compared to Nonfarm
Residents - Females
31
Relative Risks for Current Farm Workers - Males,
Age 25-64
33
Table 9a
Table 9b
Table 10
Table Ila Diagnoses with High Relative Risks Associated with an
Agricultural Occupational History,
Ages 25-64
36
Table 11b Diagnoses with High Relative Risks Associated with an
Agricultural Occupational History,
Ages i65
37
Table 12a In-Hospital Characteristics by Final Diagnosis Mai es
39
Table 12b In-lospital Characteristics by Final Diagnosis Females
41
"able 15
Comparative Pregnancy and Newborn Statistics
Table 14
Comparisons of Original Respondents, Telephone
Respondents, and Nonrespondents - Douglas
County
44
Comparisons of Medical Characteristics of Ques
tionnaire Respondents and N-ynrespondents
45
Table 16
Comparisons of Discharge Rates
48
Table 17
Comparative Percentage Distributions for Selected
Diagnoses
49
Diagnoses Significantly Associated with a C’garette
Smoking History
52
Table 15
Table 13
v
(
43
LIST OF FIGURES
Figure 1 Distribution of Hospitals in the Study Area
Figure 2 The PAS System - Case Abstract
Figure 3 Agricultural Occupation and Smoking Questionnaire
4
Vi
Page No.
7
9
13
INTRODUCTION *
The Utah Biomedical Test Laboratory (UBTL) recently completed a
survey of the existence and availability of occupationally related
injury and illness data in agriculture in the United States [1].
Case
data were available primarily from two sources: the Workmen’s Compensa
tion System and the National Safety Council’s Farm Accident Survey.
Workmen's Compensation agricultural data were available from six states,
with only California providing a substantial amount of data.
The other
state provided little or no data due vo the exclusion of coverage to
farm workers or due to the small number of hired farm workers covered.
A Farm Accident Survey had been completed in twenty-one states at the
time of this report.
Additional injury and illness data that may be
occupationally related to agriculture are collected by the Bureau of
Labor Statistics, the National Center for Health Statistics, the Public
Health Service, and individual state health agencies; however, detail is
lacking and specific problem areas are difficult to identify.
Several deficiencies in available agricultural health statistics
were obvious from the survey.
Most data do not contain illness informa
tion, especially of long-term etiolo^v; the large agricultural areas of
the midwest are under represented; and accurate estimates of the number
of workers at risk arc difficult to obtain to use with the available
accident statistics.
The Rural Health Study was designed to investigate alternate data
sources which did not contain the deficiencies described above; namely,
a study to obtain illness information in the midwest, from which rates
could be calculated, was the primary goal.
A secondary purpose was to
develop and test a method which has utility as a screening technique to
identify possible occupational health problems in a population, as an
alternative to a much more costly cohort study.
t
The data source chosen to be investigated was hospital records.
Houten.
Bross, and Viadana [2,5] successfully used hospital records and occupa
tional histories in a retrospective survey of the relationships between
*A study based on data from a ftotal1 of *.2,222
16,598 discharge cases collected
from six hospitals for the period from April1 J. 1976, through March 31,
1977.
’
1
occupation and cancer. The Rural Health Study attempts to look at
illnesses other than cancer and to pair hospital records and occupa
tional histories with population estimates, where possible.
>
/
1
I
METHODOLOGY
Initial Project Plans
The original plan for designing a study which met the desired
criteria was to select a rural midwestern county which contained one
centrally located, wel1-equipped hospital such that practically ^11 of
the county's hospital u.vperience would be captured by the one hospital.
Using county census estimates of the farm and nonfarm populations and
farm and nonfarm workers, rates could be calculated and relative risks
computed of farm to nonfarm residents and workers for a variety of
medical conditions,
The county selected was to contain no large known
hazardous occupational groups so as to provide a relatively clean non-
farm comparison group.
The Commission on Professional and Hospital Activities (CPHA) in
Ann Arbor, Michigan, was identified as an independent agency involved in
the standardized abstracting and collection of hospital records through
the Professional Activity Study (PAS).
Over 4G°a of the short-term
hospital discharges in the United States arc included in CPIL\ programs.
To eliminate costly and time-consuming abstracting or’ hospital records,
it was deemed advantageous to enlist CPHA cooperation and limit the
study to hospitals participating in the PAS system.
Relevant data,
routinely collected through the PAS system, include demographic char
acteristics of the patient plus dates of hospitalization, type of
discharge, and diagnoses coded by th? Hospital Adaptation of the Inter
national Glassification of Diseases, H-ICDA (I).
Information concerning place of residence and occupation was not
available in the PAS system but such data could be independently ob
tained at participating hospitals and coded into otherwise unused fields
on the PAS form by hospital personnel without extensive training and
without excessive burden to the patient,
CPI LX agreed to provide peri-
odic data tapes of selected dvmographi c and medical information plus the
<• ‘ditional occupational information.
This data set and census estimates
could be used to compare the hospital experience of different occupa
tional groups.
3
Several candidate hospitals in South Dakota, Iowa, and Minnesota
met the initial criteria for study and were further evaluated as to
their suitability for the Rural Health Study.
•>
Douglas County Hospital
in Alexandria, Mir.r.., rta, was the final selection.
Formal agreements
were made with the hospital and CPHA for the collection of data over a
one-year period.
Revised Proiect Plans
Prior to the initiation of data collection, a NIOSH review board
suggested expansion of the study.
This posed problems in that it was
difficult to find a large, rural area where all of the hospitals belonged to PAS or a similar system and where the service area could be
defined by estimable or county boundaries,
An additional problem was
that it would be imperative to have cooperation from all of the hos
pitals in the area.
A number of hospitals in rural west central Minnesota, near Alexan
dria, belonged to PAS.
The largest hospital, in Willmar, Minnesota,
basically met the requirements for being centralized, well equipped, and
servicing the county population, but the smaller hospitals could not be
tied to an estimable service area,
it was decided to enroll as many of
the hospitals as possible for inhospital comparisons to complement the
population-based comparisons from Willmar and Alexandria.
Preliminary estimates suggested that 20,000 total discharges would
yield at least 2,000 males and 2,000 females who had spent most of their
lives on farms.
For inhospital comparisons (case-control), these num
bers were deemed sufficient to detect a relative risk of two of farmers
to nonfarmers (a®.05, 6s.SO) for any diagnosis accounting for roughly
one-half of one percent of all diagnoses.
Using data from the National
Health Survey [S], most circulatory, respiratory, digestive, and genito
urinary conditions and several prevalent cancers met this criterion.
Ten candidate hospitals (including Alexandria and Willmar) were
identified and contacted icgarding participation in the Rural Health
4
Study.
Initial cooperation was received from nine of the hospitals; two
of the larger hospitals later declined due to the magnitude of the work
involved; and one of the smaller hospitals was terminated after the
start of the study due to nonperformance of the required duties.
The
remaining six hospitals were expected to provide data on about 16,000
total discharges.
Table 1 presents hospital characteristics of parti
cipating hospitals and Figure 1 shows the distribution of these hos
pitals in the study area.
Table 2 provides a description of the popu
lation in the study area.
Study Variables
Pertinent data already collected by CPHA that was requested was
patient number, age, sex, dates of hospitalization, height, weight,
admission blood pressure, discharge status, final diagnosis explaining
admission, and supplementary diagnoses (diagnoses coded by H-ICDA).
Figure 2 shows the PAS data abstracting form.
It was necessary to com
pose a questionnaire to be administered to all patients which would
provide information on variables of interest not available in the CI'HA
data set.
Th i^*l'n format ion could then be merged with the medical and
demographic data collected by CPHA.
Lacking from the CPHA data set was any occupational or residence
information.
Since farming is a lifestyle in addition to an occupation,
it was decided to obtain information on whether a patient resided on a
farm plus whether he worked on a farm.
Since farm workers are spread
over a large area, to obtain information on a large number of current
farm workers would require a huge study in more hospitals than the scope
of this study.
Therefore, a patient's work history regarding agri
culture was examined so that illnesses in retired farm workers could also
be investigated in relationship to their farm exposure.
This would also
provide data on people leaving agriculture due to health problems.
Type of farm was originally thought to be an important variable for
comparison, but after studying the agricultural characteristics of the
area, most farmers were engaged in similar but multiple activities such
that meaningful discrimination would be difficult.
Type of farm was
included on an earlier draft of the questionnaire and caused problems in
5
••••••••
Table 1.
• ••••
!
Study Hospital Characteristics
' ’ S’’•?a*
Locat ion
County
«of Peds
/\d:?.issions/Ycar
A1 bany Con-nun i t y
Albany
Stearns
26
1000
2
Fa^ily Practice
Doufjas County
Alexandria
Douglas
101
4600
25
Family Pra-. ice,
Int>—nal Me 'icine,
Gcn.ral Sur .cry,
Pediatrics, Orthopedics,
Opt »3tt.ology, Urology
Glacial Ridge
Glenwood
Pope
34
900
2
Panily Prac.ice
Melrose
Melrose
Stearns
28
1500
4
Fan ily Practice
Paynesville
Community
Paynesville
Stearns
43
1400
4
Family Practice
Rice Memorial
Ki Ilnar
Kandiyohi
175
7300
50
Family Practice,
Internal Medicine,
General Surgery,
Pediatrics, Urology,
Pathology, Radiology,
Opthamology,
Psychiatry, ENT
cr
* Thysicians
Physi- ian Specialties
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Table 2.
Population Characteristics of Study Counties
i
I9~0 Ccn>u* Statistics
County
Dcuilas
kun41> ohi
Place*
Mth Study
Hospitals
Alexjun Jria
»*U» r
Places wtth
•ion-study
Hospitals
None
None
197(» County
Pcpulation
2S.000
33.000
* Males
50
50
•Aon-white
0.1
0.2
t 18-64
Years Old
50
'HvJian
- 31
Age
52
3 of Those
Over 16
Employed in
Agriculture
Rural f.T«
Rural Nonfarn
Urban
23
28
42
30
17
25
33
42
29
43
34
23
12
20
40
40
1 Population Dittrilution
• ‘
I
r-Jcdian
• 31
Age
Pope
Glenwod
Cfi
Starbuck
12.000
51
0.2
48
Median
Afe
• 3t
Srcarnj
Albany
Me 1 rose
Paynesville
St. Cloud
Sauk Center
104,000
50
0.4
51
I'ledian
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THE PAS SYSTEM
7T.
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B AO
1975 CASE ABSTRACT
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Figure 2.
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a pretest.
The biggest problems were the time involved to explain and
define the types of farr’S and the patient’s inability to choose a cate
gory since his farm consisted of multiple commodities.
Table 3 sum
marizes agricultural characteristics of the area.
Since smoking is related to some of the diseases under investi-
gation, it was decided to include smoking history on the questionnaire
for the purpose of stratification, since farmers are generally regarded
to smoke less than nonfarmers [6],
In addition to the above ideas, the questionnaire would have to he
easily understood, should leave little room for indecision on the part
of the interviewer or patient, should be short so as to minimize patient
and interviewer burden, and should be precoded so the data could be
added to the CPIIA forms with a minimum of errors,
figure 3 presents the
questionnaire in its final form.
2?11 j)esir.n
The final study design attempted to obtain valid information on the
health of agricultural workers via three different approaches.
Hope
fully, common problem areas would be evident through several of the
comparison^.
By obtaining information on place of residence, data from the two
populution-based hospitals in Douglas and Kandiyohi Counties can bo
combined with census population estimates updated to the time of the
study and diagnosis-spccific hospital discharge rates can be calcu
lated.
Iron the rates, estimates of the relative risk of farm residents
to nonf.irm residents can be calculated.
The rates will be underesti
mated because not all of the hospitalizations of county residents will
be captured, but by looking at data from some of the hospitals in
neighboring counties, it can be determined whether the people from the
study counties going to hospitals outside the county possess the same
characteristics as county residents admitted to the in-county hospitals.
If this is true, then estimates of relative risk are valid; otherwise,
adjustments should be made.
•«
10
Table 3.
Agricultural Characteristics of Study Counties
County
Number uft Farms
Land in Farms
Mean Farm Size
(Acres)
: Employing Hired
Workers
Douglas
Kandi yohi
Pone
Stearns
All Farms
1469
1575
1095
33S3
Class 1-5 Farms
1266
1453
1019
3031
All Farms
77
81
SO
81
Class 1-5 Farms
73
78
78
All Farms
218
256
311
205
Class 1-5 Farms
240
270
327
219
38
36
29
37
39
5S
31
92:
92rt..
92'-
94*.
• O
7°
s:
2:
r.
r.
2 s:
so:
6i:
17:
162
57:
13"
All Fams
Class 1-5 Farms
Fam Ownyrshin__ (C1 ass 1-5 I-arms)
Individual or Family
Partnership
Corporation or Other
(Class 1-5 Farms)
Dairy
4«:
Livestock
ig:
Cash-grain
2c:
45:
General
5:
5:
Poult ry
n
3:
1:
2:
Other
5:
3:
3:
5:
11
'
Table 3.
T*".
**■•-*•
Agricultural Characteristics of Study Counties (continued)
County
% Farms Raising
(Class 1•5 Farms)
Douglas
Kandivohi
Pope
Stearns
Livestock or Poultry
84
75
82
93
Cattle
78
63
73
84
Milk Cows
57
40
44
67
Hogs 6 Pigs
28
27
27
41
Poultry
19
13
12
18
Sheep 6 Lambs
4
5
3
2
Oats
55
59
75
79
Alfalfa
78
62
7
84
Corn
77
87
84
87
Wheat
50
43
57
8
Barley
21
10
1
Soybeans
19
42
13
Source:
(»6
1974 Census of Agriculture^ U. S. Department of Commerce,
Bureau of the Census, Volume 1. State Reports, Part 23,
Minnesota. State and County Data, D. S. Government Printing
Office, 1977.
•Class 1-5 farms arc farms with sales over $2S00/ycar.
12
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—
By obtaining information on occupation, similar estimates of dis
charge rates and relative risks of farm workers to nonfarm workers can
be made.
The number of people evaluated in this manner will be substan
tially less since the primary group of interest would be males between
25 and 64 years of age.
To effectively use all of the data from participating hospitals, a
case-control, inhospital comparison can be undertaken.
This type of
analysis makes use of data from small hospitals (reducing any bias due
to hospital size, such as cost) and includes data on patients using the
two population-based hospitals who reside in another county and who were
not evaluated in the first two analyses.
Evaluating years of agricul
tural exposure is more valid than previous analyses for retired or
exfarmers, for farm workers not living on farms, and for farm residents
not working on farms.
By using all the data, a case-control study effec
tively doubles the number of cases from the population-based analysis.
Selection of an inhospital control group for the above analysis is
an important but difficult task.
Relative risks from the population
based analysis should give good information on the types of diagnoses
for which farmers and nonfarmers are at equal risk and, hence, should be
suitable for use as control diagnoses.
Through the addition of smoking
histories, it is possible to adjust for smoking habits, an adjustment
not generally possible in the population-based analyses.
To complement the above analyses, a variety of inhospit.!'
tistics can be calculated for farmers and nonfarmers, such as diagnosis
specific lengths of stay, age and sex distributions, and admission
blood pressures.
Birth statistics such as percent of abnormalities or
stillbirths, average age of mothers, complications, etc., may provide
valuable information.
Hospital mortality statistics are not necessarily
valid in this study since mortality can be affected by distance to the
hospital and since m my patients dying in the hospital would have incomnle*^
*t ional and smokin ’, histories.
It is hoped that by looking at data from a variety of hospitals in
several different types of analyses, a reasonable picture of the relative health of farmers and nonfarmers in rural Minnesota can bo provided.
11
• - -»!
Statistical Methods
lor the population-based hospitals, sex-specific discharge rates,
age adjusted by the direct method to the nonfarm population were cal
culated for the groups of interest.
The ratios of farm to nonfarm rates
were used to calculate relative risks.
Data from the two counties and
hospitals were combined to obtain sufficient numbers of cases for
meaningful comparisons.
For the case-control analysis, estimates of
relative risk were calculated as given by the Cornfield [7] approxi
mation.
Relative risks of the farm exposure categories to the nonfarm
group for the individual smoking and age categories were made for diag
noses of interest and then summarized over age and smoking categories
using the estimator "R" of Mantel and llaenszel [8].
Since it was necessary to provide an assessment of the relative
importance of each relative risk, tests of statistical significance were
used as a moans of identifying diagnoses whose increased relative risk
for farmers exceeded chance fluctuations.
One-sided significance tests
were used since the purpose of this study was to identify possible
problem health areas in agriculture.
lor the population-based hospitals, differences in the age adjusted
rates were compared by computing the standard errors of the rates as
given by Keyfitz [9] and then by calculating a z-statistic for the dif
ference between two rates.
In the case-control analysis, a Mantcl-
Haenszcl chi-square statistic [8,10] was first used to test for a dose
response type relationship between years of exposure and summary rela
tive risks. For each exposure category, another Mantel-llaenszel chi-
square statistic tested the significance of each summary relative risk,
disregarding whether a dose-response relationship exi stcd.
IS
u
THE USE OF HOSPITAL DATA IN EPIDEMIOLOGICAL RESEARCH
The aforementioned study plan has as its basis hospital records,
summary
jA
the advantages and disadvantages of using hospital data is
important to the understanding of the significance and limitations of
the rer.Jts of the study.
This type of study is meant to be a rough
screening over a variety of conditions and does not replace a carefully
directed population study involving examinations and case histories.
