Starling Anne P, Umbach David M, Kamel Freya, Long Stuart, Sandler Dale P, Hoppin Jane A
Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, DHHS, Research Triangle Park, North Carolina, USA Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Biostatistics Branch, National Institute of Environmental Health Sciences, NIH, DHHS, Research Triangle Park, North Carolina, USA.
Occup Environ Med. 2014 Sep;71(9):629-35. doi: 10.1136/oemed-2013-101659. Epub 2014 Apr 12.
To estimate associations between use of specific agricultural pesticides and incident diabetes in women.
We used data from the Agricultural Health Study, a large prospective cohort of pesticide applicators and their spouses in Iowa and North Carolina. For comparability with previous studies of farmers, we limited analysis to 13 637 farmers' wives who reported ever personally mixing or applying pesticides at enrolment (1993-1997), who provided complete data on required covariates and diabetes diagnosis and who reported no previous diagnosis of diabetes at enrolment. Participants reported ever-use of 50 specific pesticides at enrolment and incident diabetes at one of two follow-up interviews within an average of 12 years of enrolment. We fit Cox proportional hazards models with age as the time scale and adjusting for state and body mass index to estimate HRs and 95% CIs for each of the 45 pesticides with sufficient users.
Five pesticides were positively associated with incident diabetes (n=688; 5%): three organophosphates, fonofos (HR=1.56, 95% CI 1.11 to 2.19), phorate (HR=1.57, 95% CI 1.14 to 2.16) and parathion (HR=1.61, 95% CI 1.05 to 2.46); the organochlorine dieldrin (HR=1.99, 95% CI 1.12 to 3.54); and the herbicide 2,4,5-T/2,4,5-TP (HR=1.59, 95% CI 1.00 to 2.51). With phorate and fonofos together in one model to account for their correlation, risks for both remained elevated, though attenuated compared with separate models.
Results are consistent with previous studies reporting an association between specific organochlorines and diabetes and add to growing evidence that certain organophosphates also may increase risk.
评估特定农用杀虫剂的使用与女性糖尿病发病之间的关联。
我们使用了农业健康研究的数据，该研究是爱荷华州和北卡罗来纳州农药施用者及其配偶的大型前瞻性队列研究。为了与之前对农民的研究具有可比性，我们将分析限制在13637名农民妻子中，她们在入组时（1993 - 1997年）报告曾亲自混合或施用农药，提供了关于所需协变量和糖尿病诊断的完整数据，并且在入组时报告无糖尿病既往诊断。参与者在入组时报告了50种特定农药的使用情况，并在入组后平均12年的两次随访访谈之一中报告了糖尿病发病情况。我们以年龄为时间尺度拟合Cox比例风险模型，并对州和体重指数进行调整，以估计45种有足够使用者的农药各自的风险比（HR）和95%置信区间（CI）。
五种农药与糖尿病发病呈正相关（n = 688；5%）：三种有机磷酸酯类，地虫硫磷（HR = 1.56，95% CI 1.11至2.19）、甲拌磷（HR = 1.57，95% CI 1.14至2.16）和对硫磷（HR = 1.61，95% CI 1.05至2.46）；有机氯类狄氏剂（HR = 1.99，95% CI 1.12至3.54）；以及除草剂2,4,5 - T/2,4,5 - TP（HR = 1.59，95% CI 1.00至2.51）。在一个模型中将甲拌磷和地虫硫磷放在一起以考虑它们的相关性时，两者的风险仍然升高，尽管与单独模型相比有所减弱。
结果与之前报道特定有机氯类与糖尿病之间关联的研究一致，并进一步证明某些有机磷酸酯类也可能增加风险。
