an unattended finding: associations of agricultural airborne pesticide vapors

An unattended finding: associations of An unattended finding: associations of agricultural airborne pesticide vapors agricultural airborne pesticide vapors

attaining inhabited areas with attaining inhabited areas with respiratory symptoms of 7–11 years old children respiratory symptoms of 7–11 years old children

in Heves county, Hungaryin Heves county, Hungary

M. J. VarróM. J. Varró11, Z. Virágh, Z. Virágh11, Gy. Gombkötõ, Gy. Gombkötõ22, M. Szeremi, M. Szeremi22, P. Rudnai, P. Rudnai11

11Fodor József National Center for Public Health,Fodor József National Center for Public Health, National Institute of Environmental Health; Budapest, Hungary; National Institute of Environmental Health; Budapest, Hungary;

22National Public Health and Medical Officer Service,National Public Health and Medical Officer Service,Institute of Heves County; Eger, HungaryInstitute of Heves County; Eger, Hungary NCPH NIEH NCPH NIEH

NPHMOSNPHMOS

NCPH NIEH NCPH NIEH NPHMOSNPHMOS

INTRODUCTION 1.INTRODUCTION 1.

Nat. Inst. Environ. HealthNat. Inst. Environ. Health

Fodor József Nat. Center Publ. Health,Fodor József Nat. Center Publ. Health,

(formerly: Nat. Inst. Hyg.,)(formerly: Nat. Inst. Hyg.,)

Budapest, HungaryBudapest, Hungary

Nat. Publ. Health & Med. Officer ServiceNat. Publ. Health & Med. Officer Service

series of series of

highly uniform highly uniform

environmental epidemiologic surveys environmental epidemiologic surveys

among 7–11 y childrenamong 7–11 y children



1995/961995/96 CESAR - international survey CESAR - international survey

- - 5 towns, N=37205 towns, N=3720

- questionnairequestionnaire

- physical examination- physical examination

- spirometry- spirometry

- measures of outdoor air pollutants - measures of outdoor air pollutants



QuestionnaireQuestionnaire

- health endpoints- health endpoints

- indoor environmental factors- indoor environmental factors

- other influencing factors- other influencing factors

Main findingMain finding

- respiratory symptoms - respiratory symptoms

& yearly average cc PM& yearly average cc PM



19971997 12 towns,12 towns, N=6221 N=6221

19981998 6 towns, 6 towns, N=1768N=1768

19991999 3 towns, 3 towns, N=1579N=1579

2000 2000 6 counties, 6 counties, N=2354N=2354

20012001 Heves county,Heves county, N=2540N=2540

20022002 Budapest 2 distr.+1 suburban,Budapest 2 distr.+1 suburban, N=567N=567

... arised:

agricultural airborne pesticide sprays

do attain inhabited areas (no report)

Highly significant associations

with health endpoints




OBJECTIVEOBJECTIVE

To evaluate the associations To evaluate the associations

of pesticide spraysof pesticide sprays

with respiratory symptoms with respiratory symptoms

- of 7–11- of 7–11 year old children year old children

- in 40 - in 40 villages of an area of Heves county villages of an area of Heves county

- in 2001- in 2001

Allergic symptomsAllergic symptoms

- house dust - house dust

- pollen- pollen

- animal hair, feather- animal hair, feather

- food- food

- medicine- medicine

- other- other

- diagnosis: by a doctor?- diagnosis: by a doctor?

METHODS 1.METHODS 1.


Neurotic symptoms:Neurotic symptoms:

at least two ofat least two of

- lack of appetite- lack of appetite

- fatigue- fatigue

- headache- headache

- irritability- irritability

- anxiety- anxiety



Head mucosal symptoms:Head mucosal symptoms:

at least one ofat least one of

- conjunctivitis- conjunctivitis

- blocked nose- blocked nose

- sinusitic complaints- sinusitic complaints

- earache- earache



Bronchitic symptomsBronchitic symptoms

regular coughregular cough

- in autumn-winter- in autumn-winter

- mornings- mornings

- days/nights- days/nights

- daily, >3 months- daily, >3 months

- with sputum- with sputum



Asthmatic symptomsAsthmatic symptoms

- in the last 12 months- in the last 12 months

- wheezing- wheezing

- dry cough at night - dry cough at night

- asthma- asthma

- ever diagnosed by a doctor- ever diagnosed by a doctor





Data entry, - processionData entry, - procession

- Epi Info 6.04d- Epi Info 6.04d

AnalysisAnalysis

- STATA 7.0- STATA 7.0

- bivariate tabulation- bivariate tabulation

- backward logistic models - backward logistic models

Reported symptoms 1. Reported symptoms 1. 7–11 years old children, 7–11 years old children,

Villages, Heves county, Hungary, 2001Villages, Heves county, Hungary, 2001 %%

00

5050

21.821.8 20.320.3

N=1718N=1718 NCPH NIEH NCPH NIEH NPHMOSNPHMOS

Allergic symptomsAllergic symptoms Min. 2 neur. sy.-sMin. 2 neur. sy.-sN=1647N=1647

2525

NN00=2437=2437

N=1819N=1819

74.6%74.6%

N=1471N=1471

Reported symptoms 2. Reported symptoms 2. 7–11 years old children, 7–11 years old children,

Villages, Heves county, Hungary, 2001 Villages, Heves county, Hungary, 2001 %%

00

5050 46.346.3

14.114.1

N=1647N=1647NCPH NIEH NCPH NIEH

NPHMOSNPHMOS

Head mucosalHead mucosal AsthmaticAsthmatic

2525 15.515.5

BronchiticBronchiticN=1623N=1623

Agricultural airborne pesticide sprays Agricultural airborne pesticide sprays attaining inhabited areas attaining inhabited areas

Villages, Heves county, Hungary, 2001Villages, Heves county, Hungary, 2001

No spraysNo sprays SpraysSprays

%%

7575

5050

00

2525

90.890.8

9.29.2

100100


NPHMOSNPHMOS

82.5%82.5%of the villagesof the villages

(n=40)(n=40)

Agricultural airborne pesticide sprays Agricultural airborne pesticide sprays attaining inhabited areas attaining inhabited areas

Villages, Heves county, Hungary, 2001Villages, Heves county, Hungary, 2001

Vineyard territoriesVineyard territories General agriculturalGeneral agricultural

%%

7575

5050

00

2525 6.16.1

13.913.9

100100


NPHMOSNPHMOS

93.993.9 86.186.1OR=2.48***OR=2.48***

(95% CI= (95% CI= 1.76–3.44)1.76–3.44)

N=653N=653


Agricultural airborne pesticide sprays/ Agricultural airborne pesticide sprays/ inhabited areas and inhabited areas and allergicallergic symptoms symptoms

7–11 years old children, 7–11 years old children, Villages, Heves county, Hungary, 2001Villages, Heves county, Hungary, 2001

%% OR=2.13*** OR=2.13*** (95% CI=1.48–3.07)(95% CI=1.48–3.07)mOR=2.23*** mOR=2.23*** (95% CI=1.48–3.37)(95% CI=1.48–3.37)goodness-of-fit: p=0.69goodness-of-fit: p=0.69

5050

00

2525 20.120.1

34.934.9

7575


N=1451N=1451



%% OR=2.19*** OR=2.19*** (95% CI=1.51–3.17)(95% CI=1.51–3.17)mOR=2.33*** mOR=2.33*** (95% CI=1.55–3.51)(95% CI=1.55–3.51)goodness-of-fit: p=0.18goodness-of-fit: p=0.18 5050

00

2525

18.618.6

33.333.3

7575


N=1391N=1391

Agricultural airborne pesticide sprays/ Agricultural airborne pesticide sprays/ inhabited areas and inhabited areas and neuroticneurotic symptoms symptoms


Agricultural airborne pesticide sprays/ Agricultural airborne pesticide sprays/ inhabited areas and inhabited areas and head mucosalhead mucosal sy.-s sy.-s


%%

OR=1.51* OR=1.51* (95% CI=1.08–2.14)(95% CI=1.08–2.14)