The use of hospital data in epidemiological research has been
described by Masi [11] and in a report sponsored by the National Center
for Health Statistics [12].
Advantages include the availability of a
large number of cases of varying diagnoses plus cases which can be used
for controls; the possibility of collecting information on independent
variables of interest such as smoking; the high degree of diagnostic
accuracy in defining case and control population; and, certainly, time
and cost considerations.
Limitations include the possibility that hospital-detected cases
may be selective subjects of the true disease cases; adequate control
groups often arc difficult to determine; and often the population at
risk cannot be precisely defined.
parability among hospitals.
Data can vary in quality and com-
Estimates of the incidence of chronic
disease arc less valid than for acute attacks.
The use of only hospital
data loses the diseases and conditions treated on an outpatient basis
and the mortality occurring outside the hospital.
Berkson [13] has
pointed out problems in validity which arise when admission rates for
cases and controls arc different and arc related to the independent
variable under study.
The use of secondary diagnoses is not necessarily
valid since the secondary diagnosis alone often would not result in
hospitalization.
Another problem area is the reliability of hospital discharge
abstracts.
If the researcher has enough time and resources, he can
perform a carefully controlled abstracting of the medical records for
his own purposes, but usually the researcher can only use already
17
Preceding page blank
u
j
abstracted data from existing sources.
The National Academy of Sciences
Institute of Medicine sponsored a study of the reliability of hospital
discharge abstracts [11] in which data from six abstracting services,
including CPil\, were evaluated.
Items such as age, sex, and dates of
stay were found to be at least 98*6 reliable upon reabstracting but the
reliability of the fourteen chosen target diagnoses in the sample
varied,
using H-ICDA coding, four-digit reliability was 65OO and three-
digit reliability was 74no.
A CPHA study gave 88°o reliability for diag
Factors such as training of abstrac
noses coded to four digits [IS].
tors, procedures and supervision in the medical record department,
thoroughness of record review, and the necessity of relying on pro
fessional judgment due to the inadequacy of nomenclature, coding guide
lines, or the presence of multiple diagnoses are influential in deter
mining reliability.
Since these studies, CPIIA and the other abstracting
service have attempted to correct some of the reliability problems.
Diamond and Lilicnfeld [16] studied tie effects of misclassification of
diagnosis or patient status with regard to the independent variable
under study.
Problems arise when the misclassification rates are dif
ferent between cases and controls.
The Institute of Medicine report gave recommendations for using
hospital data.
Analysis involving age, sex, and length of stay are
reliable and data on principal diagnoses arc adequate for general
program management and monitoring purposes.
For research and evalua
tion, diagnoses should be coded to three rather than four digits and
even coarser groupings of diagnoses will provide greater reliability.
Kith regard to the previous discussion, attempts were made in the
Rural Health Study design to incorporate as many of the suggestions as
possible, notably the use of multiple hospitals to balance selective
admissions, the use of several analyses to evaluate the adequacy of
controls and the use of three-digit and cruder H-ICDA coding.
18
u
DATA COLLECTION
Questionnaire Administratinn
Questionnaires were administered by hospital personnel to all
patients 18 years of age and older.
Those patients under 18 years were
required to have only the county and place of residence recorded on the
questionnaire form,
One questionnaire was to be submitted for each
discharge, even if only the county of residence and patient number were
recorded.
If a patient would not or could not respond to the ques-
t ionnaire. it was suggested to obtain as much information as possible
from the patient's records.
Because of differing hospital procedures and workloads, it was left
to the hospital to determine the best time, person, and place to ad
minister the questionnaires.
Some hospitals used admitting personnel,
some used nurses, and some used special persons designated to collect
the information.
Time of administration in some hospitals was during
admittance, while in others administration came after the patient had
been settled in his room or after his condition had stabilized.
To
minimize missing data, the former method was preferable but the latter
method is thought to give more reliable information since more time was
taken.
In one hospital, it was necessary to complement the post admittance
administration with a telephone follow-up, since a large number of
patients with short stays was missed,
for patients with more than one
admission during the study period, some hospitals repeated adminis
tration of the quest ionn.ii re unless the patient objected, while other
hospitals did not repeat the questionnaire.
Repeat adninist rat ion is
the preferred mode of action to get an estimate of the reliability of
questionnaire i.c.o.
Cod i n,I and Rece ipt of P.it.i
At the end of each month of the study (when preparing the patient
abstracts to be sent to (TIL\), the medical records personnel added the
19
precoded questionnaire responses to predetermined, previously unused
fields on the PAS abstract form.
CPHA then provided quarterly data
tapes of the required medical and demographic information, plus the
questionnaire responses.
Completed questionnaires were then sent by the
hospitals to the UBTL after the responses had been recorded each month.
These were used to compare with the cata tapes to check for transcrip
tion errors and were used when editing of the data tapes revealed
inconsistencies.
After nine months of the study were completed, one of the hospitals
changed abstracting services from CPHA to the MED-ART system of Diver
sified Computer Services (DCA) of Palo Alto, California.
Data for the
last three months of the study were then obtained from DCA.
The change
over did not disrupt data collection or quality; coding was the same or
similar to that previously used; the only differences related to the
study were in format.
Data Quality
A total of 16,598 discharge cases were collected from the six
hospitals for the period from April 1, 1976, through March 31, 1977.
Of
(
these, 3594 cases were under IS years of age and minimal questionnaire
information required.
for the remaining 13,004 cases, Table 4 gives a
breakdown of the number of cases, and the cases with missing or in-
complete data, both on a per hospital basis and a per county resident
As a function of the method
basis for the population-based hospitals.
of questionnaire administration, Douglas County Hospital showed a high
proportion of missing data.
Telephone follow-up was conducted only for
residents of Douglas County, reducing the missing data proportions for
the county residents to acceptable levels.
Before counting a case as
missing, it was checked for additional admissions with complete data
during the study period.
lor the first few months, .ill questionnaires were compared to the
computer listings and errors tabulated.
sample was compared.
After that, approximately a 25°>
Computer editing revealed incorrect codes, missing
data, shifts in coding, and inconsistency in responses, while the
20
• •••
Table 4.
• •••
Rural Health Study Cases - April 1976-March 1977
Per Cent Cases With Missing Data
lor Selected Quest jonnai re Itccss
Tut al So.
of Cases
Nu. of Cases <18 Yc.»r$
Newborn
Other
No. cf Cases
z!8 Years
No. of Cases ?!8 Years
With Complete U.ntn
(i'er Cent)
Question 2
Question J
Question 7
Mi Cases
7512
664
635
5813
5’05
(931)
0.4
1.5
1.9
County Residents
Only*
4244
520
4 79
324 5
3173
(97.8)
0.5
1.7
2.2
Ail Cases
4534
414
493
367’
3312
(90.2)
7.5
9.7
9.8
County Residents
Only*
34 50
330
352
2768
2621
(94.7)
2.8
5.3
5.3
Me I r >
Ml Cases
1512
166
199
1127
1121
(99.5)
0.1
0.5
0.5
I iynesv iI*e
All Cases
1371
218
186
967
929
(96.1)
1.8
3.4
3.9
A I*' »ny
All Cases
97$
120
135
720
719
(99.9)
0.0
0.0
0.1
All Case*
8.4
72
67
705
69 7
(98.9)
0.1
0.9
l.l
All Cases
16593
1674
1920
13004
12483
(96.0)
2.4
3.7
4.0
County Residents
Only*
7t9S
850
831
6013
$ 764
(96.4)
1.6
3.4
3.6
••: 1:
J
:.li
Tutd
!
'I kIcs data from all study h-spttals.
comparison of questionnaires and listings revealed errors in trans
cription which would not ordinarily be found during computer editing.
Table 5 summarizes the frequencies of various types of errors and
inconsistencies in questionnaire responses.
When questionnaires differed among multiple admissions, it was
decided to use the first response in the analysis, so that the data were
comparable to all of the patients with single admissions,
Conflicts
within admissions, however, were resolved by using the most consistent
answers or by taking the positive answer (i.e., if a person stated that
he had never been a farmer and then stated that he had worked in agri
culture for 20 years, it was assumed that the first answer had been
recorded erroneously).
CPiLV data had been previously edited and were used as they were
received, subject to the limitations described earlier.
From multiple
admissions, an occasional difference in age or sex was noticed, however,
and could be resolved.
Popu1 a t ion I.s t i ma tes
Pi/pulation estimates were not available for the categories desired
except from the 1970 census.
Current estimates were made as a combina
tion of 1970 census figures and any new relevant information.
U. S.
census data for 1970 were the basis for making estimates of the number of
farm and nonfarm residents plus the number of farm and nonfarm workers
in Kandiyohi and Douglas Counties.
The Minnesota State Planning Agency
is the official census designate in Minnesota and makes yearly estimates
and projections of the population of Minnesota counties, including
breakdowns by age and sex [17].
mates arc made.
\o farm, non fa rm, or employment csti-
Thc Minnesota Department of Fmploymcnt Services in
conjunction with the U. S. Department of Agriculture Statistical Re
porting Service makes county monthly employment estimates of farm
and non farm employment but uses different definitions than the census
*•
and does not distinguish by age and sex.
Using 1970 census figures and 1975 State Planning Agency figures
for county and major city populations (Willmar in Kandiyohi County and
Alexandria in Douglas County), projections were made for the 1976 total
4
Tabic 5.
Rates of I'rrors anJ Inconsistencies
i yp e of i rror or I neons i stoney
No. of Cases with Errors
or Inconsistencies
Total Possible Cases
Rate
227
12,063
1.99.
Inconsistency • thin Case
261
12,063
Inconsistency among Multiple Admissions
(Average of 3.6 questions
per admission)
661
4,266
2.2°j
15.6‘o
Coding or Transcription Error
(15,338
responses)
(4.3* per
question)
population, the difference between the county and city populations
being the ru^.U population.
Using 1970 census ratios of rural farm to
rural nonfarm, the projected 1976 farm population was determined, with
the city and rural nonfarm population comprising the nonfarm population.
Farm and nonfarm age and sex proportions from the census were adjusted
to the 1975 Planning Agency age and sex proportions, and then applied to
the 1976 projections.
The end result was 1976 estimates of the farm and
nonfarm population by age and sex.
Table 6 gives these figures.
As a
check, straight line projections of 1970 age, sex, and residence cate
gories w^re not far from the estimates in Table 6.
In determining the number of workers, the 1976 population estimates
were multiplied by the 1970 census proportions of each age group who
were in the labor force, thus obtaining the labor force.
Rates of
increase in the number of farm workers and nonfarm workers as obtained
from the Minnesota Department of Employment Services for 1970 to 1976
were used in conjunction with 1970 census figures t. divide the labor
force into farm and nonfarm workers.
Table 7 presents the estimates.
Comparisons of these estimates and the 1970 ccnsu; figures show the ratio
of farm to nonfarm workers to be about the same.
*
Table 6
POPULATION BY AGE, SEX, & RESIDENCE
Females
Males
Kandiyohi County
ESTIMATED 1976
Age Category
Farm
Non Farm
Ratio
Farm
Non Farm
Ratio
<15
1184
2786
2.4
1040
2747
2.6
15 - 24
919
2751
3.0
611
2734
4.S
25
34
298
1378
4.6
374
1360
3.6
35
44
473
1085
2.3
506
1082
2.1
45
54
492
1507
2.7
491
1294
2.6
55 - 64
559
1244
2.2
372
1439
3.9
74
241
1G32
4.4
169
1144
6.8
i75
139
665
4.8
97
1005
10.4
Total
Population
(33,038)
4505
12,268
2.8
3660
12,805
3.5
65
Foma 1es
Ma 1 c s
Douglas County
Farm
Non Farm
Rat io
Earn
Non Farm
Rat io
<15
904
2084
2.3
1003
1952
1.9
15 - 24
764
1835
2.4
592
1891
3.2
25
34
322
937
2.9
297
997
3.4
35
44
375
729
1.9
369
793
2.1
45
54
129
786
1.8
592
G72
55
64
497
863
1.7
581
957
2.5
65 - 74
529
2.5
202
1002
5.0
•75
112
725
6.5
104
9( 1
8.7
Total
Population
(25,215)
3732
8778
2.4
3340
95(5
2.8
Age Category
25
Tabic 7.
MALE FARM WORKERS BY AGE - ESTIMATES 1976
I Houglas County
Kandiyohi County
Age Category
Farm
Workers
Other Workers
Ratio
Farm
Workers
Other Workers
Ritio
25 - 34
249
1,342
5.4
253
961
3.S
35 - 44
314
1,139
3.3
327
760
2.3
45 - 54
407
1,104
2.7
36o
696
1.9
55 - 64
4 SO
1,055
2
476
717
1.5
TOTAL
1,480
4,620
3.1
3,134
2.2
2(>
RESULTS /VXD DLSCUS^IOX
Analysis of I’opulat ion-B.isod HoS|>ita 1 s
1.
Analysis by Place ol l‘vsiJencc.
Primary diagnoses were tabu
lated by age and sex for current farm and .nonfarm residents.
Age group
ings used ten-year intervals with those patients under 13 and '5-andolder comprising the end groupings.
Age adjusted discharge rates were
calculated for three groupings of residents: less than 25 years old, 2561 years old, 05 years and older.
The ratios of the age adjusted rates
for farmers to nonfarmers gave the relative risks.
Since the rates are
known to be underestimated for both farm and nonfarm residents, only the
relative risks and number of cases are presented.
Bata from both
counties are combined in order to maxinice the number of cases and to
ensure privacy ot an individual hospital’s data.
Patient origin studies during November, 1976, as conducted foz*
Minnesota Hospital Research and Educational Trust, were used to test the
adequacy of the assumption that most of the hospital experience of
residents from Douglas and Kandiyohi County was captured.
presents the results of the one-r.K>nth study.
Table 8
Eighty percent of Douglas
and Kandiyohi County residents went to study hospitals; however, most of
the patients attending other hospitals went to large referral hospitals
where a bias in hospital selection for farmers is not suggested.
In
fact, 9r« of the county residents going to hospitals in the immediate
area went to study hospitals.
In. the Rural Health Study, data on only thirty Douglas County
residents were obtained from other study hospitals; almost all went to
Glenwood. No discernible differences in the proport ion of farmers could
be seen between these thirty patients and those attending Douglas County
Hospita1.
Kandiyohi County residents Koing to other study hospitals numbered
1«2, 169 of these going to Paynesville Connunity Hospital, which is two
miles from Kandiyohi County, and eleven cases going to the Glenwood
f
Table 8.
Origin Study, November 1976,
Kandi;.oni ana oougiaS Counties
Hospital Destination for County Residents
Douglas
County
Kandiyohi
County
Total
Hospital in the Same County as Residence
270
249
S19
Neighboring* Study Hospital
1
8
9
Neighboring* Non Study Hospital
18
13
31
Non Neighboring Non Study Hospital
8
Rtfcrral Hospitals in Twin Cities.
Rocheste-, St. Cicud
42
48
90
Total
339
325
664
Per cent of county residents going to
study hospitals
so;
79;
so;
Per cent of county residents going .o
study hospitals as a per cent of coi.nty
residents going to hospitals in th*,
immediate area
94;
95;
94;
Neighboring hospitals
*■
15
the hospitals which arc the closest hospitals
Minnesota Hospital Research -S Educational Trust.
25
V
Hospital, twenty-six miles from the county line.
About 40% percent of
Kandiyohi County residents admitted to the out-of-county study hospitals
lived on farms, as opposed to about 20% admitted to in-county hospital.
Willmar Hospital is the largest in the western part of the State so it
would lose patients to a smaller hospital usually only when distance or
cost was a factor.
Since Paynesville is so close to the county border,
it naturally attracts many Kandiyohi County residents tc it; but only
two other hospitals would be closer than Willmar for a few Kandiyohi
County residents.
Based on the patient origin study plus the size,
distance away, and number of neighboring hospitals, at most 150-200
county residents per year would choose these hospitals.
As for deter
mining relative risks, the differential in percentage of farm residents
attending the in- and out-of-county hospitals could result in under
estimating the farm hospital discharges by 30-40 cases; and, likewise,
overestimating the nonfarm discharge • by the same amount, a possible 7
percent underestimation of the overall relative risk for Kandiyohi
County farm residents.
Cases were counted and relative risks tabulated using the major
disease classifications from H-ICDA.
These major classifications were
further broken down using H-ICDA subclassifications and, in some in
stances, to three-digit coding when the number ot cases was sufficiently
large.
For patients with multiple admissions, only the first admission
in the disease class, subclass, or individual code under study was used.
In this way, a patient would only be used once for each major classi
fication, but might also be found in several of the subclassifications,
so the totals of the subclasses do not necessarily equal the totals in
the major classifications.
Appendix I presents the number of cases and
relative risks of living on a farm compared to not living on a farm.
Tables 9a and 9b summarize the primary diagnoses for which farm
residents show increased relative risks over nonfarm residents.
The
only statistically significant increased relative risks were for lacera
tions and open wounds for male patients loss than 25 ycais of age;
diseases of the liver, gall bladder, and pancreas (primarily gall blad
der) for male patients 25-64 years old; and pneumonia, hernia of the
abdominal cavity, and benign prostatic hypertrophy in male patients
older than (5 years of age.
Female farm residents over 65 showed
29
• •••
Tabic 9a.
Diagnostic Categories with Increased Relative Risks for Farm
Residents as Compared to Non Farm Residents - Males
Males
Diagnostic Category
Age
Age 25-64
Age >65
o
N.S.
