Medically reported work-related ill-health in the UK agricultural sector

Our plain-English summary of Medically reported work-related ill-health in the UK agricultural sector, by S.J. Stocks, S. Turner, M. Carder, et al (Occupational Medicine, 2010).

The study

• Authors: S.J. Stocks, S. Turner, M. Carder, L. Hussey, R. McNamee, R.M. Agius
• Journal: Occupational Medicine
• Published: 2010;60(5):340-7
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Self-reported work-related ill-health (WRI) statistics suggest that agricultural workers in the UK are at an increased risk of musculoskeletal disorders (MSD), skin and respiratory disease. However, there is little comprehensive medically reported information on WRI in the UK agricultural sector.

Methods: Cases of WRI within the UK from 2002 to 2008, as reported to The Health and Occupation Reporting (THOR) network by occupational physicians, clinical specialists and general practitioners, were analysed. Directly standardized incidence rate ratios (SRRs) for the agricultural sector versus all other sectors were calculated for dermatological, musculoskeletal, respiratory and psychological illness, using as the standard population the UK working population as estimated from the Labour Force Survey.

Results: During 2002-08, 471 cases within the agricultural sector were reported to THOR (2% of all cases). Based on reports by clinical specialists, male agricultural workers aged <65 years had significantly raised SRRs for MSD (2.3, 95% CI 1.6-3.3), allergic alveolitis (32, 95% CI 19-51), asthma (1.9, 95% CI 1.2-3.0) and skin neoplasia (7.9, 95% CI 5.8-10.9) and a significantly reduced SRR for asbestos-related respiratory disease (0.4, 95% CI 0.2-0.7). Reports of mental ill-health in agricultural workers were low.

Conclusions: These medically reported incidence data provide information on WRI in the UK agricultural sector. Consistent with other sources, there are increased risks for asthma, allergic alveolitis and MSD and a reduced risk for mental ill-health. The raised incidence of skin cancer requires confirmation and further comparison with reliable estimates of the incidence in the UK workforce.

In plain English

This study analysed cases of work-related ill-health in the UK reported by doctors from 2002 to 2008 to The Health and Occupation Reporting (THOR) network, a voluntary surveillance scheme. The authors compared agriculture and forestry workers with all other employment sectors combined, using age-standardized rate ratios based on Labour Force Survey population estimates. Of 28 162 actual case reports from clinical specialists, 471 were in the agricultural sector. Few reports involved women, so standardized ratios were given for males only. Among male agricultural workers aged 16 to 65, ratios were raised for skin neoplasia (7.9, 95% CI 5.8 to 10.9), allergic alveolitis (32, 95% CI 19 to 51), asthma (1.9, 95% CI 1.2 to 3.0) and musculoskeletal disorders (2.3, 95% CI 1.6 to 3.3). For pneumoconiosis, mesothelioma and non-malignant pleural disease combined, the ratio was significantly reduced (0.4, 95% CI 0.2 to 0.7). Asbestos was the suspected agent in 12 of 13 actual cases. No lung cancer was reported in agricultural workers. The authors concluded that the raised rates of asthma, allergic alveolitis and musculoskeletal disorders confirmed previous reports, but that the high skin cancer estimates need confirming.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Analysis of a voluntary medical surveillance scheme (THOR), with directly age-standardized incidence rate ratios comparing the agricultural sector with all other sectors combined
• Who was studied: Cases of work-related ill-health reported to THOR in the UK from 2002 to 2008. Clinical specialists returned 28 162 actual case reports, of which 471 were in the agricultural sector (1.7% of actual cases and 2.2% of estimated cases). Standardized ratios were calculated for males only, for workers aged 16 to 65.
• Exposure: Employment in the agriculture and forestry sector (UK Standard Industrial Classification 2007 codes 01 and 02), compared with all other sectors. Within this, asbestos was the suspected agent in most of the reported pneumoconiosis, mesothelioma and non-malignant pleural disease cases.
• Main results:
  • For pneumoconiosis, mesothelioma and non-malignant pleural disease combined, the standardized rate ratio was significantly reduced in male agricultural workers. Asbestos was the suspected agent in 12 of 13 (92%) of the actual cases.
  • For pneumoconiosis, mesothelioma and non-malignant pleural disease combined, the standardized rate ratio was 0.4 (95% CI 0.2–0.7) in males aged 65 or under. The crude rate ratio was 0.05 (95% CI 0.02–0.09) in males over 65.
  • There were no reports of lung cancer in agricultural workers.
  • Skin neoplasia: standardized rate ratio 7.9 (95% CI 5.8–10.9) in males aged 65 or under. Exposure to sunlight was the suspected agent in all neoplasia cases.
  • In male agricultural workers, the ratios for asthma and especially allergic alveolitis were significantly raised: asthma 1.9 (95% CI 1.2–3.0) and allergic alveolitis 32 (95% CI 19–51) in males aged 65 or under. The ratio for all respiratory disease was not significantly raised.
  • Musculoskeletal disorders: standardized rate ratio 2.3 (95% CI 1.6–3.3) in male agricultural workers aged 65 or under, reported by rheumatologists.
  • Psychiatrists' reports gave a low ratio for mental ill-health in male agricultural workers: 0.6 (95% CI 0.3–1.1), which was not statistically significant.
  • Occupational physicians reported eight actual cases of pesticide poisoning: seven from inhaling phosphine gas and one related to organophosphates.
• The authors' conclusion: The authors concluded that the raised ratios for asthma, allergic alveolitis and musculoskeletal disorders confirm previous reports, but that the high estimates of skin cancer incidence need confirming.
• Limitations the authors state:
  • The exact share of the Labour Force Survey population covered by the reporting physicians is not precisely known.
  • The analysis assumed that workers in all employment sectors are equally likely to be seen by a clinical specialist, which may cause bias.
  • If more agricultural workers keep working past age 65 than workers in other sectors, the rate ratios for males over 65 may be underestimated.
  • Only five actual melanoma cases were reported in agricultural workers. The raised melanoma ratio reflects low numbers of reports from other sectors rather than high numbers in agriculture.
  • Few reports came from female agricultural workers, so standardized ratios were given for males only.

Topics

Medical terms in this study, explained in our Lexicon: Incidence.

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• Increased risk of lung cancer in pesticide-exposed male agricultural workers — E. Barthel (1981)
• Mesothelioma in an agricultural community of India: a clinicopathological study — P.B. Das, A.G. Fletcher, et al. (1976)
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