Juliana de Rezende Chrisman

Cancer mortality among agricultural workers from Serrana Region, state of Rio de Janeiro, Brazil

One of the proposed hypotheses to explain the higher incidence of specific-site cancers among agricultural workers is their higher exposure to pesticides. The role of pesticide exposure in morbidity and mortality profiles in Brazil is not well known. Therefore, in order to contribute to increase knowledge on this subject, an ecological analysis aiming to investigate cancer mortality among agricultural workers in an important agricultural area of the Rio de Janeiro State, Brazil, was performed. All causes of death for male workers 30-69 years old provided by the National Mortality Information System between 1979 and 1998 were evaluated. To estimate cancer mortality risks of selected sites, mortality odds ratio (MOR) was employed, and three reference populations were used. Higher mortality of esophagus, stomach, and larynx cancer in agricultural workers 50-69 years old was observed in the period from 1979 to 1988 and of esophagus and stomach cancer from 1989 to 1998. Agricultural workers 30-49 years old showed higher, but not statistically significant, mortality by stomach, esophagus, liver, testis, and prostate cancer, and soft-tissue sarcoma in the period of 1979-1988, and by testis and penis cancer, leukemia, and soft-tissue sarcoma in the period of 1989-1998. Despite the limitations of ecological approaches concerning causality ascertainment, we believe that this study raises questions of the possible role of pesticide exposure on the cancer mortality profile among Brazilian agricultural workers.

Pesticide sales and adult male cancer mortality in Brazil

In Brazil, where the use of pesticide grows rapidly, studies that evaluate the impact of pesticide exposure on cancer incidence and mortality are very scarce. In this study, we evaluated the degree of correlation between pesticide sales in 1985 in eleven Brazilian states and cancer mortality rates during 1996-1998. Information of all cancer deaths occurred in men 30-69 years old from 1996 to 1998 were collected from National Mortality System. Single and multiple linear regression coefficients were obtained to assess the relationship between per capita sales of pesticides in 1985, specific-site cancer mortality rates (prostate, soft tissue, larynx, leukemia, lip, esophagus, lung, pancreas, bladder, liver, testis, stomach, brain, non-Hodgkins lymphoma, and multiple myeloma) during 1996-1998, and several covariates. In addition, states were stratified into three groups according to tertiles of pesticides sales and cancer mortality rate ratios (MRR) were then calculated using first tertile as reference. Finally, a factor analysis was performed to reveal unapparent relationships between pesticide use and cancer mortality. Pesticide sales showed statistically significant correlation with the mortality rates for the cancers of prostate (r=0.69; p=0.019), soft tissue (r=0.71; p=0.015), leukemia (r=0.68; p=0.021), lip (r=0.73; p=0.010), esophagus (r=0.61; p=0.046), and pancreas (r=0.63; p=0.040). Moderate to weak correlations were observed for the cancers of larynx, lung, testis, bladder, liver, stomach, brain, and NHL and multiple myeloma. In addition, correlation between pesticide sales and specific-site cancer mortality rates was reinforced by multiple regression analysis. For all specific-sites, cancer mortality rates were significantly higher in the states of moderate (2nd tertile) and high (3rd tertile) pesticide sales, with MRR ranging from 1.11 to 5.61. Exploring hidden relationships between pesticide sales and cancer mortality in Brazil, through a factor analysis, revealed that affluence; public policies and lifestyle behaviors may explain almost 70% of the variance of the studied association. The results suggest that population exposure to pesticides in the 1980s in some Brazilian States may have been associated with selected cancer sites observed a decade later.

Mood disorders hospitalizations, suicide attempts, and suicide mortality among agricultural workers and residents in an area with intensive use of pesticides in Brazil.