H-ICDA Codes
No. of Cases
Farm
Non Farm
Relative
Risk
Significancc
Appendiciti s
540-545
15
17
1 .9
N.S.
Lacerations 8 Open bounds
S70-S97
9
9
2.6
p<.OS
Diseases of the Dlood ii Blood
Forming Organs
280-289
2
1
4.4
N.S.
Diseases of the Liver, Gall
Bladder, 8 Pancreas
570-577
16
19
2.0
P<.05
Infective 8 Parasitic Diseases
001-136
5
9
2.0
N.S.
Endocrine, Nutritional, 8
Metabolic Di seises
240-27y
17
2.3
N.S.
Diseases of the Blood 8 Blood
Forming Organs
280-289
4
6
5.5
N.S.
Diseases of the Fye
370-378
7
20
1.9
N.S.
.-'cute Upper Respiratory
In feetions
460-470
2
5
4.3
N.S.
Pncu.T.on ia
430-486
17
35
2.3
p<.05
Hernia of the Abdominal Cavity
550-553
17
24
2.7
p<. 05
Diseases of the Urinary System
580-599
IS
46
1.6
N.S.
Benign I'rostatic Hypertrophy
600
19
49
1.8
p<. 03
Osteomyelitis f. Other Diseases
of Bone 8 -Joint
720-729
6
7
5.0
N.S,
Not statistically significant, a = .05
Table 9b.
Diagnostic Categories with Increased Relative Risks for Farm
Residents as Compared to Non Farm Residents - Females
No. of Cases
Farm
Non Farm
Signficancc
6
2.2
N.S
5
3.3
N.S
3
2.6
N.S
4
8
1.8
N.S
623
8
13
1.7
N.S
Diseases of the Skin G Sub
cutaneous Tissue
680-709
7
10
2.1
N.S
Cerebrovascular Disease
430-438
8
40
1.9
N.S
Diseases of Veins, Lymphatics,
G Other Circulatory Diseases
450-458
5
26
1.7
N.S
Diseases of Gall Bladder
575
11
17
5.1
p<.01
Uterovaginal Prolapse
623
3
14
1.7
N.S.
Diagnostic Category
Age <25
Diseases of the Gall Bladder
S75
3
Age 25-64
Diseases of the Eye
370-378
5
Diseases of the Arteries,
Arterioles, G Capillaries
440-448
Append icit i s
540-543
Uterovaginal Prolapse
Age -65
N.S.
Relative
Risk
H-ICDA Codes
Females
Not statistically significant. a = . 05
u
1
$
1
statistically significant increased relative risks for only diseases of
the gall bladder.
The relative risks of farm to nonfarm residents for all diagnoses
(one admission per patient) was 0.8 for patients less than 25 years old
and patients 25 to 64 years of age.
risk jumped to 1.3.
For patients over 65, the relative
This may indicate a problem health area for older
farm residents but could also indicate problems with identifying farm
residence in older retired farmers.
Many older persons mignt report,
living on farms which would not be classified as farms by the census
because no goods were sold.
Over all age groups, farm residents had
slightly lower hospitalization rates than nonfarm residents.
Of special note is the category "Injuries and Adverse Effects" for
which the relative risks are always close to one for the age and sex
groups.
If farm and nonfarm residents are at equal risk, then this
broad classification with a large number of occurrences and no one
frequently occurring condition could be an appropriate control group for
the case-control comparison.
2-
Analysis by Occupation.
Tabic 10 presents numbers of cases
and age-adjusted relative risks for current male farm workers, ages 25-
64.
Since the number of cases is sharply decreased, only relative risks
for the major disease classifications are given.
Farm workers showed
lower relative risks than nonfarm workers for almost all disease clas
sifications.
A possible explanation could be that active farm workers
are being compared to a group of nonfa*m workers which includes a large
number of sedentary occupations.
This result could also reflect the
true relative health of farmers but might indicate problems due to the
lack of precise estimates of the number of farm workers.
Douglas County
relative ris.'.s were lower than those from Kandiyohi County, so the
problem may be in Douglas County estimates.
Again of notice is the
relative risk for injuries and adverse effects.
The relative risk is
near one (equal to one for Kandiyohi County), which strengthens the
assumption that injuries and adverse effects could be used as a control
group.
32
TABLE 10.
RELATIVE RISKS FOR CURRENT FARM WORKERS - MALES. AGE 25-64
No. of Cases
ll-ICDA Codes
Farm
Workers
Non Farm
Workers
Relative
Risk
Infective u Parasitic Diseases
001-156
1
19
0.1
Neoplasms
140-239
3
25
0.2
Endocrine, Nutritional, 6
Metabolic Diseases
240-279
2
15
0.4
Diseases of the Bicod 5
Blood Forming Organs
230-239
1
2
.Mental Disorders
290-318
2
27
1.0
0.1
Diseases of ’he Nervous System
h Sense Oi ans
320-3S9
6
19
0.8
Diseases of the Circulatory
System
390-458
26
82
0.8
Diseases of the Respiratory
System
460-519
5
21
0.6
Diseases of the Digestive
System
52O-S77
33
112
0.7
Diseases of the Genitourinary
System
580-629
11
60
0.4
Diseases of the Skin
cutaneous Tissue
bS0-709
3
17
0.4
Diseases of the Musculo
skeletal System
Connective
T issue
710-739
8
38
0.6
Signs, Symptoms, III Defined
Conditions
770-795
8
49
0.4
Injuries 5 Adverse Effects
800-999
22
72
0.8
All Diagnoses
001-999
131
558
0.6
Diagnostic Category
u*
Sub
u
Case-Control Anu 1ysis
because of problems in the accurate estimation of populations nt
risk and in the collection of all hospital experience in the study
counties, plus the limited number of cases used in the population-based
analysis, a third type of analysis attempts to utilize all of the data
from the six hospitals.
Selection of a control group is of primary
importance for an inhospital comparison.
Because of the consistency of
relative risks near one in the previous analyses, the group of cases of
primary diagnoses of injuries and adverse effects (H-ICDA code* 800-999)
was selected for use as a control group.
This category, composed of
acute conditions, is also suitable for comparison because the indepen
dent variable under consideration is ’’Years of farming," which is not
necessarily related to acute conditions due to the number of exfarmers
or retired farmers.
The "Injuries and Adverse Effects" category is
composed of a variety of conditions, none of which occurred with high
frequency.
By comparing all other diagnoses of interest to this control
group, diagnoses with large relative risks for farmers can be identificd.
At the very least, such an analysis can give an idea of the
rcl.rive importance of various health problems for the farming popu-
lat ion.
"Years of Farming" was divided into three categories:
19 years, and 20 years and over.
none,
none, one to
The relative frequencies of these
' /’categories in the control and test groups were then compared by diag-
nosis.
For the age 65-and-older groups, the exposure category 1-19
years was eliminated due to the small number of patients in the category
(especially for the control diagnoses).
The relative risks were ob-
. .tamed by calculating summary relative risks from the farming-diagnosis
breakdown, stratified by age and smoking history.
Relative risks are
given separately for the age 25- to 61-year-old group, stratified by
ages 25-H and 45-64, and by "never smoked", "previously smoked",
"current smokers"; and for the 65 years and older group, stratified by
ages 63-74 and 7S-and-older, and by "never smoked"
and "ever smoked”.
Appendix II presents the number of cases and the summary relative risks
31
for all diagnoses containing sufficient numbers of cases in the strati
fied groups.
,\s in the population-based hospital analysis, only a
patient s first discharge is tabulated within a disease class or sub
classification and only primary diagnoses arc used.
Tables Ila and 11b summarise the diagnoses for which patients with
farming exposure show increased relative risk.
For patients 25-64 years
of ago, there were statistically significant relationships between years
of farming exposure and relative risk (as tested by the Mantel-llaenszcl
test) for benign prostatic hypertrophy and osteoarthritis and allied
conditions in males, and for acute myocardial infarction and utero
vaginal prolapse in females.
Females also showed significantly elevated
relative risks for patients in the 1-19 year exposure category for
diseases of the urinary tract, diseases and conditions of the eye, and
ulcer of the duodenum.
for patients over 65 years of age, males with greater than 20 years
of agricultural exposure showed relatively few increased relative risks
while females with the same exposure had a large number of increased
relative risks.
Signifleant 1y large relative risks for this group of
faim females were tor the diagnoses: neoplasms (including primarv malig
nant neoplasms); diseases of the respiratory system; diseases of the
gall bladder; diseases of veins, lymphatics and other circulatory di
seases; diseases of the digestive system (including diseases of the
esophagus, stomach, and duodenum); diseases of the genitourinir'’ svstem
(including uterovaginal prolapse); and osteoarthritis and allied conditions.
Over a 11 diagnoses for patients between 25 and 64 years of age,
those patients with farming exposure showed relative risks near or
Slightly less than one, as compared with patients with no farming
exposure.
Males over
with farming exposure had an overall relative
risk of 0.7, while females over (>5 with the same exposure had a relative
risk of 1.5.
Only 111 discharges were recorded for current hired ♦'arm workers,
60 tor males and 48 tor females.
Because of the small numbers, no
attempts were made to evaluate differences in diagnosis patterns be
tween hired farm workers and family farm workers.
55
Table Ila.
Diagnoses with High Relative Risks Associated with an
Agricultural Occupational History,
Ages 25-64
Diagnosis Category
Males
Females
H-ICDA Codes
Relative Risks
1-19 Yrs. in Ag.
(No. of Cases)
£20 Yrs. in Ag.
Diseases of the Blood 6
Blood Forming Organs
280-289
0.0
(0)
3.5
(4)
Psychoses not Attributable
to Physical Conditions
306-309
1.7
(6)
3.1
(6)
Heart Failure
427
2.9
(1)
5.1
(S)
Phlebitis 5 Thrombo
phlebitis
451
1.8
(3)
2.1
(6)
Hemorrhoids
455
1.3
(5)
2.1
(ID
Bronchitis, Emphysema,
Asthma
489-496
0.9
(3)
2.2
(14)
Inguinal Hernia
560
1.5
(30)
1.6
(43)
Biliary Calculus
574
2.4
(3)
1.7
(4)
Other Bladder Disease
596
1.9
(1)
4.9
(5)
♦ Benign Prostatic Hypertrophy 600
1.0
(6)
2.2* (29)
♦ Osteoarthritis 8 Allied
Conditions
713
5.2
(4)
5.9* (11)
Cancer of Large Intestine
153
0.0
(0)
2.5
(4)
Diabetes Mel 1itus
250
0.6
(5)
2.2
(12)
Diseases G Conditions of
the Eye
360-379
2.0* (10)
0.6
(4)
410
1.3
(3)
8.0
(9)
Cerebrovascular Disease
430-438
3.0
(4)
2.3
(3)
Disease of Arteries,
Arterioles, Capillaries
440-448
0.5
(1)
2.0
(5)
Ulcer of Duodenum
532
4.8* (6)
1.4
(3)
Intestinal Obstruction
560
0.3
(1)
2.1
(3)
Diverticular Disease of
Intestine
562
0.8
(2)
2.1
(S)
Other Diseases of Urinary
Tract
599
5.9**(7)
3.2
(4)
Endometrios i s
619
2.2
(10)
1.4
(5)
♦ Acute Myocardial Infarction
623
0.5
(4)
3.2**(27)
Diseases of Skin
Sub
cutaneous Tissue
680-709
0.9
(6)
3.3
(12)
Osteoarthritis -5 Allied
Conditions
713
2.1
(4)
1.3
(5)
♦ Uterovaginal Prolapse
Statistically sign11 leant relationship to years of exposure, p <.05.
’*
Relative risk statistically significantly greater than 1, p <.05, p <.01.
36
u
Tabic 11b.
Diagnoses with High Relative Risks Associated with a
Agricultural Occupational History
Ages 265
H-ICDA Codes
Diagnosis Category
Males
Females
Relative Risk (No. of Cases)
£20 Yrs. in Ag.
Psychoses not Attributable to
Physical Conditions
306-309
2.0
(5)
Diseases of Veins, Lymphatics,
S Other Circulatory Diseases
450-45S
2.3
(24)
Diseases of the Gall Baldder
575
1.6
(31)
Other Symptoms Referable to
Cardiovascular 5 Lymphatic
System
775
2.0
(7)
Neoplasms
140-239
1.7* (94)
Primary Malignant Neoplasms
140-195
1.6* (60)
Malignant Neoplasm of Large
Intestine
153
2.1
(13)
Secondary Malignant Neoplasms
196-199
2.0
(14)
Diseases of the Blood G Blood
Forming Organs
280-239
2.1
(9)
Diseases of Veins, Lymphatics,
€ Other Circulatory Diseases
450-4SS
1.9* (39)
Diseases of the Respiratory
System
460-519
1.7* (69)
Pneumonia
480-486
1.8
Other Diseases of the Respiratory
System
500-519
2.5
Diseases of the Digestive System
520-577
(ID
1.6**(140)
Diseases of the Esophagus, Stomach,
Duodenum
530-537
1.8* (38)
Gastritis f, Duodenitis
535
3.6
(8)
Hernia of Abdominal Cavity
550-553
2.0
(14)
Biliary Calculus
574
1.9
Diseases of Gall Bladder
575
(14)
1.9* (36)
Diseases of Genitourinary System
580-629
1.8* (73)
Diseases of th' Breast
610-611
2.7
Uterovaginal Prolapse
623
(9)
3.1**(25)
Infections of the Skin 6 Sub
cutaneous Tissue
6S0-6S6
2.7
Osteoarthritis 6 Allied Conditions
713
(28)
(9)
2.3**(53)
Relative risk statistically significiantly greater than 1, p<.0S, p<-.01
37
Co rip a rat ivc Hospital Statistics
lor the major disease classifications, comparisons of several
hospital statistics are given in Tables 12a and 12b.
These statistics
are tabulated for patients never having worked in agriculture versus
those who have worked in agriculture.
/\n obvious result of this di-
chulomizat ion is that the patients ..I:’.* a../ :»gricultrrn 1 occupational
history are older than those patients not having worked in agriculture.
Therefore, the statistics describing mean length of stay, case mortality
rates, and admission blood pressure have all been age-adjusted to the
Over all diagnoses, patients with farming
combined age distribution.
exposure had almost identical lengths of stay, case mortality rates,
and admission blood pressures as those patients having never worked in
agriculture.
A comparison of pregnancy and newboc:-. . tat i sties fo:
and nonfarm residents or workers is shown in Table 15.
.1 .• farm
No large dif
ferences can be seen in the outcome of pregnancies between the farm and
nonfarm groups.
Current farm workers or housewives hod a slightly
larger percentage of spontaneous abortions than the nonfarm females, but
the difference is not statistically significant (\* [1 d.f.]:2.37).
Medical characteristics of patients for whom no (Questionnaire data
were obta i**' 1 we** ’
nairc data.
”
’
» j •«. ~
•?
Table II presents the results,
• • , . -.
lor Douglas County, where a
telephone follow-up interview was used to obtain data on patients who
did not h.ve a completed (Questionnaire during their hospital stay, the
characteristics of original respondents, telephone respondents, and nonI ron these tables, as can be
resp..»nd’nt • ar<* compared in lable 15.
easily seen, there is a much higher proport ion of deaths in the nonre
spondent gre'ip; patients died before (Questionnaire could be adminis
tered.
Ibis t act plus the fact th it study data do not contain infor-
m.»t ion on qutsou'. dying outside of the hospital
•n anin.;f il mortal itv compari
make any attempt at
ms in these data tenuous.
The high?r
project ion of circulatory diseases in nonrespondents reflects the most
comr.on c.ru.es of death.
