Parks Christine G, Leyzarovich Darya, Hamra Ghassan B, Costenbader Karen H, Chen Dazhe, Hofmann Jonathan N, Freeman Laura E Beane, Sandler Dale P
Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Durham, NC, USA.
DLH Corp., Bethesda, MD, USA.
Sci Rep. 2024 Dec 2;14(1):29978. doi: 10.1038/s41598-024-76179-2.
Pesticides and farming have been associated with increased rheumatoid arthritis (RA) risk, but the role of specific pesticides remains unknown. We examined RA risk among licensed pesticide applicators (97% white male farmers), from North Carolina and Iowa, in the Agricultural Health Study, in relation to lifetime use of 45 pesticides reported at enrollment (1993-1997, updated 1999-2003). In 22,642 applicators ages ≥ 67 years with ≥ 24 months Fee for Service Medicare data (1999-2016), we identified 161 (0.7%) incident cases with ≥ 2 RA claims (including ≥ 1 by a rheumatologist), ≥ 30 days apart, after ≥ 12 months without RA claims. Relative risks (RR) and 95% Confidence Intervals (CI) were calculated using log-binomial models adjusted for age, state, education, smoking, and correlated pesticides. Risk was elevated (RR > 1.5 or lower CI > 0.95) for use of nine pesticides: four insecticides [malathion (RR = 1.77;95%CI = 1.14-2.73), phorate (1.40;0.96-2.04), carbaryl (1.65;1.10-2.46), carbofuran (1.41;0.99-2.01)], four herbicides [alachlor (RR = 1.40;95%CI 0.99-1.98), metolachlor (1.57;1.11-2.23), S-Ethyl dipropylthiocarbamate (1.57;1.00-2.44), metribuzin (1.45; 1.01, 2.08)], and one fungicide [benomyl (1.56;0.99-2.44)]. Exposure-response was seen for greater intensity-weighted lifetime days use of malathion and carbofuran (p-trends = 0.03 and 0.05). Some specific pesticides, including several currently approved and commonly used in agricultural, public health, or residential settings may increase RA risk among older adults.
农药与农业生产一直被认为与类风湿性关节炎（RA）风险增加有关，但具体农药所起的作用仍不清楚。在农业健康研究中，我们调查了来自北卡罗来纳州和爱荷华州的持牌农药施用者（97%为白人男性农民）患RA的风险，这些风险与他们在入组时（1993 - 1997年，于1999 - 2003年更新）报告的45种农药的终生使用情况有关。在22642名年龄≥67岁且拥有≥24个月服务收费医疗保险数据（1999 - 2016年）的施用者中，我们识别出161例（0.7%）新发病例，这些病例有≥2次RA索赔（包括至少1次由风湿病专家提出的索赔），且在无RA索赔≥12个月后，两次索赔间隔≥30天。使用对数二项式模型计算相对风险（RR）和95%置信区间（CI），模型针对年龄、州、教育程度、吸烟情况以及相关农药进行了调整。有9种农药的使用使风险升高（RR > 1.5或下限CI > 0.95）：4种杀虫剂[马拉硫磷（RR = 1.77；95%CI = 1.14 - 2.73）、甲拌磷（1.40；0.96 - 2.04）、西维因（1.65；1.10 - 2.46）、克百威（1.41；0.99 - 2.01）]，4种除草剂[甲草胺（RR = 1.40；95%CI 0.99 - 1.98）、异丙甲草胺（1.57；1.11 - 2.23）、S - 乙基二丙基硫代氨基甲酸酯（1.57；1.00 - 2.44）、嗪草酮（1.45；1.01，2.08）]，以及1种杀菌剂[苯菌灵（1.56；0.99 - 2.44）]。对于马拉硫磷和克百威，终生使用强度加权天数增加时可见暴露 - 反应关系（p趋势 = 0.03和0.05）。一些特定农药，包括目前在农业、公共卫生或居住环境中批准并常用的几种农药，可能会增加老年人患RA的风险。
