Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA.
Social&Scientific Systems, DHL, Silver Spring, MD, USA.
Environ Int. 2023 Nov;181:108251. doi: 10.1016/j.envint.2023.108251. Epub 2023 Oct 7.
Self-reported shingles was associated with history of high pesticide exposure events (HPEE) in licensed pesticide applicators aged >60 years in the Agricultural Health Study (AHS). In the current study, using AHS-linked Medicare claims data, we examined incident shingles in relation to pesticide-related illness and pesticide poisoning, as well as HPEE.
We studied 22,753 licensed private pesticide applicators (97% white males, enrolled in the AHS 1993-97), aged ≥66 years with >12 consecutive months of Medicare fee-for-service hospital and outpatient coverage between 1999 and 2016. Incident shingles was identified based on having ≥1 shingles claim(s) after 12 months without claims. At AHS enrollment, participants were asked if they ever sought medical care or were hospitalized for pesticide-related illness, and a supplemental questionnaire (completed by 51%) asked about HPEE and poisoning. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazards regression, adjusted for age, sex, race, state, and education.
Over 192,053 person-years (PY), 2396 applicators were diagnosed with shingles (10.5%; age-standardized rate, 13.6 cases per 1,000PY), with higher rates among those reporting hospitalization for pesticide-related illness, pesticide poisoning, and HPEE (23.2, 22.5, and 16.6 per 1,000PY, respectively). In adjusted models, shingles was associated with hospitalization for pesticide-related illness (HR 1.69; 1.18, 2.39), poisoning (1.49; 1.08, 1.46), and HPEE (1.23; 95% CI = 1.03, 1.46), especially HPEE plus medical care/poisoning (1.78; 1.30, 2.43).
These novel findings suggest that acute, high-level, and clinically impactful pesticide exposures may increase risk of shingles in subsequent years to decades following exposure.
在农业健康研究（AHS）中，年龄>60 岁的持牌农药施用者自述带状疱疹与高农药暴露事件（HPEE）史有关。在当前的研究中，我们使用 AHS 链接的医疗保险索赔数据，研究了与农药相关疾病和农药中毒以及 HPEE 相关的带状疱疹发病情况。
我们研究了 22753 名持牌私人农药施用者（97%为白人男性，1993-97 年参加 AHS），年龄≥66 岁，在 1999 年至 2016 年期间有>12 个月的医疗保险按服务收费的住院和门诊覆盖范围。根据在没有索赔的情况下，有≥1 次带状疱疹索赔，确定了带状疱疹的发病情况。在 AHS 登记时，参与者被问到他们是否因农药相关疾病寻求过医疗或住院治疗，一份补充问卷（由 51%的人完成）询问了 HPEE 和中毒情况。使用 Cox 比例风险回归估计了风险比（HR）和 95%置信区间（CI），并根据年龄、性别、种族、州和教育程度进行了调整。
在 192053 人年（PY）中，有 2396 名施用者被诊断为带状疱疹（10.5%；年龄标准化率为每 1000PY 13.6 例），报告因农药相关疾病、农药中毒和 HPEE 住院的发生率更高（分别为每 1000PY 23.2、22.5 和 16.6 例）。在调整后的模型中，带状疱疹与因农药相关疾病住院（HR 1.69；1.18，2.39）、中毒（1.49；1.08，1.46）和 HPEE（1.23；95%CI=1.03，1.46）有关，尤其是 HPEE 加医疗/中毒（1.78；1.30，2.43）。
这些新发现表明，急性、高水平和具有临床显著影响的农药暴露可能会增加接触后数年至数十年内带状疱疹的风险。