Nonrcspandents and respondents were basically
the .amc age but the nonre pendents had a slightly shorter length of
5S
e
t I
i
Table I2a. In-llo.pital Cb.arac ter i st its by Final Diagnosis - Males
Medi an
H-ICbA
bia;:nostic Catcgory
lam
Exposure
No. of
Case;
(Years)
Mean
length of
a
Stay (Days)
Mean Admission
Blood Pressuroj_
Systolic
Diastolic
Infective G Parasitic
Di souses
001-136
Ever Famed
Nev -r Famed
53
IS
63
41.5
5.0
4.6
1.2
3.2
142.4
Neoplasms
i:n-25i)
I vor Fimed
Never I a med
244
121
73
67
12.2
10.9
13.3
22.8
139.7
Ever Famed
Never tamed
51
30
69
39.5
7.7
6.7
5.6
3.9
137.4
Ever Famed
Never Famed
IS
6
73
63
10.2
5.7
10.8
0.0
134.3
132.0
134.8
85.2
74.0
78.1
76.8
80.3
84.2
endocrine. Nutri
tional, G Metabolic
Di senses
240-2’9
Diseases of the Blood 5
Blood Fuming Organs
2 SO-cSO
Mental Disorders
290-31S
Ever Famed
Never Famed
96
.89
5S
41
7.4
S.O
0.0
0.0
141.0
137.6
85.7
85.4
Diseases of the Nervous
System G Sense Organs
520-3S9
Ever Famed
Never Famed
115
3(>
69
34
4.9
5.8
0.6
0.0
142.6
133.2
83.4
75.5
Diseases of the Cir
culatory S.sten
390-438
Ever Famed
Never Farmed
441
8.8
9.3
11.9
10.7
14S.8
145.4
85.6
85.6
Diseases of :he Re
spiratory ystem
460-319
Ever Farmed
Never Farmed
1’3
117
7.5
9.4
6.3
157.3
155.2
77.6
76.6
Diseases of the Di
gest jvc Sy>te:n
520-5”
Ever Famed
Never t amed
51
6.9
(>.7
1.6
3n2
1.9
158.4
137.5
80.3
SO. 1
Diseases of Genito
urinary System
5S0-629
[ ver Famed
Never Famed
34 3
70
60
6.5
6.2
0.7
0.7
144.1
142.1
S2.3
82.9
Diseases of the Skin
l\ Subcutaneous Tissue
bS;)-709
Ever Famed
Never Famed
48
63.3
30.5
9.5
7.5
1.3
0.0
141.2
131.7
78.6
79.7
tzl
I
Case
Mortality
Rate
63
60
63
179
40
146.4
120.0
67.5
65.0
Table 12a. In-Hospital Characteristics by Final Diagnosis - Males
No. of
Cases
Median
Age
(Years)
Diseases of the Musculo- 710-739
skeletal System G
Connective Tissue
Ever Farmed
X'ever Farmed
147
110
65
48.5
7.7
7.5
0.0
0.0
142.0
142.8
84.1
83.0
Congenital Anomalies
740-759
Ever Farmed
Never Farmed
15
14
54
39.5
4.2
5.8
0.0
0.0
141.2
134.9
87.8
78.3
Signs, Symptoms G
770-796
Ill-Defined Conditions
Ever Farmed
Never Farmed
149
150
62
46
3.9
4.3
1.2
1.0
138.3
141.9
80.6
80.2
Injuries G Adverse
Effects
880-999
Ever Farmed
Never Farmed
288
272
57
30
6.5
6.1
1.1
1.5
137.8
137.9
80.9
78.9
All Diagnoses
001-999
Ever Farmed
Never Farmed
2306
1658
67
51
7.3
7.3
4.8
5.6
141.5
139.8
81.9
81.0
Diagnostic Category
o
a
Mean
Length of
Stay (Days) a
Farm
Exposure
Age adjusted
H-ICDA
Codes
Case
Mortality
Rate -a
Mean Admission^
Blood Pressure*.
Diastolic
Sysrolic
Tabic 12b. In-Hospital Characteristics by Final Diagnosis Fennies
Farm
Exposure
No. of
Cases
Median
Age
(Years)
Ever Farmed
Never Farmed
S3
81
63
36
4.6
4.8
1.4
2.0
134.0
127.8
74.2
75.2
Henn
Length of
a
Stay (Days)
Case
Mortality
Rate e.a
Mean Admission Q
Blood Press::rc‘
Systolic
Diastolic
Diagnostic Category
H-ICDA
Cedes
Infective 6 Parasitic
Diseases
001-155
Neoplasms
140-259
Ever Farmed
Never Farmed
253
250
65
4S
9.2
9.6
6.3
7.1
138.0
133.3
78.6
80.1
Endocrine, Nutrit ional, 6 Metabolic
Diseases
240-279
Ever Farmed
Never Famed
63
55
6S
60
10.0
5.6
0.0
0.0
144.7
146.8
78.3
80.7
Diseases of the Blood
5 Blood Forming
Organs
2S0-2S9
Ever Farmed
Never Farmed
18
16
67
57.5
8.1
4.1
0.0
0.0
131.5
151.5
70.6
77.4
Mental Disorders
290-318
Ever Farmed
Never Farmed
92
174
61
43.5
9.6
8.2
0.0
0.6
155.6
140.3
82.8
84.1
Diseases of the Nervous 320-389
System 6 Sense Organs
Ever Farmed
Never Farmed
150
155
72.5
66
6.3
7.0
0.6
0.0
143.4
143.7
80.0
SI.2
Diseases of the Cir
culatory System
390-4S3
Ever Farmed
Never Farmed
337
290
75
70.5
10.1
S.3
10.9
8.4
149.3
149.2
84.2
Diseases of the Res
piratory System
400-519
Ever Farmed
Never Farmed
107
125
74
54
8.2
7.4
2.2
1.4
135.2
136.5
75.3
75.1
Diseases of the
Digestive System
520-577
Ever Farmed
Never Farmed
309
371
66
50
7.5
7.8
1.5
0.4
134.7
136.0
78.8
76.6
Diseases of Genito
urinary System
550-629
Ever Farmed
Never Farmed
293
417
52
41
5.0
4.0
0.2
0.0
133.5
129.7
77.6
76.2
Ever Farmed
Never Farmed
483
1224
26
24
3.4
3.5
0.0
0.0
124.6
122.8
74.3
74.3
Delivery 6 Compli
651-678
cations of Pregnancy,
Childbirth,
the
Puerperium
83.8
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Table 13.
Comparative Pregnancy and Newborn Statistics
Females .Age 1S-5S
H-ICPA Codes
Current Farm Worker
or Housewife
Not Current Farm
Worker or Housewife
Number of Cases
631-67S
529
2364
Complications of
. Pregnancies
631-639
29 (5.5’-)
157 (5.8“.)
643
24 (4.5t)
73 (3.It)
650-664
311(58.St)
1152(48.7t)
201(64.6t of
Deli verics)
7SS(()S.4t of
Del ivories)
Spentanfous
Abortion
Delivery
Delivery Without
Complicat ions
630
Median Age of
Mothers (years)
25
H-ICIU Codes
Farm Residence
Total births
Y2O-V32
500
St i1Iborn
Y3O-Y32
Liveborn
Y20-Y29
496
Congenital Anomalies
74n-''59
11 (2.2*)
22 (2.(K)
Diseases of Newborn
Infants
760-~6S
35 (7.K)
81 (7.4^)
Other Secondary
Diagnoses
All others
9 (1.St)
33 (S.Ot)
Birx hs
\11
4 (0.8M
Non-Farm Residence
1098
6 (0.5S)
1092
Secondary hiarnoses
of Liveborn
Liveborn Statistics
7 lb. 10 o:.
Median Length of Stay
7 lb. 13 o:.
3 days
No. of Males (t)
266 (54t)
561 (Sit)
No. of heaths (t)
1 (0.2t)
2 (0.2t)
Median Birthweight
43
3 days
u
Table 14.
C
Comparisons of Original Respondents, Telephone
Respondents, and Nonrespondent-S - Douglas County
Original Tel ephone
Respondents Respondents Xonresnondents
Total no. of cases (% of all cases)
4S4
Number of deaths (% of total)
68
Mean length of stay (days)
Median age (years)
(15%) 77
(21%) 75
(3.0%)
(18%)
27
(3°c)
(35.1%)
7.4
4.6
7.5
62
52
60
Diagnostic Category
H-ICDA Codes
Cases
Infective ti Parasitic
Diseases
001-136
44
Neoplasms
140-239
Endocrine, Nutritional, 6
Metabolic Diseases
(82%) 412
2279
Patients living on a farm (% of total)
Cases
%
1.9%
14
201
8.8°
16
Cases
c
3.4°,
1
1.3;
3.9*
4
5.2°.
0.5°,
2
2.6C?
240-279
58
2.5°o
Diseases of the Blood 6
Blood Forming Organs
280-289
17
0.7%
->
0.50?
0
Mental Disorders
0.0°c
290-318
92
4.0'o
15
3.6;
3
3.9;
320-3S9
101
4.4’o
13
3.2;
1
1.3‘
390-458
318
14.O’o
59
14.3;.
26
33.3;
460-519
139
6.1%
19
4.6oo
5
6.5%
520-577
310
13.6%
52
12.6%
4
5.2%
580-629
230
10. 1%
51
12.4%
11
14.3%
631-678
290
56
13.6%
13
16.9%
680-709
32
1.4%
4
1. O’
0
0.0%
Diseases of the Nervous
System q Sense Organs
Diseases of the Circula
tory System
Diseases of the Respi ratory System
Diseases of the Digestive
System
Diseases of the Genito
urinary System
Delivery 6 Complications of
Pregnancy, Childbirth, fi
the Peurperium
Diseases of the Skin 6
Subcutaneous Tissue
Diseases of the Musculo
skeletal System 6 Connect ivc Tissue
Congenital Anomalies
Signs, Symptoms, 6 Illdefined Conditions
Injuries 6 Adverse
Effcct s
Supp1 omenta ry C1 a s s i f i cat ions
710-739
94
4.1%
13
3.2%
2
2.6%
’40-759
8
0.4%
3
0.7%
0
0.0%
770-796
152
6.7%
39
9.5%
2
2.6%
800-999
170
7.5%
42
10.2%
3
3.9%
Y00-Y86
23
1.0%.
12
2.9%
0
0.0%
1
44
Table 15. Comparisons of Medical Characteristics of
Questionnaire Respondents and Nonrespondents
Males
Females
Respondents Nonrespondents Respondents Nonrespondents
Total number of cases
5032
257
Number of deaths (% of total)
232 (4.6?o)
49
Median hge (years)
63
64
47
46. S
Mean length of stay (days)
7.2
6.3
6.4
5.1
% Cases
% Cases
(19.1%)
7431
264
112 (1.5%)
27
(10.2%)
Diagnostic Category
H-ICDA
Codes
Cases
Infective G Para
sitic Diseases
001-136
99
2.0%
3
1.2% 142
1.9%
4
1.5%
Neoplasms
140-239
4S4
9.6%
10
3.9% 569
7.7%
13
4.9%
Endocrine, Nutri
tional u Metabolic
Diseases
240-279
87
1.7%
1
0.4% 142
1.9%
5
1.9%
Diseases of the
Blood and Blood
Forming Organs
280-289
24
0.5%
0
0.0%
46
0.6%
0
0.0%
Mental Disorders
290-318
263
5.2%
21
8.2% 354
4.8%
10
3.8%
Diseases of the
Nervous System 6
Sense Organs
320-389
184
3.6%
2
0.8% 317
4.3%
11
4.2%
Diseases of the
Circulatory System 390-458
852
16.9%
62
24.1% 711
9.6%
34
12.9%
Diseases of the Re
spiratory System
460-519
336
6.7%
15
5.8% 248
3.3%
6
2.3%
Diseases of the Di
gestive System
520-577
810
16.0%
23
8.9% 780
10.5%
16
6.1%
Diseases of the
Gen i touri nary
System
574
11.4%
19
7.4% 768
10.3%
29
11.0%
1842
24.8%
68
25.8%
94
1.3%
0
0.0%
•1. S’, j 14
5.3%
580-629
Delivery
Compli
cations of Preg
nancy, Childbirth
G the Pcurpcrium
631-678
Diseases of the
Skin G Subcutane
ous Tissue
680-709
Diseases of the
Musculoskeleta1
System % Connec
tive Tissue
710-739
92
1.8%
1
0.4%
276
5.5%
16
6.2% 316
45
% Cases
u
1
Table 15 (continued). Comparisons of Medical Characteristics
of Questionnaire Respondents and Nonrespondcnts
H-ICDA
Diagnostic Category Codes
Congenital Anomalies 740-759
Signs, Symptoms G
Cases
•s Cases
% Cases
% Cases
%
31
O.(v.
1
0.4-,
16
0.2^
1
0.4°,
770-796
316
6.3Av
21
8.2* 401
s.n
20
7.6*>
Injuries fj Ad
verse Effects
-800-999
583
11.5 •
59
23.0’ 505
6.85>
24
9.1®c
• Supplementary
Classifications
Y00-Y86
41
0.8°o
3
1.2% ISO
2.4*>
9
3.4S
Ill-Defined Condi
tions
46
stay.
Telephone respondents were younger with shorter lengths of stay
than original respondents but the percentage of patients living on farms
was close to the same for both sets of respondents indicating that there
was no bias as to place >f residence in the nonrespondents.
From the case-control analysis, all delivery and complications of
childbirth and the puerperium cases showed relative risks near one for
females in the low exposure farming group.
The high exposure group is
composed of older women and is not necessarily a valid comparison.
Comparison of Results with Published Statistics
National Center for Health Statistics Reports. A Nationa1
1.
Center ftHealth Statistics publication presents health characteristics
by geographic region and place of residence for 1969-70 [IS].
The
number of discharges per 1,000 persons per year is given for the North
Central Region (12 states) by sox, tabulated by farm and nonfarm (out
side of SMSA’s) places of residence.
Table 16 gives a comparison ot
these rates with the Douglas and Kandiyohi County rates.
These county
rates arc acknowledge!y underestimated but they seem to underestimate
the NCHS rates by similar proportions for farm and nont arm breakdowns.
Another NCHS report (5] presents the relative frequency and sevelit.y of selected health conditions. Table 17 provides a comparison of
1974 NCHS statistics and all of the discharge data included in this
study.
The percentage distributions were fairly comparable between the
Rural Health Study and the NCHS survey, indicating that the study area
hospital experience is somewhat representative oi national experience.
A state-of-the-art report on occu
2
pation il .'af-tv and health in agriculture done by the University of Iowa
assessed the relative health of farmers (191. lhc health ot tamers was
compared in a study in Iowa and nationally using National Center for
Health Statistics reports.
It was rnnrhidrd
concluded that farmers
farirors are not as
”
healthy as generally thought.
Data on injuries were somewhat equivocal.
Nationally, farm rcsi-
dents had more days of b-l disability for injuries than did nonfarm
47
u
Table ’6.
Comparisons of Discharge Rates
Disch»*;o0 per 1 ,000 persons per year
Males
Females
Nonfarm
Farm
Nonfarm
Farm
NCHS North Central
Region (1969-70)
122
88
179
121
Douglas County
(1976-77)
102
S3
157
95
Kandiyohi County
(1976-77)
97
72
141
111
Counties Combined
(1976-77)
99
77
148
103
48
Table 17.
Comparative Percentage Distributions for Selected Diagnoses
Diagnosis Category
H-ICDA Codes
Percent Distribution of
Total Discharges
NCHS
Rural Health
Survey
Study
Diarrheal Disease
009
1.0
1.3
Malignant Neoplasms
140-209
4.7
5.4
Benign Neoplasms 8 Neo
plasms of Unspecified Nature
210-239
2.1
Diabetes Mellitus
250
1.5
1.2
Acute Myocardial Infarction
410
1.3
1.6
Other Ischemic Heart Disease
411-414
0.8
l.S
Cerebrovascular Diseases
430-438
1.9
2.0
Acute Respiratory Infections
except Influenza
460-466
1.7
1.1
Pneumonia, All Forms
480-486
2.1
2.0
Hypertrophy of Tonsils
and Adenoids
500
2.5
1.3
Ulcer of Stomach, Duodenum,
Peptic Ulcer of Unspecified
Site ft Castro jejunal Ulcer
531-534
1.3
1.3
Inguinal Hernia
550-552
1 .6
2.1
Cholelithiasis, Cholecyst i t is,
and Cholangitis
574-576
1.8
2.S
Disorders of Menstruation
626
1.7
1.3
Complications of Pregnancy,
Childbirth, •S the Pucrper
631-67S
11.0
13.3
Fractures, All Sites
800-829
3.6
4.3
Lacerations G Open Wounds
870-897
1.0
0.9
Mean Length of Stay
7.8 davs
6.6 days
Percent Males
4 0".
4 3".
Fatality Rate (per 100
d ischargcs)
2.6
2.6
49
residents. Farm residents under 45 had fewer injuries than nonfarm
residents but those farm residents over 45 had higher injury rates than
their nonfarm counterparts.
Acute conditions with more days of bed disability for farm resi
dents than for nonfarm residents were infective and parasitic diseases;
respiratory conditions other than upper respiratory conditions and
influenza; and digestive conditions.
For chronic conditions, farmers
were found to be more likely to have hernias of the abdominal cavity,
gall bladder conditions, and ulcers of the stomach and duodenum.
Other
possible problem areas for farmers were suspected angina pectoris,
hypertension, arthritis, psychological distress, and hearing problems.
Smoking and Health.
A large number of health problems h.ve
been attributed to the smoking of cigarettes [20].
In the Rural Health
Study, data on smoking habits were collected to be used as a cnvariate
in the adjustment for the differential in smoking habits between farm
and nonfarm workers and residents in the analysis of the diseases as
sociated with smoking.
By using the independent variable (farming
exposure) as a covariate and by changing the covariate (smoking) to the
independent variable, the relationship between smoking and various
diseases (adjusted for farming exposure) can be investigated.
Data from
the Rural Health Study were used in this way as a means of validating
known smoking relationships with th' data collected by the procedures
outlined in this report, so as to lend credence to the use of these
procedures
Appendix III presents age and farming adjusted relative risks for
lung cancer, circulatory diseases, respiratory diseases, and ulcers for
" i* ’ ent
with low and hi,.h smoking histories.
Those patients in the
high smoking group smoked one pack or more per day for at least 10
years, or less than one pack per day for at
.it least 20 years.
Patients in
the low smoking group consisted of all other patients with a cigarette
smoking history.
The control group was again injuries and adverse
offert s,
.'o
Table 18 summarizes the significant relationships between smoking
and diagnostic categories,
’’ ii< >H.«enszel chi square statistics were
used to test for dose-icspor-' relationships between amount of smoking
;»ad increased risk. Two- i .
•is of significance were used in this
case in order tn !<• <.onputable to other studies.
I1* teased relative risks were found for all of the diagnosis cate-
‘d“- -?s studied, with a number of those increased risks statistically
significant.
Circulatory problems related to smoking seemed to be more
prevalent in the 25-64 year old age groups and respiratoiy problems wore
more often associated with smoking in the 65-and-older age groups.