5050

00

2525 45.145.1

55.655.6

7575


N=1391N=1391


%%

OR=1.93** OR=1.93** (95% CI=1.28–2.92)(95% CI=1.28–2.92)

5050

00

2525 14.514.5

24.624.6

7575


N=1382N=1382

Agricultural airborne pesticide sprays/ Agricultural airborne pesticide sprays/ inhabited areas and inhabited areas and bronchiticbronchitic sy.-s sy.-s 7–7–

11 years old children, 11 years old children, Villages, Heves county, Hungary, 2001Villages, Heves county, Hungary, 2001


%% OR=1.82** OR=1.82** (95% CI=1.20–2.78)(95% CI=1.20–2.78)

5050

00

2525 13.313.3

21.921.9

7575


N=1450N=1450

Agricultural airborne pesticide sprays/ Agricultural airborne pesticide sprays/ inhabited areas and inhabited areas and asthmaticasthmatic sy.-s sy.-s



DISCUSSION 1.DISCUSSION 1.

Whether it is really possible? Whether it is really possible?

- to check - to check retroretrospectively spectively

- flight documentations - flight documentations

- to check - to check proprospectively spectively

- biological monitoring- biological monitoring


DISCUSSION 2.DISCUSSION 2.

ChanceChance

- high p-values!- high p-values!

BiasBias

- recall bias?- recall bias?

ConfoundingConfounding

- not probable- not probableNCPH NIEH NCPH NIEH

NPHMOSNPHMOS

SUMMARY 1.SUMMARY 1.

- Pesticide sprays do attain inhabited areas- Pesticide sprays do attain inhabited areas

- Respiratory symptoms- Respiratory symptoms

- 7–11 y children- 7–11 y children

- N=1819 survey questionnaires- N=1819 survey questionnaires



- - allergic and neurotic symptomsallergic and neurotic symptoms

- - prevalences: 21.8%, 20.3%prevalences: 21.8%, 20.3%

- pesticide sprays attaining inhabited areas: 9%- pesticide sprays attaining inhabited areas: 9%

- odds ratios: 2.13*** (2.23***), 2.19*** (2.33***)- odds ratios: 2.13*** (2.23***), 2.19*** (2.33***)



- head mucosal, bronchitic, asthmatic sy.-s- head mucosal, bronchitic, asthmatic sy.-s

- prevalences: 46.3%, 15.5%, 14.1%- prevalences: 46.3%, 15.5%, 14.1%

- odds ratios: 1.51*, 1.93**, 1.82*- odds ratios: 1.51*, 1.93**, 1.82*


CONCLUSIONCONCLUSION

Specially designed Specially designed investigationsinvestigations

- environmental health impact- environmental health impact

- pesticide spraying- pesticide spraying

Official measuresOfficial measures


HUNGARIAN NEHAP SECRETARYHUNGARIAN NEHAP SECRETARYDr. Anna Páldy Dr. Anna Páldy

„„Fodor József” NCPH NIEH Fodor József” NCPH NIEH DEPT. COMMUNITY HEALTHDEPT. COMMUNITY HEALTH

Annamária Mácsik, Tamás Rudnai, Eszter Szabó, Annamária Mácsik, Tamás Rudnai, Eszter Szabó, Renáta Szentmihályi, Györgyi TóthRenáta Szentmihályi, Györgyi Tóth

SCHOOLS, MUNICIPALITIES, HEALTH SERVICESSCHOOLS, MUNICIPALITIES, HEALTH SERVICES directorship of schools, class leaders, maires, directorship of schools, class leaders, maires,

youth and district nursesyouth and district nurses

FAMILIESFAMILIES parents, childrenparents, children

THANKSTHANKS


Thanks Thanks

for the for the

attentionattention


an unattended finding: associations of agricultural airborne pesticide vapors

Documents

ncph nieh nphmos1997

ncph nieh nphmosnat

sputumncph nieh nphmosmethods

doctorncph nieh nphmosmethods

ncph nieh nphmosdata

area of heves county

asthmatic symptoms

neurotic symptoms