As suicide rates have increased in rural areas in Brazil, it was postulated that pesticide exposure may play a role in this phenomenon. Our study compared the suicide mortality rates observed among agricultural workers from a pesticide-intensive area in Brazil to the suicide mortality frequency noted in three reference populations. In addition, hospitalization rates attributed to suicide attempts and mood disorders including depression in residents of the same agricultural area were compared to two reference populations. Finally, data on pesticide sales per agricultural worker were obtained for each city of Rio de Janeiro State and suicide mortality risk was then calculated according to the quartiles of pesticide sales per agricultural workers, using the first quartile as reference. Agricultural workers were at greater risk for lethality due to suicide when compared to all three reference populations. In addition, residents of the same study area showed higher hospitalization rates by suicide attempts and mood disorders than observed in comparison populations. Results also showed that the risk of death by suicide was significantly higher among agricultural workers who lived in areas of Rio de Janeiro State displaying higher rates of pesticide expenditure per agricultural worker. These results suggest that pesticide exposure may indeed increase the risk of suicide frequency, especially among agricultural workers.

Pesticide use and non-Hodgkin's lymphoma mortality in Brazil.

INTRODUCTION Brazil is one of the major pesticide consumers in the world. The continuous exposure to these substances may be etiologically associated with the development of Non-Hodgkins Lymphoma (NHL). OBJECTIVE Estimate the correlation between the per capita sales of pesticides in 1985 (exposure) and NHL mortality rates between 1996 and 2005 (outcome), by Brazilian micro-regions. METHOD In this ecological descriptive study, the per capita consumption of pesticides in 1985 was used as a proxy of the population exposure to these chemicals in Brazil. All deaths by NHL occurred in the 446 non-urban micro-regions, between 1996 and 2005, among individuals with ages between 20 and 69, of both sexes, were retrieved from the Brazilian Mortality Information System. Micro-regions were then categorized into low, medium, high and very high pesticide consumption, according to the quartiles of per capita consumption of pesticides. NHL mortality rates and rate ratios for each quartile were obtained using the lowest quartile as reference. In addition, the Spearmans correlation coefficient between pesticide consumption and NHL mortality rates was estimated. RESULTS A moderate correlation between per capita pesticides consumption and standardized mortality rate for NHL was observed (r=0.597). In addition, using the lowest quartile of pesticide consumption as a reference, the higher the quartile of pesticide consumption, the higher was NHL mortality risk: men - (second quartile - MRR=1.69, CI 95% 1.68-1.84; third quartile - MRR=2.41, CI 95% 2.27-2.57; fourth quartile - MRR=2.92, CI 95% 2.74-3.11) and females (second quartile - MRR=1.87, CI 95% 1.69-2.06; third quartile - MRR=2.28, IC 95% 2.10-2.47; fourth quartile - MRR=3.20; CI 95% 2.98-3.43). CONCLUSION Our results suggest that pesticide exposure may play a role in the etiology of NHL.

Esophageal cancer among Brazilian agricultural workers: case-control study based on death certificates.

Several studies suggest that agricultural workers are at higher risk to develop and die by certain types of cancer. Esophageal cancer is not commonly listed among these types. However, some recent studies indicated that if there is an association between agricultural working and esophageal cancer, it s more likely to be observed among workers highly exposed to pesticides. In the present study, the magnitude of the association between agricultural working and esophageal cancer mortality was evaluated in a high pesticide use area in Brazil, through a death certificate-based case-control study. Cases were individuals from both genders, 30-59 years old, for whom basic cause of death was ascertained as cancer of the esophagus. For each case, one control was randomly selected from all possible controls for which the basic cause of death was ascertained as different from neoplasm and diseases of the digestive system. In addition, controls matched their cases by sex, age, year of death, and state of residence. Crude and adjusted odds ratios were then calculated to estimate the magnitude of the risk. Results showed that, in general, agricultural workers were at significantly higher risk to die by esophageal cancer, when compared to non-agricultural workers. Stratified analysis also revealed that the magnitude of such risk was slightly higher among illiterate agricultural workers, and simultaneous adjustment for several covariates showed that the risk was quantitatively higher among younger southern agricultural workers. These results suggest the esophageal cancer may be included among those types of cancer etiologically associated to agricultural working.