The observations that many of the known relationships between
smoking and disease were confirmed in this study using crude smoking
categories seems to substantiate that data collection procedures, such
as those used in the Rural Health Study, have some validity and utility
in the assessment of health problems.
SI
Table 18.
Diagnoses Significantly Associated with a
Cigarette Smoking History
Age and Sex
Group
Diagnosis Category
Males
25-64
on
(10)
0.9
(37)
1.6
(179)
412
0.4
(1)
2.0
(27)*
440-443
5.3
(3)
8.5
(20)*
532
2.7
(9)
5.7
(25)*
162-163
0.4
(1)
2.8
(19)*
413
6.3
(3)
12.1
(9)*
439-496
1.8
(ID
2.8
(37)
Chronic Obstructive
Lung Disease
496
2.7
(5)
3.9
(19)**
Ulcer of Duodenum
532
1.8
(4)
2.9
(14)*
Acute Myocardial Infarction
410
3.1
(2)
13.2
(14)
430-438
1.6
(D
4.7
(7)
532
1.6
(2)
3.6
(D*
162-163
14.7
(D
11.4
(2)**
460-470
2.1
(D
3.6
( D*
162-163
Diseases of the Circula
tory System
390-458
Diseases of the /Xrteries,
Arterioles, and Capil
laries
Ulcer of Duodenum
Malignant Neoplasm >f
Trachea, Bronchus, tnd
Lung
Angina Pectoris
Bronchitis, Emphysema,
Asthma, and Related
Cond i t ions
Females
25-o4
Cerebrovascular Disease
Ulcer of Duodenum
Malignant Neoplasm of
Trachea, Bronchus, and
Lung
Females
2 65
Acute Upper Respiratory
Infect ions
♦♦♦
Bid1 atlvc »<Dks (No. of Cases)
Low Smoking j High SmoMnQ
(0)
Malignant Neoplasm of
Trachea. Bronchus, and
Lung
Chronic Ischemic Heart
Disease
Males
2 65
H-ICDA Codes
Statistically significant relationship between risk and
amount smoked, p'-'.OS, p<.01, p<.001.
s
52
CONCLUSIONS AND RECOMMENDATIONS
Agricultural Health
The results of this study show that the health of farmers and the
health of nonfarmers in a rural raidwestern setting are not radically
different when hospital records are the basis for comparison.
Overall,
patients with an agricultural background even seem to be slightly
healthier than patients with no agricultural history.
Nevertheless,
over all the analyses, several diagnoses consistently showed increased
risks for people with farm backgrounds.
These include the following
conditions for both males and females:
diseases of the blood and blood
forming organs; osteoarthritis and allied conditions; diseases of the
gall bladder; hernia of the abdominal cavity; diseases of the veins,
lymphatics, and other circulatory diseases; and diseases and conditions
of the eye.
In addition to these increased risks, farm males showed
increased risks for benign prostatic hypertrophy, and farm females
showed increased risks for uterovaginal prolapse, acute myocardial in
farction, diseases of the skin and subcutaneous tissue, and neoplasms.
This increased risk for neoplasms is somewhat surprising and is an area
in which more research might be warranted.
Females over 65 years of age
with 20 years or more agricultural exposure exhibited the largest number
of increased risks and is the only group of farm workers cr housewives
whose overall health was worse than the corresponding nonfarm group.
Data on smoking history collected by this study gave evidence of
relationships of cigarette smoking to lung cancer, ulcers, and several
circulatory and respiratory problems.
This may be taken as support for
the data collection procedures used in this study since these findings
corroborate national findings on smoking and disease.
Met hodnIngy
The method of administering occupational questionnaires to hos
pitalized patients and then using such data in conjunction with ab
stracted hospital data available from abstracting services such as
53
u
t
can work efficiently.
In this study, hospitalizations to both farm
residents and past and present farm workers were evaluated, since it is
hard to separate those "working" and "living" on a farm.
In choosing
agriculture as a target occupational group, a large area (including many
small hospitals) must be investigated.
This can pose problems such as
obtaining cooperation from a large number of hospitals; obtaining con
sistent questionnaire administration, record abstracting, and data
coding; and being able to define the hospital's service area including
making accurate population estimates.
To use the methodology in studying other occupational groups, the
following recommendations are made:
The studv should be limited to
specific age and sex groups in areas with sufficient estimable numbers
of workers at risk.
All hospitals in the area of interest should be
included; contacts with hospital associations and local medical socie
ties would be of assistance in obtaining cooperation.
Sufficient mone
tary compensation should be awarded and, if feasible, additional persons
should be employed to assist with the study so as to minimize hospital
staff burden.
The amount of monetary compensation could also effect
cn-.^cs in hospital procedures rather than limit the investigator to
existing nonrescarch-orientcd procedures.
pertaat J
Hospital selection is im-
to the amount and quality of cooperation that must be
received.
It is important, but not necessary, that all hospitals subscribe to
an abstracting service or have an equally effective inhospital data
handling system.
To help in identifying areas where there is full or
almost full coverage by PAS, CPIIA publishes a list of such areas in the
U. S. [21].
If only a few of the hospitals do not belong to any ab
stracting service, it might be possible for the investigator to pay the
fee for enrolling in such a program for several years or, if absolutely
necessary, the records could be abstracted independently in order to
complete full coverage in an area.
Patient origin studies done by the
hospitals or hospital associations are of great assistance in deter
mining hospital service areas.
51
Questionnaire design should incorporate the features of being short
and relevant but should try to obtain the required occupational infor
mation in several ways so that confidence in the responses can be
maximized.
Available population estimates of the woikers at risk
should be examined so that questions cun ue 5ui.tvvarcJ to give answers
based on the same definitions as those used in the population estimates.
The selective collection of data on other variables of interest, such as
smoking, is recommended.
These questions should be structured to be
comparable to similar questions in related studies.
Valuable infor
mation about biases in hospital utilization among different groups of
workers could be obtained by collecting data on insurance coverage,
since the presence of insurance coverage may determine whether■ a person
would go to the hospital and which hospital he might choose,
These data
are routinely available in many hospital data sets.
Adn.ini st rat ion of the questionnaire should be as soon as the
patient can provide reliable answers.
Ml attempts should be made to
retrieve missing data such as the use of telephone follow-up or by
contacting relatives.
In this current study, there were only a few
patients who refused to participate; obtaining cooperation is a function
of how and when the questions arc uM.cd.
A re-administration of the
questionnaire to a random sample of patients, utilizing telephone follow-up,
might prove productive in assessing the reliability of questionnaire
responses.
A paid interviewer or .it least the use of a small number of
well-trained hospital personnel would also benefit data quality.
Precoded questionnaire forms help minimize transcription errors.
Questionnaire data do not actually have to be added to the abstracting
forms.
The completed questionnaires could be sent to the investigator
for coding and data handling and then paired with the data files sup
plied by the abstracting service, using the patient number and date of
discharge.
Prior to entering into another study, it would oc advantageous to
try to validate the use of these procedures as a screening technique.
This would involve the evaluation of hospital records in an area where
health problems have already been discovered by a more thorough study.
3.'
u
If these procedures can also detect the same health problems, as well as
fail to detect health problems which were also not evident in the more
thorough study, then the procedures would seem to have utility as a
relatively low-cost screening technique.
The recommended method of study is the population-based study.
The
case-control approach can be used when it is necessary to cover a wide
area to obtain enough worker cases.
It might also be possible to
convince CPI1A or other abstracting services to include occupation as
part of the required abstract information; however, occupation usually
cannot be described by a single question.
The problem would be for
midable to construct a single, relevant, occupational classification
system.
The use of a small population-based study as a means of selecting
control groups and verifying results of a much larger case-control study
is a valuable tool when large scale population-based studies are not
fcasible.
5b
u
ACKNOWLEDGEMENTS
The authors would like to thank the following people and organiza
tions for their contributions:
, Mr. Norman F. deGroot, previous Head of Information Systems Section,
Agricultural Research Program, Utah Biomedical Test labora
tory.
The administrators and staff of the six participating hospitals.
The many cooperative people at state and hospital agencies in
Minneapolis and St. Paul.
Commission on Professional and Hospital Activities, Ann Arbor,
Michigan.
Diversified Computer Applications, Palo Alto, California.
and especially
Dr. J. T? T. Higgins, Department of Epidemiology, School of Public
He 1th, University ot Michigan, for his valuable comments,
criticisms, and ideas throughout the study.
u
4
KefeFences
1.
Burkart, J. A., X. F. deGroot, and 1.. B. Koi fen son. Second Annual
^po22_J2JL_2£'^ill^
and Injury Hata in Apriculturo, llfah
Biomedical lest Laboratory, IR 201-003, “-larch, 1970^
Oecouf’e, P. , K. Stanislawczyk, L. Houten, I. !). J. Bross, and
L. V lauana, A Rctrosncc^cc ?.jivev of Cancer in Relation to Occti111112?..• National Institute for Occupational Safety and lieaTFh
Research Report, DHEIV (N’lOSH), Publication No. 77-178, 1977.
3.
Houten, L., I. P0.
Bross, and li. Viadana, ’’Hospital Ao:;.i>sion
Records: A Source for Identifyinj; Occup.itional Groups
. ; at Risk
of Cancer,” Occupationa1 Carci nogenesis, \nnals of the ‘Jew York
Ac ader v o f S c j e!)y t-_s , 2 iTJsT-'TST^
4.
HI
Hosni t.i 1
— -------- --- ——_—J2lL2.cJ11’ Comission on Processional and
Hospital Activities, Ann Arbor, Michigan,
"i'chi^an, V. 1, 1973.
5.
GlicL-nn, I
. hyrLtL«lia.i.H :ation_of _Shorr-Stav Hospitals be
no... u.e A,non.ll health ur.ey. Series 13, \o. 30, [ill!/.-.
Publication .No. 7 -1783, 1977.
6.
ll.ienscel, li. , M. H, Shinkin, and II. P. Hiller, Tobacco <
Public Health Service ■•.•^^••h'' n. IS
I'Hl.h lITiSj Publication Ao. doS 1<>3()
Cornfield, J., "A 'lethod of Istiratin’ 1Cor-parat ive Rates fron
Clinical Bata, Applications to ( ancer o f the I.ung, Breast, and
Cervix,” Journal of the National Cancer Institute. ££ • 12 6 9•12 7 5,
1931.
S.
•lintel,
;v. ||.lcIIS;e!i ••statistical Aspects of the Analvsis
o Itrot. Retrospective Studies of Hisease.” Journal of the
•Sj l11 EL* C Cancer 1
t ut e, 22 19- 748 1 959.
-------------------------
9.
Kcvf’.tx, \
llnri.iii Bio!
10.
of'1the,'i'’.;t’ .?ni'S'!'‘NN'rCSt:i "i!’1 C,,e l’t'i:r<’e of l ree'!^ Intensions
o« t.K imtU-ll.uns.el 1 rocedure.” .Imiml of the Vterienn <tt i < t i c . 1
Ajy-oc i
ion, £8:(.9ii.7eo, 19u5.
19o3.
-------------------------------------------------------- A—
1 I.
x- T-. ’’Potential Uses and Lirr.nrations
’
of Hospital Hata in
l.pidcnioloe.ic Research,” A:\e_rican Journal
___ 1 of rub!ic 11 ra!th,
: (>38-o<>7, 19t>5.
Preceding page blank
.v1)1'-Vi2ri,‘nce ul* St;,,kJ;“d i :e.l Mortality Rates,”
S9
Refercnccs (con11nucd):
12.
U. S. National Committee on Vital and Health Statistics, Use of
Hospital Data for Epidemiologic and Medical-Care Research, National
Center for Health Statistics, Series 4, No. 11, DHEW, June, 1969.
13.
Berkson, J., "Limitations of the Application of Four-fold Table
Analysis to Hospital Data,” Biometrics Bulletin, £:47-53, 1946.
14.
Reliability of Hospital Discharge Abstracts, Institute of Medicine,
National Academy of Sciences, Washington, February 1977.
15.
Loup, R. 1., ’’Consistency of Final Diagnosis Coding in a Hospital
Patient Record Data System,” paper presented at the Seventh Annual
Interdisciplinary Conference on Health Records, Chicago, Illinois,
June 1976.
16.
Diamond, E. L. , and A. M. Lilienfeld, ’’Effects of Errors in Classi
fication and Diagnosis in Various Types of Epidemiological Studies,”
American Journal of Public Health, 52:1137-1144, 1962.
17.
Minnesota Population Projections, 19'0-2000, Office of the State
Demographer, Minnesota State Planning Agency, St. Paul, Minnesota,
November 1975.
IS.
Namey, C. h ., *.r' ’ !? W. Wi 1 rar., ! 'ypj
rharnct cri st : c< by
ranh i c
Rev.ion, I.arge 'let ropoI i tan Areas , .ird <)t hev Places of Residence,
H?"s .7~i"969 - i oTo, Vital and Health Statistics, data from the National
Hea’l t’if Su r v ey , Sc r i os 10, No. 86, DHI.K (I IRA), Publication No. 74-1513,
1974.
19.
Burmeister, L. I-'., “The Relative Health of the Farming Occupation,”
State-of-tiie-Art Report on Occunat jonal Safety and Health in Arri cu 11ure7~77.’ . .
,
ursiiy of Iowa Institute
of Agricultural Medicine, 1974.
20.
The Health Consequences of Smoking: A Reference Edition, Selected
Lhapteis from 1971 through 1973 Reports, Dlll.h, 19*6.
21.
i'AS lull Coverage Xrc.ts in the United States, ('PH.\ 715-6-74,
Conn'fs’bi"cnTm I’rofcsion71 and Hospital .Activities, Ann Arbor,
Michigan, 1976.
(.0
u
1
J
I
}
APPENDIX I
RELATIVE RISKS FOR POPULATION-BASED HOSPITALS
A.
FArcl/NOSFARM RELATIVE RISKS FOR POPULATION’ BASED HOSPITALS - MALES
Age £ 65
No. of Cases
Age 25-64
No. of Cases
Age <23
No. of Cases
Farm
Non
Farm
Relative
Risk
Farm
Non
Farm
Rclative
HICDA Codes
Risk
Farm
Non
Farm
Relative
Risk
Infective & Parasitic
D i seises
001-136
6
26
0.6
3
20
0.4
5
9
2.0
Neoplasms
140-239
1
S
0.5
6
33
0.3
14
77
0.8
Ma I i gnant N’eop 1 a sms
140-209
0
1
0.0
4
23
0.3
14
72
0.3
Endocrine, Nutritional, 6
Metabolic Diseases
240-279
2
6
0.9
4
15
0.6
7
17
2.3
Diseases of the flood 4
Elood Forming Organs
2S0-2S9
1
2
1.5
2
1
4.4
4
6
3.5
Mental Disorders
290-31S
3
11
0.7
5
37
0.2
1
22
9.2
Di senses of the Nervous
System 6 Sense Organs
320-339
2
50
0.2
6
23
0.7
11
28
1.9
Diseases of the Eye
570.378
1
11
0.2
5
10
1.3
7
20
1.9
Diseases of the Circulatory
System
390-438
1
0.3
36
103
0.8
59
167
1.0
Ischemic Heart Disease
110-414
0
0
15
50
0.7
16
59
1.1
Acute Myocardial
Infarction •
4 10
0
0
10
30
0.8
6
26
0.8
Chronic Ischemic
Heart Disease
412
0
0
7
13
0.8
8
35
1.0
4
14
0.7
12
39
1.2
8
0.5
3
26
0.6
21
1.4
2
10
0.9
Diagnostic Category
A.
A.
A.
1.
B.
Cerebrovascular Disease
450-458
0
0
C.
Diseases of Arteries,
Arterioles,
Capillaries
440-448
0
1
0.0
Diseases of Veins, Lynpbatics,
other Cir
culatory Diseases
450-458
1
5
0.5
D.
13
A. FAR.M/NOXFARM RELATIVE RISKS FOR POPULATION BASED HOSPITALS - MALES
Diagnostic Category
iHCD.A Codes
Age <25
No. of Cases
Non
Relative
Farm
Farm
Risk
Age 25-64
No. of Cases
Non
Relative
Farm
Farm
Risk
Age 5 65
No. of Cases
Non
Rclat ivc
Farm
Farm
Risk
Diseases of the Respiratory
Syst?m
160-519
19
100
0.5
9
25
0.8
26
66
1.8*
Acute Upper Respiratory
Infect ions
460-470
6
30
0.5
->
3
1.2
2
3
4.3
3
6
0.9
17
35
2.3*
A.
B.
Pneumonia
4SO-486
5
2S
0.4
C.
Bronchitis, Emphysema
Asthma 6 Related
Cond it ions
489-496
6
IS
0.8
2
6
O.S
6
27
0.9
Diseases of the Digestive
System
520-577
26
58
1.1
SO
128
O.Q
33
105
1.3
530-537
1
4
0.6
10
23
0.9
2
25
0.3
A.
Diseases of the Esophagus,
Stomach q Duodenum
B.
Append it it is
540-543
13
17
1.9
2
11
0.4
0
1
0.0
C.
Hernia of Abdominal
Cavity
550-553
10
27
0.9
21
51
1.0
17
24
2.7*
Other Diseases of Intestine
6 Peritoneum
560-569
1
3
0.8
1
19
0.1
4
22
0.7
Diseases of the Liver,
Gall Bladder, 8 Pancreas
570-377
0
->
0.0
16
19
2.0*
9
35
1.2
575
0
1
0.0
9
13
1.6
5
-> 2
0.9
580-629
5
28
0.4
22
61
0.8
40
99
1.8**
16
0.3
12
37
O.S
18
46
1.6
0.6
11
25
1.0
23
56
1.9*
7
11
1.3
19
49
1.8*
D.
E.
1.
Diseases of the Gal 1
Bladder
Diseases of the Genitourinary
System
A.
B.
Diseases of the Urinary
System
530-599
Disease of the Male Genital
Organs
600-607
3
12
600
0
0
1.
Benign Prostatic
Hypertrophy
• •••
A.
• •••
FAiCf/XO\'FAR.M RELATIVE RISKS FOR POPULATION’ BASED HOSPITALS - MXLES
Age <23
No. of Cases
Age 25-64
No. of Cases
Age a 65
No. of Cases
HICDA Cedes
Fam
Non
Farm
Relative
Risk
Fam
Non
Fam
Relat ive
Risk
Fam
Non
Farm
Relative
Risk
P1 eascs of the Skin u
Subcutaneous 1 issue
650-709
6
12
1.3
2
19
0.2
1
6
1.1
Diseases of the Musculo
skeletal System
Connective Tissue
710-739
S
15
1.4
14
43
0.7
10
24
1.6
10
0.4
5
15
1.4
Diagnostic Category
A.
Arthritis S Rheumatism
710-718
1
1
2.4
2
B.
Osteomyelitis 6 other
Diseases of Bone Ji
Joint
720-729
5
13
1.0
11
20
1.3
6
7
3.0
50
0.4
19
59
0.7
10
33
1.3
Signs, Symptoms, Ill
Defined Conditions
770-796
Injuries J. Adverse Effects
800-999
4;
98
1.2
33
85
0.9
14
57
1.1
A.
Mu s c u 1 o s k •» 1 e t a 1 Injuries
800-849
21
49
1.2
23
49
1.1
7
31
1.1
B.
Lacerations & Open
Wounds
870-897
9
9
2.6*
2
12
0.4
0
3
0.0
001-999
126
4 14
0.8
207
619
0.8
184
608
1.3
All diagnoses
, **
Rate for fam residents is statistically significantly greater than rate for non-fam residents
p<.05.
p<.01
••••
B.
rvr!/.\’O.\rARM jxvhve risks isr populvtios based hospitals - n: iai.i.s
Dia.noetic Category
Infective
Disc isos
Age <25
No. of Cases
Non
ReIntive
Farm
farn
Risk
HILDA Cede-.
Age 25-64
No. of Cases
Fa mi
Non
Fam
Age ? 65
■No. of C.i’.cs
Relative
Risk
!• *'Fam
Non
F a rra
Rclativc
Risk
Parasitic
X’co pl asms
0.5
01)1-156
9
29
1.0
6
22
0.S
1
140-259
4
18
0.9
28
101
0.8
12
73
1.2
1.3
15
56
1.1
8
65
1.0
5
15
0.6
1
24
0.2
5
6
1.2
1
6
0.8
Malignant .Xcoplasms
1 10-209
Endocrine, Nut ri t ionaI, X
Metabolic Diseases
240-279
A.
••••
0.5
1
I
i
Diseases of the Blood ft
Blood Forming Organs
280-289
Mental Disorders
290-51S
19
0.5
11
65
0.3
I
4
5o
0.9
Diseases of the Nervous
System 6 Sense Organs
520-589
20
1.0
15
27
1.8
i
9
82
0.9
Diseases of the t.ye
3'0-5’S
5
1.4
5
5
5.5
8
65
1.1
Discas.s of th** Circulatory
Sys* cm
590-458
9
1.0
70
1.0
51
192
1.4
Ischemic Heart Disease
410-414
0
0
5
18
0.9
10
69
1.2
Infarction
4 10
9
0
5
10
0.9
4
55
0.9
Chronic Ischemic
Heart Disease
412
0
0
I
S
0.8
5
54
1.4
I
5
0.9
S
40
1.9
A.
A.
I.
0
5
0
Acute Myocardial
B.
Cerebrovascular Disease
450-458
0
0
C.
Diseases of Arteries,
Arterioles, f4 Capillaries
4 10-448
0
1
0.0
5
2.6
4
27
1.4
Diseases of Veins, Lym
phatics,
other Cir
culatory Diseases
450-458
8
1.1
50
0.7
5
26
1.7
I).
I
I
••••
B.
FAR.’!/:;O:,TAR.M RELATIVE RISKS FOR POPULATION BASED HOSPITALS Age <25
No. of Cases
PRIMES
I
Age 25-64
No. of Ca es
Age £ 65
No. of Cases
HICO\ Codes
Farm
Non
F a rm
Rd at ivc
Risk
Farm
Non
Farm
Relative
Risk
Farm
Non
Farm
Relative
Risk
Diseases of the Respiratory
System
460-SIP
20
73
0.7
12
32
1.1
S
56
1.1
Vutc Upper Respiratory
’. rifec t i ■;! .
460-470
3
26
0.3
*>
8
0.7
1
9
1.2
R.
Pnvmonia
4 SO-486
7
17
1.1
3
11
0.8
3
24
0. J
C.
Broachi t i s, I rphysena
\sthma 6 Related
489-496
4
13
0.8
3
9
0.9
3
15
1.6
Di a.•...»•> st ic Category
. '.’id it ions
Lis
' of the I'itiestivc
Svstem
520-577
15
54
0.9
31
13S
0.7
21
94
A.
Diseases of the Esophagus,
Stomach f. Duodenum
530-537
2
S
0.6
2
26
0.3
6
30
8.
'.ppend ic i t is
540-543
6
28
0.7
4
8
1.8
1
0
Hernia of \bdc:~inal
Cavity
550-553
2
3
1.5
2
17
0.4
0
8
0.0
Other Diseases of Intestine
■ri Peri toncun
560-569
1
5
0.9
6
25
0.7
5
32
0.6
Diseases of the Liver, Gall
LI adder 6 Pancreas
570-577
3
9
1.5
17
61
0.9
11
25
3.6* *
L.
I.
Diseases of the Gall
Bl ad kr
1.4
573
3
6
2.2
9
28
1.0
11
17
S.l**
Diseases of the Genitourinarv
Sy stun
380-629
8
66
0.4
51
190
0.7
8
56
1.0
Di cases of the Urinary
Seston
580-599
4
29
0.4
8
27
0.8
3
30
0.8
612-617
1
20
0.2
3
10
0.8
0
0
».
F’is■Mses of the ilvary,
I il lopi ci Tu’-.
••••
B.
FAIUI/NONFARM RELATIVE RISKS FOR POPULATION BASED HOSPITALS - FEMALES
Diagnostic Category
C.
O'
Diseases of Uterus 6
Female Genital Organs
1. Uterovaginal Prolapse
Disorders of Menstrual
Cycle
Diseases of the Skin fi Sub
cutaneous Tissue
Diseases of the Musculo
skeletal System 6
Connective Tissue
A. Arthritis 6 Rheumatism
8. Osteomyelitis G other
Diseases of Bone fi
Joint
Signs, Symptoms, Ill
Defined Conditions
HICDA Codes
Age <25
No. of Cases
Non
Relative
Farm
Farm
Risk
Age 2S-64
No. of Cases
Non
Relative
Farm
Farm
Risk
Age i 65
No. of Cases
Farm
Non
Farm
Relative
Risk
1.3
1.7
0.8
1.7
3
8
126
13
3
19
14
1.1
16
71
0.6
0
1
0.0
5
0.9
7
10
2.1
3
15
1.4
0.8
0
10
0
7
3
48
13
0.4
0.6
6
4
50
29
1.1
1 .1
720-729
I
7
0.5
3
25
0.4
2
14
l.S
770-796
6
33
0.4
21
60
0.9
10
63
1.1
13
119
619-629
623
3
16
0
0
626
2
7
6S0-709
1
710-739
710-718
2
0.7
37
i
800-999
18
56
1.0
27
70
1.1
Musculoskeletal Injuries
800-349
7
26
0.9
16
39
1.2
6
93
1.0
0.6
Lacerations 6 Open
Wounds
870-897
3
6
1.2
I
3
0.9
0
3
0.0
001-999
92
370
0.8
232
828
0.8
117
752
1.3
Injuries & Adverse Effects
A.
B.
••••••
All Diagnoses
(Not including Conditions of
Pregnancy and Delivery
Rate for farm residents is statistically significantly greater than rate for non-farm residents p<.05.
p<.01
APPENDIX II
CASE-CONTROL RELATIVE RISKS
A.
Case-Control Relative Risks for Farming Exposure • Males
Arc > 65
Arc 25-C4
I
I!-ICt A
C -dr
I
I
Never
larrcJ
NO. Of
FarncJ 1*!9 Yc.ir»
larncJ > 20 Year
NO. of
Cj-c>
No. of
Caves
.
Rel it ivo
I
Rivk
I
Re Iut ivv
MKk
Never
rarecd
Farmed » 20 Years
Caves
No. of
Cases
35
101
10
22
0.6
So. of
Rc |..t Jvc
J<L1__
itnii.rxc< ■« Adverse
Infceme C I’arasitic
l‘i>C nc*
1. 6xarrhe.il Oxsease
Xcop’.a^’S
142
60
no:-13o
27
7
0.6
13
0.7
001 - 00>
12
3
0.5
12
1.3
7
16
Ou 9
9
0 4
10
1 .4
4
13
0.7
0.8
l-’i‘-23?
51
14
0.7
37
0.8
67
166
0.8
14'-15j
29
7
0.6
26
1.1
S8
155
0.8
ISO-!53
8
2
0.8
12
1.6
16
32
0,7
153
4
0
0
1.8
9
13
0.5
16C-165
5
3
1.7
0.6
10
13
0.5
112- i<‘5
5
3
1.7
0.6
10
13
0.5
180.IS?
9
1
0.3
0.9
28
S3
1.0
US
4
0
0
1.3
20
57
1.0
I* S
2
6
22
1.2
73
A. I'ri r .r.- ’!il Xx*3n:
flair
Tr.ichea
F-rar.^hus 4 Lan;
3. Prxr. ir» M.lxf.n.in:
Nev; l-J'S of C.-nxtoarinary Org.is.s
2
a. MiH;- in? Ntof I-*'" of fr ’itate
b. Nil;in.i-.t ' .apljiR vf i/I.’Jaer
I
1.2
s
2
l.l
• ••••
A.
• •••
Case-Control Relative Risks for Fanning Exposure - Males
» 6$
Farmed 1-19 Years
famed 4 20 Years
Never
Famed
Farmed * 20 Years
No. of
Ca>vs
No. »»f
Cases
Relative
Risk
Ko. of
Coses
No. of
Crises
35
104
0.7
7
12
0.6
0.3
4
6
0.5
10
1.0
12
24
0.7
2.0
9
1.1
1.8
8
1.0
10
9
18
18
0.6
0.6
0
0.0
4
3.5
3
12
1.2
56
24
0.9
28
0.9
13
30
1.0
296-305
10
4
1.0
6
1.1
3
11
1.5
336-309
7
6
1.7
6
3.1
I
5
2.0
0.8
5
9
0.8
Never
Famed
H-ICOA
Code
No. of
Cases
8C0-999
142
60
196-199
7
0
U. 0
5
21O-22S
11
4
0.9
4
f. Metabolic Diseases
240-279
IS
9
1.8
Diseases of Other
Endocrine Glands
250.258
11
8
llitus
250
11
7
Diseases cf the Blood 5
Blood-Fominj Organs
230-2E9
2
Mental Disorders
290-318
A. Organic Brain
Syr..!ro-.es
B. Psychoses Not
Attributed to
Ph) six. al Conditions
I'i »rno*t ic Catenary
Rclativc
I
Risk
Relative
1 Rmk
cc-.iUOE CROUP
iln.turics G Adverse
E f feet s'
ii. Secondary Malignant
Neoplasms
C. Benign Scapla^ms
75
Endocrine. Nutritional.
1. Diabetes
12
3
0.6
6
0. Personality Disorders 6
Certain Other Ncnpsychotic Mental
311-514
Pi >ordcrs
8
13
1.1
9
0.6
5
5
0.3
313
21
12
1.2
9
0.6
4
4
0.4
320-253
26
13
1.2
23
1.2
20
68
1.2
C. Neurones
I. AlCohn 115 i
Diseases of the Nervous
System G Scn--e Organs
310
• •••
A.
Case-Control Relative Risks for Faming Exposure - Males
Arc » 65
Arc 25-64
Farmed i 20 Years
Keyer
Far&cd
Farmed i 20 Year*
Relative
Risk
No. of
Cases
No. of
Cases
55
104
Never
Farmed
Farmed 1-19 Tears
Pi ignostic Catexory
II • 1CDA
Code
No. of
Caves
No. of
Casey
No. of
Cases
CCMROL GROUP
(Injuries 6 Adverse
effects)
830-999
142
60
A. Disease of Nerves 6
Peripheral Canglia
55O-3SS
6
2
B. Disease and Condition's
360-379
of the Lye
10
374
6
Diseases of the Cir
culatory System
390-458
A. Hypertensive Disease
4CO-40>
*. Essential Benifi
Hypertension
401
B. Ischc-sic Heart Disease 410-414
1. Cataract
x
,
Relative
|
Risk
75
I
Relat ivc
Risk
0.8
5
1.7
5
8
0.8
7
1.8
11
1.2
14
55
1.5
5
0.9
5
1.1
14
50
1.2
159
44
0.7
99
0.9
129
250
0.6
12
2
0.5
6
0.8
5
10
1.5
12
2
0.5
6
0.8
0
10
55
18
0.8
42
0.9
55
84
0.5
Cyl
1. Acute Myocardial
Infarct ion
410
34
9
0.7
25
0,8
28
5Q
0.4
2. Chronic Ischesi:
Heart Disease
412
13
8
1.6
14
1.5
22
41
0.6
3. Angina pectoris
413
9
I
0.5
5
0.8
5
8
1.1
C. Disorders of Heart
Rhyl hm
415-416
6
2
0.7
7
1.6
15
19
0.4
D. Other Fores of
Heart Disease
420-429
10
2
0.3
6
0.8
18
48
0.8
I. Heart Failure
427
1
1
2.9
5
5.1
16
46
0.8
E. Cerebrovascular
Disease
430-438
17
7
1.0
15
0.9
29
60
0.5
435
4
2
1.6
5
1.6
8
14
0.4
1. Transient ischendc
Attack
A.
Case-Control Relative Risks for Farming exposure - Males
>CC > 05
Afc 2 5-01
Never
I aravJ
l-H Year*
I
Kclat ive
Hi>k
lurat'd a 20 Year*
No. of
Re Lit ive
Risk
Never
I al>cj
lai’i.rd / 2U Year*
No. of
Cases
No. of
C.i'cs
35
104
Re)at 1vc
Risk
So. of
No. o f
Ca'e»;
142
<>0
4 5b
7
3
1.1
5
0.7
14
:s
0.6
4 J3-4JS
16
2
0.5
6
0.5
17
29
0.5
10
14
0.3
4
24
2.3
1.2
H-IC-A
I' I
i. .iR.'L ..r-. • •r
. but
73
111-
Vascular I’ i * c 3' e
Artvr ;ol
. 6
Caj’» l!a: ics
4S0
10
2
0.7
3
0.4
G. ’Ji c »<c5 <•!’ Vein-, and
I i ;•? it i« v . and Other
I ; :va<i-« of Circ
r.- Sys
4:0-439
28
11
0.9
23
1.3
451
4
3
1.8
6
2.1
3
8
45$
9
5
1.3
11
2.1
0
b
4OJ.513
43
IS
0.8
34
0.9
SI
104
0.6
I. Artcriosclernsi'
2. I r^crrJ-jxds
ri*c.i*ei nf the Respira
tory SystvT
A. Acute U;nt r Respiratory
inrvtti.rs
4i.G-4?C
3.
ia
1. Fur ."-.'ti: a,
Oryanisa !» Type
.N-'t Specified
C. Bronx hr t is,
Ast;.' I. s Related
Ct-nJrt ioni
1. Asthm
9
2
0.6
4
0.8
4
9
0.2
4*9-4$6
14
3
0.5
14
1.2
24
48
O.o
486
11
1
0.2
10
1.0
17
37
0.6
4S9-496
8
3
0.9
11
2.2
21
35
0.6
495
3
0
0.0
5
1.7
4
4
0.3
• ••••
A.
Case-Control Relative Risks for farming Exposure - Males
Aje 2 65
Age SS-O'J
Nr. er
Far-'-cd
I
Farmed 1-19 Years
No. of
C iv s
No .of
(.r-c*
142
CO
496
5
1
0. Other Diseases of the
Respiratory System
5C0-S19
18
Diseases of the Digestive
System
520-577
177
A. Diseases of Esophagus.
51 cmach, and l uodcr.ua
530-53’
47
11- I CHA
CUM KOI. i .l' lll’
(Injuries t Adverse
tf fee? s)
J
Chn aic Obstructive
tun . disease, Sot
Ui
• ••••
1. URer
a. Ulcer of DuoJer.ufl
2. Gastritis and
Duodcr.it 1 s
R< Lit i vc
Hi A
!
I
|
Farmed 2 20 Year*!
Never
Fanned
Jk-1 ,»t i vc
!«is4
No. t»f
Gives
N-». uf
r i- .•»
I
73
ranged 2 20 Year*
I
No. of
Re I nr > vc
Cases
M»«a
35
104
I
0.5
1
C.3
10
14
0.6
1.0
3
0.3
3
12
1.2
1.1
129
1.1
R2
170
0.7
90
1.6
24
0.'