Pesticide exposure and low birth weight prevalence in Brazil

INTRODUCTION Brazil is one of the major global consumers of pesticides and exposure to these substances can affect fetal growth. OBJECTIVE To estimate the correlation between pesticide sales in 1996 and the prevalence of low birth weight during the period 1996-1998 in Brazil. METHOD This ecological study employed secondary data aggregated at the level of Brazilian micro-regions (cluster of cities). Prevalence of low birth weight in 1996, 1997, and 1998 was obtained from the Brazilian health databases, and per capita pesticides sales in 1996 obtained from the Brazilian Institute of Geography and Statistics were utilized as an indirect measure of population exposure to these chemicals. Spearman correlation coefficient and Prevalence Ratio by quartiles were estimated, considering per capita pesticide sales and the prevalence of low birth weight. RESULTS A total of 552 micro-regions were analyzed (446 non-urban and 106 urban). In rural areas, the per capita pesticide sales were directly associated with higher prevalence of children born with low birth weight (r=0.403), with birth weights between 1500 and 2500 grams (r=0.366), and very low birth weight birth (r=0.476). All correlations were statistically significant (p<0.001). On the other hand, in urban areas there was no significant correlation. There was a gradual increase in the prevalence of low birth weight according to the quartiles of pesticide consumption. CONCLUSIONS Pesticide per capita sales may affect the prevalence of newborns with low birth weight in non-urban micro-regions of Brazil, indicating the need to strengthen policies and actions to protect the health of populations exposed to pesticides.

Prevalence of very low birthweight, malformation, and low Apgar score among newborns in Brazil according to maternal urban or rural residence at birth

Adverse birth outcomes are a major public health issue in rural areas, where several environmental risk factors, including pesticides, may endanger the health of women of reproductive age. We investigated the prevalence of selected birth outcomes among newborns from mothers living in urban and rural areas of a Brazilian municipality.

Projeto-piloto do Primeiro Inquérito Nacional de Populações Expostas a Substâncias Químicas, 2008-2009

Para viabilizar a futura realizacao de um Inquerito Nacional de Populacoes Expostas a Substâncias Quimicas, executou-se um projeto-piloto para examinar a exequibilidade, testar e adequar metodologias e estabelecer parcerias. Foram realizados tres estudos de corte transversal, respectivamente, com doadores de sangue residentes na Regiao Metropolitana de Sao Paulo-SP, conscritos do Exercito Brasileiro e criancas escolares residentes no municipio do Rio de Janeiro-RJ, mediante aplicacao de questionarios e coleta de material biologico (sangue venoso e capilar, unha e cabelo) para analise de metais e compostos organoclorados persistentes. Concluiu-se que e viavel a realizacao de um Inquerito Nacional, embora a estrategia de obtencao das amostras biologicas deva ser definida para cada subgrupo da populacao. Recomenda-se aproveitar as estruturas de servicos existentes para obtencao de amostras, utilizar matrizes tradicionais para maior comparabilidade e garantir sua realizacao periodica.

Stomach cancer mortality among agricultural workers: results from a death certificate-based case-control study

INTRODUCTION: Pesticide consumption is very high in Brazil.OBJECTIVE: The present study investigated the stomach cancer mortality among Brazilian agricultural workers in Rio de Janeiro state.METHODS: In this case-control study, cases were individuals of both genders, aged ≥20 years, for whom cause of death was ascertained as stomach cancer. Controls were individuals with causes of death other than neoplasm and diseases of the digestive system. Crude and adjusted analyses were carried out. Stomach cancer mortality risk was then estimated for the agricultural workers according to the pesticide expenditures per municipality.RESULTS: Agricultural workers showed an elevated risk of stomach cancer mortality (adjusted OR=1.42; 95%CI: 1.33-1.78). This risk was higher among male workers, aged 50-69 years, white, and among workers with 1-7 years of education. Results also showed increasing stomach cancer mortality along with the increase of pesticide expenditure per agricultural worker.CONCLUSION: Stomach cancer risk among agricultural workers may be associated with pesticide exposure.