16
30
0.6
30
20
0.8
5 31-554
30
II
1.0
14
0.7
9
0.3
11
0.8
0.6
6
10
20
7
532
1.5
S
0.5
5
0.3
15
in
5
533
2
2
0.3
8. Appendicitis
540-543
16
9
1.3
10
1.4
C. Ilcrr.ia of Alder.;..al
Cavity
$7
1 .6
0.9
3!
1.3
S3
S3
25
550-553
43
l.u
0.8
30
1.5
38
42
IS
550
8
13
0.6
13
0.8
32
0.6
34
$63-569
0
0.0
I
4
18
3
0.5
1.5
$'/:
1. Inguinal Hernia
hlthuut Mention of
Obstruct ion
D. Other Diseases of
Ir.tcst ine and
rerit'-nc’;.“i
I. intestine 0‘otrvct ion
• ••••
A.
Case-Control Relative Risks for Faming Exposure - Males
Apo 2S-G4
O
Age > 6S
Never
Never
Famed
taracd 1-19 Years
l>iTEno<tic Category
ll-ICDA
Cede
No. of
Cases
No. of
Cases
CO'-TTOL GROUP
(Injuries C Adverse
I fleets)
SOO-999
112
60
2. Functional Dis
order of Intestine
S64
8
1
L. DIsc.ihc* of the Liver,
Gallbladder and
Pancreas
S7O-S77
28
J.
Relative
Risk
Faracd 1 20 Years
Famed
Famed I 20 Years
Relative
Risk
No. of
Cases
No. of
Cases
35
104
No. of
Cases
I
73
Relative
1 Rtsk
0.2
2
0.S
2
9
1.2
14
1.2
29
1.5
24
S4
0.9
4
1.7
11
1$
0.6
1. Bi!iary Calculus
574
3
3
2.4
2. Other Diseases of
GalIbladder
575
1$
9
1.3
14
1.2
6
31
1.6
Diseases of the Genito
urinary Systea
580-629
89
34
0.9
72
1.1
75
210
1.0
A. Other Diseases of
Urinary Systca
590-599
S3
19
0.8
30
0.9
32
64
0.7
1. Calculus of Kidney
and Ureter
S92
30
8
0.6
17
0.8
6
6
0.4
2. Other Diseases of
Bladder
596
1
1
1.9
5
4.9
12
22
0.6
3. Stricture of Urethra
(ecatus)
598
7
2
0.8
3
0.7
2
6
0.9
4. Other Diseases of
Urirary Tract
599
1
2
2.2
1
2.4
3
16
1.6
8. Diseases of the Male
Cenical Organs
600-607
34
IS
1,1
44
1.6
42
149
1.3
600
14
6
1.0*
29
2.2'
40
128
1.2
680-709
21
10
1.0
11
1.1
7
18
0.9
1. Benign Prostatic
Hypertrophy
Diseases of the Skin and
Subcutaneous Tissue
• ••••
A.
• •••
Case-Control Relative Risks for Farming Exposure - Haler
A£O 25-64
IU££Host ic Category
Code
Never
Farmed
No. of
Cases
CUM KOI. f.RDtlp
(injuries f, Adverse
£ ri sen)
800-999
142
1I-1CDA
A. Infections of Skin and
Subcutaneous Tissue 680- 686
1. Other Cellulitis and
Abscess
682
Diseases of the Musculo
skeletal System C
Connective Tissue
710-739
A. Arthritis 6 Rheumatism
Except Rheumatic
Fever
710-718
1. Osteoarthritis 6
Allied Conditions
713
B. Ostconvelit is and Other
Diseases of Bone and
Joint
720-729
1. .Internal Derangement
of Joint
724
2. Disorders of Inter
vertebral Disc
72S
F-imed 1-19 Years
Farmed Jt 20 Years
No. of
Cases
No. of
Cases
60
Relative
Risk
Rclat vo
Risk
75
Never
Farmed
Ago I 6C
Farmed l 20 Years
NO. Ot
No. of
Cases
55
104
Rclat ivo
Risk
8
1.3
8
1.3
2
8
1.5
9
4
1.0
7
1.6
2
7
1.3
63
23
0.9
36
0.8
30 •
66
0.8
12
6
0.9
18
1.9
21
SO
0.8
2
4
S.2*
11
5.9*’*
17
39
0.9
44
17
1.0
IS
o.s
9
17
0.8
13
7
1.4
3
0.4
1
3
1.0
21
6
0.8
4
0.3
S
7
0.7
Congenital Anunalics
740-759
8
S
1.4
6
1.0
2
3
0.4
Signs. Symptoms 6 Illdefined Conditions
77O-7&6
88
30
0.8
50
0.9
36
55
0.5
774
6
2
1.0
7
1.3
S
3
0.3
A. Symptom Referable
to Heart 6 Vessels
• •••
A.
• ••••
• ••
Case-Control Relative Risks for Farming Exposure • Males
Sever
Famed
Ako 25-64
FaracJ 1-J9 Years
Farecd i 20 Years
No. of
Cases
IM CPA
Cede
So. of
Cases
Ko. of
SCO-9^9
142
CO
B. Other SyT-.ips’s
Fvfcr.iblc to Cardio*
vai.ula* 1
lyaphatic Systee
77$
7
2
0.7
C. Sysptoss deferable to
AbJeren t, Fcrit^-.e-.in
750
13
3
1.1
0. Other 'yopto^s Referable
to musculoskeletal
Sys’.ce
739
20
5
OPl-79?
735
273
!>» kntxtic C£tcgory
Rclativc
Risk
Helalivo
Risk
Ke ver
ParseJ
>'o. of
Cases
Ace S C!>
Farced * 20 Years
No. o f
Ciscs
Rol.it ivc
1 Risk
IVMROI.
(Inr.iric^ 4 Adverse
Lit eUS)
All Pl.ItllOAp*
(Lavvpt Control)
•
73
3$
0.4
1
7
2.0
11
0.9
3
6
0.6
0.6
8
0.7
2
3
n.s
0.9
$09
0.9
467
1.019
0.7
Relative risk statistically sign. ficantly greater than one p<.05
......
I
• Statistically significant opc^ur .■•risk relationship over tho two risk categories p*.05.
B.
Case-Control Relative Risks for Fanning Exposure - Females
Age ZS-CS
Never
Age 2 65
Never
FarTcJ
r.noed 1-19 Yean
r.iri*<.’J » 20 Years
Tarred
F:*r»cJ * 20 Years
Ko. c f
Cases
No. of
No. O t
t’SCS
ltcl.it ivo
Pisk
No. of
Cases
Cases
101
37
116
117
CM-136
43
12
0.6
13
0.7
17
23
1. 3
Incest ins I Infec
tious Pi- 3»C* iK> I -C Vj
30
6
0.5
0
0.7
?3
18
1.
ll-lCL’k
C
0 > ■>,; n m tie Otef -]_r v
|
Relative
Risk
No. <> f
He I ativc
Kisk
co:, raoi crjup
ltn;uric* 6 Adverse
111vet s)
Infective i Far
IU seaics
A.
Ui.i rr‘,.al
D i se ises
I.
00 J
23
3
0.3
5
0.7
12
10
c.s
UO-239
165
37
0.5
76
1.1
64
94
1.
140-195
56
10
0.5
31
1.2
43
60
Fri-srv •talignint
Neo;’1.1* • s of
PivcM t -c Organs
It Tcrit-'neum
152-159
5
0
0.0
5
2.2
17
26
1.9
1S3
3
0
0.0
4
2.5
8
13
2.1
Frjr.ary ’Mli-nant
.is:: vf Skin 5
Breast
170-174
24
3
0.4
14
1 .0
14
19
1.4
20
2
0.3
14
1.3
’2
16
1.4
Neoplasms
A.
Pri^a.-y ‘tai:gnan:
Neoplasms
I.
3.
a.
1
‘lal.^nj-it
Neoplasm of
lar^e Intes
tine. except
Rcctu.e
2.
41
.Mai i jjnsnt
Neo, Ins* of
Bre ist
174
1
• •••
6.
• •••
Case-Control Relative Risks for Farming Exposure - Females
Age 25-65
Never
Farxed 1-19 Years
Farmed » 20 Years
Never
Famed
Famed * 20 Years
No. of
Cases
No. of
Cases
No. of
Cases
116
J17
Diaenottic Category
H-1CDA
'•ode
Ko. of
Cases
Ko. of
Cases
COVTROi. GROUP
(Injuries 4 Adverse
Lf feels)
800-1>99
101
37
150-189
23
6
0.8
10
1.4
10
9
15
2
0.4
.3
l.l
0
1
3.
Primary Malignant
Neoplasm of
Genitourinary
Organs
a.
Q
Age > 65
Furled
Malignant Neoplasa of Cervix
Uteri
, Relative
I
Risk
Bclat ive
Kisk
41
Relative
Risk
1.2
B.
Secondary Malignant
Neopl k«s
106-199
10
0.6
5
1.2
11
14
c.
Benign .coplas^s
21O-22S
101
23
0.6
37
0.9
13
14
1.2
2.0
1.
Uterine Fibrom
218
37
6
0.4
IS
0.9
1
0
0.0
2.
Or'.er Benign Neo
pl.isa of Uterus
219
23
14
1.3
10
1.0
4
2
0.5
3.
Bc.’ign Ncoplasa
of Ovary
220
16
0
0.0
4
1.5
0
1
Endocrine, Nutrlti-'.al, 5
?JO-279
Mctjlxalic Diseases
25
10
0.9
14
1.7
24
33
5
0.7
12
2.1
18
24
1.3
0.6
12
2.2
18
23
1.3
A.
Diseases of Other
Endocrine Glands
1.4
?50-2S8
16
I. Diabetes Nellitus
2>0
14
Diseases of the Blood 8
Blood-ForrJ.ng Organs
280-2119
11
1
0.2
6
1.1
5
9
2.1
Mental Disorders
290-318
99
26
0.7
26
0.8
37
25
0.8
296-305
4
0
0.0
1
0.7
11
5
0.5
A.
Organic Brain
S/Duro^cs
3
• •••
B.
• •••
Case-Control Relative Risks for Farming Exposure - Females
Age 2 f>5
Age 25-65
Never
Never
Famed
fanned 1-19 Year*
Di.-.gnostic Category
II-1CDA
Code
No. of
Coses
Ko. of
Cases
CONTROL CROUP
(Injuries t> Adverse
Effects)
800-999
101
37
Psychoses Not
Attributed to
Physical Conditions 306-309
30
7
0.7
7
0.8
6
3
0.9
19
3
0.5
5
1.0
3
1
0.7
1.0
IS
1.3
15
14
1.1
B.
1.
Schizophrenia
306
( Relative
j
Risk
Famed 2 20 Year*
Famed
Fsracd i 20 Year*
No. of
Cases
No. of
Cases
No. of
Cases
116
117
Relative
Risk
41
Relative
1 Risk
C.
Neuroses
310
37
12
0.
Personality Disorders C
Certain Other Nunpsychotic Mental
311-314
Disorders
It
5
1.3
3
1.0
1
0
0.0
311
9
4
1.4
2
1.8
1
0
0.0
Diseases of the Nervous
Systea i Sense Organs
320-339
49
23
1.1
18
0.7
72
82
1.2
Diseases of Nerves 5
Peripheral Ganglia
3S0-358
IS
5
0.9
8
1.0
4
2
0.7
13
10
2.0*
4
0.6
61
71
1.2
4
0.9
57
59
1.1
1.
A.
B.
Personality
Disorders
Diseases and Conditions
of the Lye
360-379
374
9
7
2.4
380-389
13
4
0.6
3
0.4
4
3
0.9
Disease* of the Circulatory
390-458
Systea
98
31
0.9
55
1.3
177
218
1.3
Hypertensive Disease
400-405
12
3
0.7
7
1.0
15
18
l.S
Essential Benign
Hypertension
401
9
3
1.0
6
1.0
12
14
l.S
410-414
17
s
1.0
11
1.3
SI
53
1.1
1.
C.
A.
Disease of the Ear 6
Mastoid Process
1.
B.
Cataract
IsHier.ic Heart
Disease
• •••
B.
Case-Control Relative Risks for Farming Exposure - Females
Arc » 65
Arc 25-55
Never
Famed
Farmed 1-1? Years
hi.i;r.ostic Category
H-TCDA
C'.le
No. of
Cares
No. of
Cases
CONIROI t.ROL’F
(Injuries 6 Adverse
Effects)
693-999
101
57
Acute '!)ocardial
Infarct ion
41U
8
3
Chronic Ischceic
Heart Disease
412
7
1
415-416
12
416
420-429
I.
2.
C.
Disorders of Heart
Rhythm
1.
D.
Orher Foms of Heart
Disease
Farmed * 20 Years
Re1 at ivc
Risk
No. cf
Cases
No. of
Cases
116
117
No. c f
Cases
41
Rclative
Risk
9
8.()••»*
22
18
0.9
0.5
I
0.2
25
55
1.5
2
0.7
4
9.6
14
17
1.7
10
2
0.8
5
0.5
12
9
1.0
3
2
1.3
1
0.8
25
21
0.9
0.9
427
2
1
1.9
1
0.9
22
430-438
5
4
3.0
3
2.3
39
55
1.5
Transient Isch sic
Attack
43>
1
0
0.0
2
15.9
S
11
l.G
Acute, but IllDefined, Cerebro
vascular Disease
4 36
2
2
4.4
0
0.0
14
24
1.5
Diseases of Arteries,
Arterioles. G
440-418
Capillaries
440
1. Arteriosclerosis
5
1
0.5
5
2.0
22
30
1.3
3
0
0.0
2
5.4
12
1«
1.5
39
1 .9’
Heart Failure
Cerebrovascular
Disease
1.
2.
F.
Fai-ficd 1 20 Years
Famed
20
1.
E.
Ether Disorders <of
the Heart Rhythm
Relative
j
Risk
Never
Di<e.i-»ei of Veins and
lywpl.at its. and Other
Disc »*c> of Cir
450-458
culatory System
/
I
I
47
16
0.8
25
1.4
23
• •••
B.
• •••
Case-Control Relative Risks for Farming Exposure - Females
I Never
Age 25-65
Never
Farmed
Oingnostic Catcgary
I
Age 2r ( 5
Farmed 1-19 Years
Farmed 2 20 Years
Farmed
Farmed '<e 20 Years
No. of
Cases
No. o f
Cases
No. of
Cases
No. of
Cases
300-999
101
57
116
117
451
12
5
H-ICDA
Code
No. of
. Relative
I
Risk
Cases
ilclat ivc
Risk
Rel.it ivc
1 Risk
CONTROL CROUP
I Injuries (■ Adverse
Effects)
I.
l*lilob i t i * .muI
ihro";bu|>!ilcbit is
2.
Varicose Veins of
Louer Extremities
3.
Ilc-orrhoids
45S
Diseases of the Respiratory
System
460-519
B.
41
1.0
9
1 .6
8
8
1.2
1.8
14
8
1.3
6
0.8
7
11
14
2
0.3
4
0.9
0
4
62
10
0.5
15
0.6
43
69
Acute Upper Respiratory
Infect ions
460-470
18
1
0.2
4
0.5
10
13
1.5
480-486
19
4
0.5
3
0.6
16
28
1.8
Pneumonia
1.
rneunon i a,
Organism f, Type
Not Specified
4S6
14
5
U.S
3
0.8
12
17
1 .4
C.
Bronchitis, Emphysema,
Astl.'ta. 5 Related
Condi t ions
4S9-496
13
4
1.1
2
0.3
IS
18
1.3
0.
Other Diseases of the
Respiratory System 500-519
14
1
0.1
6
1.2
A
11
2.S
Diseases of the Digestive
System
A.
220
72
0.9
75
0.8
92
14 0
1.6“*
Diseases of Esophagus,
Stomach and Duodenun
530-537
48
17
1.3
10
0.4
23
38
1.8*
531-534
10
10
2.2
9
1.0
IS
24
1.5
531
10
3
1.3
S
1.0
9
12
1.7
1.
Ulcer
a. Ulcer of
Stomach
J.
I
§
• •••
B.
• •••
• •••
Cas$ Control Relative Risks for Farming Exposure - Females
Age i 65
Ago 25-6$
Never
farmed
Parsed 1-19 Years
Diagnostic Category
M-IC0A
Code
No. of
Cases
No. of
Cases
COVIROL Gl’Our
(Injuries 6 Adverse
Effects)
SOO-999
101
37
b. Ulcer of
Duodent s
S32
5
6
2.
Gastritis and
Ih todenitis
Relative
Risk
Faraod » 20 Years
Never
Formed
Farmed I 20 Years
Relative
Risk
No. of
Casos
No. of
Cases
116
117
No. of
Cases
41
4.8*
Relative
Risk___
3
1.4
7
6
0.8
3.6
53S
20
7
1.2
1
0.1
2
8
B.
Appendicitis
S40-543
13
S
0.7
6
1 .4
1
1
C.
Hernia of Abdominal
Cavity
SS0-5S3
26
6
0.5
S
0.8
8
14
2.0
SSI
15
2
0.3
4
O.8
3
7
3.2
Other Diseases of
Intestine and
Fcritoncua
560-SO9
46
12
0.7
17
1.2
33
35
1.1
Intestine Ob
struction
560
5
1
0.3
3
2.1
7
1?
1.6
Diverticular Disease
of Intestine
562
7
2
0.8
5
2.1
7
9
1.1
functional Disorder
of Intestine
564
20
3
0.3
6
1.0
10
7
0.9
Diseases of the Liver,
Gallbladder, and
570-577
Pracrcas
85
29
0.9
34
0.8
30
S3
2.0
1.9
1.9-
1.
0.
1.
2.
3.
E.
Other Hernia of
Abdominal Cavity
Without Mention
of Obstruction
I
1.
Biliary Calculus
S74
4C
15
0.9
15
0.8
9
14
2.
Other Diseases of
Gallbladder
575
42
14
0.8
18
0.9
21
36
• • ••
B.
• •••
Case-Control Relative Risks for Farming Exposure - Females
Ago 2S-6S
Age I 65
Never
Famed
Farmed 1-19 Years
Farmed * 20 Years
Never
Famed
ll-ICOA
Code
No. of
Cases
No. of
Cases
No. of
Casos
No. of
Cases
No. of
Cases
800-999
101
37
116
117
580-629
296
79
0.7
125
1.0
50
73
i.r*
590-599
45
12
0.7
24
1.1
28
30
1.2
590
9
1
0.3
1
0.3
4
3
0.9
Cystitis
592
595
18
5
3
0
0.4
0.0
8
4
0.8
1.4
5
5
4
5
0.9
1.3
Other Diseases of
Urinary Tract
599
4
7
5.9«*
4
3.2
7
11
1.9
610-611
48
5
0.3
10
0.5
5
9
2.7
610
Diseases of Ovary,
Fol lopian Tube,
Parametrium
612-617
1. Other Diseases of
Ovary and
Fallopian Tube
615
45
5
0.3
10
0.5
5
5
1.5
20
6
0.9
3
V 5
9
6
1.9
3
1.1
184
56
0.7
88
1.1
16
29
2.4*
IH.igncstic Category
Rolative
Risk
Pclativo
Risk
Farmed 2 20 Years
. Relative
I
Risk
CCKTHOL GROUP
(Injuries 4 Adverse
Lffccts)
Diseases of the Genito
urinary System
A. Other Diseases of
Urinary System
1. Infection of
Kidney
2. Calculus of
Kidney and Ureter
tn
3.
4.
8.
Diseases of the
Breast
1.
C.
D.
Fibrocystic
Disease of
Drcast
Diseases of the Uterus
6 Other Female
Genital Organs
<
619-629
41
• •••
B.
Case-Control Relative Risks for Farming Exposure - Females
Age i 6$
Age 2S-6S
Never
Tarred
Farmed 1-19 Years
[>i ignostic Category
H-ICDA
Code
No. of
Cases
No. of
Cases
CONTROL (’
.ROUP
(Injuries 6 Adverse
L(feels)
800-999
101
37
l.ndorretl iosis
619
9
10
2.2
5
1. I
Uterovaginal
Prolapse
623
17
4
0.5*
27
3.
Other Diseases of
Uterus
625
26
8
0.8
4.
Disorders of
Menstrual Cycle
626
107
25
S.
Menopausal
Postmenopausal
Symptoms
627
14
Del ivory a-id Compl icat ions
of Pregnancy, Child
birth 6 the
Pucrperium
i631-678
1.
cr
A.
B.
Farmed i 20 Years
No. of
Cases
No. of
Cases
No. of
Cases
116
117
3.2**>*
10
25
3.f
13
0.8
1
1
2.1
0.5
27-
0.7
1
0
0.0
0
0.0
12
0.9
2
0
0.0
599
263
0.8
52
0.5
Rclat ive
Risk
Rclativc
Risk
<11
Complications of
Pregnancy
631-639
51
23
0.8
4
0.3
1.
Hemorrhage of
Pregnancy
632
10
5
0.9
1
0.5
2.
Other Complications
Mainly Related to
Pregnancy
634
25
14
1.0
2
0.4
640-M6
33
1.3
10
1 .4
Abortion
1.
C.
Farmed S 20 Years
Never
Farmed
Spontaneous
Abortion
Delivery
643
32
20
1.3
9
1.3
650-664
546
233
0.8
42
0.5
|
Relat ivc
Risk
B.
C^e-Control Relative Risks for Farming Exposure - Females
A|;o 2S-65
Never
F.’. med
Farmed 1-19 Years
No. of
Cases
No. of
Cases
SOO-999
101
37
Without Mention
of Complication
650
362
154
0.7
26
0.4
2.
i’cI i very
Complicated by
Dystoclc Position
of Fetus
656
25
10
0.7
0
0.0
3.
Del ivory
Complicated by
Prolonged Labor
of Other Origin
Del ivory with
Laceration of
Perineum Without
Mention of Other
Lacerat ion
Delivery with
Other
Coraplications
657
10
5
0.6
2
1.1
658
64
35
1.1
8
0.S
664
38
17
0.9
4
0.6
680-709
17
6
0.9
12
680-686
7
5
1.5
700-709
8
0
0.0
II-ICDA
Ci'de
I>i »unn<t ic Cit epory< UM IUH. CROUP
(Injuries ' Adverse
Effects)
I.
4.
5.
, Relative
I
Risk
A£c J 6S
Farmed 2 20 Years
No. of
Rc1 a t i ve
Cases
Risk
Never
Farmed
No. of
Cases
Cases
41
116
117
3.3
14
26
1.8
4
2.2
3
9
2.7
4
3.0
7
12
1.8
I
Farmed t 20 Years
No. of
Relative
Risk
Lie 1 i very
Diseases of the Skin
and Subcutaneous
Tissue
A.
Infections of Skin
and Subcutaneous
Tissue
B.
Other Diseases of
Skin .ml Sub
cutaneous Tissue
• •••
B.
••••
• •••
Case-Control Relative Risks for Farming Exposure - Females
Agr 25-6S
Age * 65
Never
Farmed
Fanned 1-19 Year?
Farmed i 20 Years
No. of
Cases
Never
Farmed
No. of
Cases
No. of
Cases
116
117
Farmed X 20 Years
diagnostic Category1
ll-ICDA
Code
No. of
Cases
No. of
Cases
COMROL CROUP
(Injuries G Adverse
effects)
SOO-999
101
37
710-739
Arthritis 8 Rheuma
tism except
Rheumatic Fever
710-718
1. Osteoarthritis &
\* Iied Conditions
713
Osteomyelitis and
Other Diseases of
Bone and Joint
720-729
1. Disorders of
Intervertebral
Disc
725
Other Diseases of
Musculoskeletal
System
730-739
73
20
0.7
34
1.1
55
80
1.5
19
4
0.5
12
1.0
31
63
2.2-*
6
4
2.1
5
1.3
24
S3
2.3
40
13
0.8
16
1.0
19
11
0.6
24
4
0.3
6
0.7
4
0
0.0
Diseases of the Mus
culoskeletal System
6 Connective Tissue
A.
B.
co
c.
Ritat ivo
Risk
Relative
Risk
41
Relative
Risk
15
3
0.6
7
1.4
6
7
1.4
Signs. Symptoms G
Ill-Defined Conditions 770-796
184
35
0.7
55
1.3
54
60
1.2
1.
Otner Symptoms
Referable to
Cardiovascular
6 Lymphatic
System
775
6
1
0.5
5
1.2
6
11
1.6
2.
Symptoms Referable
to Abdomen G
Peritoneum
780
32
12
0.6
14
1.6
8
12
1.9
• •••
B.
•••••
••••••
Case-Control Relative Risks for Farming Exposure - Females
AjiC 25-65
Ago a 65
L’2£U£iIi£ Category
II- 1CDA
Code
Never
Famed
Ko. of
Cases
COXfRCI. GROUP
(Injuries C Adverse
(.ffccts)
SOO-999
101
5’
7;.9
17
5
0.8
5
0.8
10
7
0.7
001-799
1,732
586
0.8
S30
1.0
628
802
1.3
3.
Other Symptoms
Referable to
Muscu1oskc1etal
System
All Diagnoses
Farmed 1-19 Years
No. of , Relative
Cases
|
Risk
Farmed > 20 Years
No. of
Relative
C-aCS
Risk
Never
Farmed
No. of
Cases
Farmed » 20 Yrars
No. of
Relative
Cases
J Risk
4]
116
117
Rol-tive risk statistically j igniflcantly greater than one p<.05, p<.01.
Statistically significant exposure - risk relationship over the two risk categories p<.(5.
KI
APPENDIX III
RELATIVE risks for smoking and selected diagnoses
t
• •••
• •••
• ••••
Relationships Between Smoking History and Selected Diagnoses - Males
A.
Age 2S-64
Never
Smoi ••A
Low Smoking
Ago i 65
High ’wbokii.if
Pi.ivjh'stic Catcgary
H-ICD-X Codes
\’o. or
Cases
No. of
Cases
Control Croup
(Injuries (, Adverse
Lf fects)
S09-M9
82
84
Malignant Neoplasm of Trachea
Bronchus & Lung
162-163
0
0
Pisca>cs of the Circulatory
System
390-4S8
66
37
0.9
179
400-405
410-414
3
30
S
6
1.4
0.4
410
19
2
412
413
7
2
3
A. Hypertensive Disease
B. Ischemic Heart Diseases
1. Acute Myocardial
Infaict ion
Relative
Risk
Never
Smoked
Low Smoking
High Smoking
No. of
Cases
No. of
109
63
31
10
5
1
0.4
19
2.8*
1.6**
187
59
0.6
178
1.1
12
79
3.5
1.4
4
2.2
1.1
6
69
1.5
$6
4
29
0.2
47
1.3
27
12
0.9
37
1.4
1
3
0.4
2.9
2.0*
2.8
14
3
7
1.0
6.3
0.7
1.2
12.1*
1.2
28
1
IS
28
9
3
27
11
9
13
1.1
5
3
1.0
10
1.2
37
6
0.3
25
0.8
9
5
1.0
23
1.3
54
10
0.4
34
0.7
1.8
8
6.1
11
1
0.1
14
1.5
Relative
Risk
Vo. of
Cases
Cases
Relative
Risk
No. of
Cases
Relative
Risk
56
1.3
2. Chronic Ischemic
Heart Disease
3. Angina Pectoris
C. Disorders of Heart Rhythm 415-416
D. Other Forms of Heart
Disease
420-429
L. Cerebrovascular Disease
430-438
1.9
1. Transient Ischemic
Attack
435
1
2. Acute, but Ill-defined
Cerebrovascular Disease
4 36
4
2
1.0
9
1.1
24
2
0.1
19
1.0
F. Diseases of Arteries,
Arterioles, 6 Capillaries
410-418
1
3
5.5
20
8.5*
25
6
0.4
25
l.i
440
1
2
4.2
12
15
15
1.2
32
14
13
1
2
0.2
450-458
5.1
1.4
0.4
13
18
1.0
1.3
4S1
4
5
1.9
4
0.6
S
1
n.s
3
1.2
455
7
3
0.5
15
1.6
3
0
0.0
3
0.9
1. Arteriosclerosis
G.
Diseases of Veins
Lymphatics 5 Other
Circulatory Diseases
1.
Phlebitis & Thrombo
phlebitis
2.
Hemorrhoids
J
• ••••
• •••
• ••••
F
s
i
A.
Relationships Between S.noking History and Selected Hiagnoses - Males
Age
Age 25-64
Never
Smoked
No. of
High Smoking
Low Smoking
Rclat ivc
Risk
No. of
Cases
£«i.ir tost ic Cat ego i'V
II-ICPA Codes
Cases
No. of
Cases
Control Croup
(Injuries and A Iverse
Effects)
800-999
32
84
Diseases of the Respiratory
System
400-519
25
IS
0.8
57
ICO -470
3
2
0.6
9
G5
l.ow Smokinr,
Relative
Risk-
.’•’ u . o f
Cases
No. of
C.i 'CS
63
31
1.4
71
19
0.5
2.2
9
1
0.9
40
5
Pel nt ivc
Risk
109
A. Acute Upper Respiratory
Infections
: ver
: .iokcd
lit ph Smoking
No. of
Cases
!
I
Rvlatjvc
Risk
56
82
1.3
0.2
5
0.7
0.2
34
1.0
B. Pneumonia
480-486
11
3
0.4
17
C. Bronchitis, Emphysema,
Astk.-'i 5 Related
C.nditsons
439-496
4.
5
3.0
16
2.1
14
11
1.8
37
2.8
0.4
4
3
1.8
1
0.2
2.8
5
5
2.7
19
3.9**
1. As th ‘.a
493
3
2
1.7
3
2. Chronic Ob--.tract ivc
Lung Disease
496
1
0
0.0
6
D. Other Diseases of the
Respiratory System
500-519
8
S
0.6
IS
1.3
8
3
0.6
7
531-534
10
1.3
35
9
6
1.0
23
3
9
2.7
25
4
4
1 .8
14
2.9*
532
2.0
S.7*
1.1
2.6*
10
(Except Controls) 001-799
433
310
0.8
816
1.2
681
255
0.7
720
1.1
ra
Ulcer
A. Ulcer of Duodenum
All Diagnoses
Statistically significant relationship between amount smoked and relative risk
p<.05.
pc.Ol
4
••••
• •••
B.
••••
••••
Relationships Between Smoking History and Selected Diagnoses - Females
Age 2S-64
Nover
S...okcd
;c Category
H-JCD\ CoJcs
No. Of
Cases
Control Croup
(Injuries 6 Adverse Effects)
SOO-999
9S
45
162-163
1
0
Syston
390-45S
104
A. Hypertensive Disease
40 ;-405
15
I
'L»i ignar.t Nv’.'plasn of Trachea,
?ro.icmis i Lung
II
Diseases of the Circulatory
B. Ishccrsic Heart Disease
1. Acute Myocardial
I a fret i v n
i
Low Sr.oking
2. Chronic Ische-.ic
heart Disease’
C. Disorders of Heart Rhythm
410-414
410
No. of
Cases
Rcl .it ive
Kisk
Age x OS
High Smoking
No. of
Cases
Ke 1 ativc
Kisk
Never
S:..okcd
Di seas?
E. Cerebrovascular Disease
F. Diseases of Arteries,
Arteri'ler- ar.d
Ca;-11 i ar it t
1. Arteriosclerosis
No. of
Cases
231
5
7.4
3
1
14.7
2
39
1. rali-bitis (,
Ihrj-tonhlcbitis
Re I ative
Risk
No. of
Cases
Re!ative
Risk
14
0.0
3
25
0.5
55
1.4
380
IS
2.0
33
1.5'
3
0.4
4
0. 7
29
2
2.2
4
IS
2.2
2
0.S
16
2.4
100
4
2.1
12
2.0
4
2
3.1
11
13.
38
2
2.6
6
2.3
11.4
412
7
0
0.0
2
0.6
56
2
2. fi
415-416
4
8
1.4
2
0.6
8
2.0
26
1
l.S
6
3.6
1
0.7
0
0.0
46
1
1.3
2
0.8
1
1.6
7
1.7
97
2
1.4
5
1.2
420-429
I
S
4 30-4 38
440-419
7
3
1.8
1
0.3
48
0
0.0
440
5
2.0
1
3
14.7
1
2.9
29
0
0.0
2
1.4
52
16
0.5
20
1.1
60
5
3.1
2
0.6
0.5
5
0.9
14
2
3.6
1
1.0
G. ?ise.:ses of kcins,
!'h it i < s, 4 Other
Cirv Jatory Diseases
High Snoking
No. of
D. Other For s of Heart
I
Low Sr.okir.g
45C-4S8
451
1/
r
B.
Relatio.iships Between Smoking History and Selected Diagnoses - Females
Age 2;-G4
Never
S.nokcd
Lew Sacking
A c x GS
High Sacking
Never
Sacked
Nu. of
Casos
No. of
Cases
Lew Soo ing
High Sacking
No. of
Cases
No. of
Cases
803-999
95
45
2. Varicose Veins of Lower
I\t remitics
454
19
6
0.5
3
0.5
17
2
5.1
0
0.0
5. iL-orrhoids
4$S
9
3
0.5
8
2.0
6
0
0.0
0
0.0
460-519
38
24
1.0
25
1.4
10S
3
1.3
13
2.2
460-47U
10
9
1.6
4
0.7
19
1
2.1
4
3.6*
4S0-486
9
8
1.5
9
2.1
44
1
1.2
4
1.7
439-496
9
3
0.5
7
1.7
30
0
0.0
5
2.6
500-519
11
5
0.5
5
1.0
18
1
3.5
0
0.0
531-53!
16
7
l.H
14
2.1
33
2
2.’
3
1.2
A. Ulcer of Stomach
5 31
8
5
2.4
5
1.4
19
1
1.8
2
1.7
o. Ulcev uf DuoJc.nua
$32
5
2
1.6
7
3.6*
12
1
417
0
0.0
0C1-799
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333
0.7
451
1.0
1400
75
2.2
99
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>
t ic Category
H-ICHA Codes
tr.'I Croup
(Injuries 5 Adverse Effects)
Relative
Risk
Rclat ive
Risk
59
of
4-
i dative
Risk
S
231
No. of
Cases
Relative
Risk
14
u. ric'.’.ises of Veins.
l.> - ■*> »t ics , G Other
Cj 1tulatory Diseases'
(x-ont.)
t»f the Respiratory
c L’r.cr Respiratory
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f
a
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Statistically significant relati< nship between amount sacked and relative risk
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Position: 4700 (1 views)