Cerhan J R, Cantor K P, Williamson K, Lynch C F, Torner J C, Burmeister L F
Department of Preventive Medicine and Environmental Health, The University of Iowa College of Medicine, Iowa City 52242-1008, USA.
Cancer Causes Control. 1998 May;9(3):311-9. doi: 10.1023/a:1008877204830.
To update the cancer mortality patterns among Iowa (United States) farmers for the years 1987-93 and compare these results with those previously reported for 1971-86 as well as relate the PMR patterns to risk-factor survey data.
We extracted usual occupation and cause of death from 88,090 Iowa death certificates for White males aged 20 and older for the years 1987-93. Proportional mortality ratios (PMR), adjusted for age, and 95 percent confidence intervals (CI) were calculated using deaths among nonfarmers to generate expected numbers. We compared lifestyle profiles for farmers and nonfarmers using male controls (n = 1,596) from a population-based case-control study conducted in Iowa from 1986-89.
Iowa farmers had deficit PMRs for all-cause cancer mortality (PMR = 0.92, CI = 0.90-0.94) and for lung (PMR = 0.70, CI = 0.66-0.73), liver (PMR = 0.65, CI = 0.50-0.86), and other cancer sites strongly related to smoking and alcohol use. Farmers at all ages had excess deaths for cancers of the prostate (PMR = 1.26, CI = 1.19-1.33), rectum (PMR = 1.29, CI = 1.07-1.56), brain (PMR = 1.10, CI = 0.92-1.32), multiple myeloma (PMR = 1.17, CI = 0.98-1.40), non-Hodgkin's lymphoma (PMR = 1.09, CI = 0.96-1.23), and Hodgkin's disease (PMR = 1.62, CI = 1.04-2.54). Younger farmers (aged 20 to 64 years) had excess deaths for colon cancer (PMR = 1.52, CI =1.26-1.85) and skin melanoma (PMR = 1.60, CI = 1.07-2.38), while older farmers (aged 65+ years) had excess deaths for cancers of the pancreas (PMR = 1.18, CI = 1.04-1.34), lip (PMR = 1.58, CI = 0.59-4.21), and leukemia (PMR = 1.26, CI = 1.09-1.46). Since the 1970s, the PMR for stomach cancer has declined to expected values, while the PMRs for prostate, large intestine, pancreas, and Hodgkin's disease have increased; PMRs for other sites are consistent with earlier data. A survey from 1986-89 showed that farmers, compared with nonfarmers, smoked less, used less alcohol, had less formal education, and consumed more total calories, and calories from protein, fat, and meat while consuming fewer calories from fruits and vegetables.
Iowa farmers continue to be at elevated risk of mortality due to certain cancers, and, of particular interest, the risk for prostate and colon cancer appears to be increasing since 1970.
更新1987 - 1993年美国爱荷华州农民的癌症死亡模式，并将这些结果与之前报告的1971 - 1986年的结果进行比较，同时将比例死亡率（PMR）模式与风险因素调查数据相关联。
我们从1987 - 1993年爱荷华州88,090份20岁及以上白人男性死亡证明中提取了通常职业和死因。使用非农民的死亡人数来生成预期数量，计算了年龄调整后的比例死亡率（PMR）和95%置信区间（CI）。我们使用1986 - 1989年在爱荷华州进行的一项基于人群的病例对照研究中的男性对照（n = 1,596），比较了农民和非农民的生活方式概况。
爱荷华州农民的全因癌症死亡率（PMR = 0.92，CI = 0.90 - 0.94）以及肺癌（PMR = 0.70，CI = 0.66 - 0.73）、肝癌（PMR = 0.65，CI = 0.50 - 0.86）和其他与吸烟和饮酒密切相关的癌症部位的PMR均低于预期。各年龄段的农民前列腺癌（PMR = 1.26，CI = 1.19 - 1.33）、直肠癌（PMR = 1.29，CI = 1.07 - 1.56）、脑癌（PMR = 1.10，CI = 0.92 - 1.32）、多发性骨髓瘤（PMR = 1.17，CI = 0.98 - 1.40）、非霍奇金淋巴瘤（PMR = 1.09，CI = 0.96 - 1.23）和霍奇金病（PMR = 1.62，CI = 1.04 - 2.54）的死亡人数均高于预期。较年轻的农民（20至64岁）结肠癌（PMR = 1.52，CI = 1.26 - 1.85）和皮肤黑色素瘤（PMR = 1.60，CI = 1.07 - 2.38）的死亡人数高于预期，而较年长的农民（65岁及以上）胰腺癌（PMR = 1.18，CI = 1.04 - 1.34）、唇癌（PMR = 1.58，CI = 0.59 - 4.21）和白血病（PMR = 1.26，CI = 1.09 - 1.46）的死亡人数高于预期。自20世纪70年代以来，胃癌的PMR已降至预期值，而前列腺癌、大肠癌、胰腺癌和霍奇金病的PMR有所上升；其他部位的PMR与早期数据一致。1986 - 1989年的一项调查显示，与非农民相比，农民吸烟较少、饮酒较少、受正规教育较少，总热量、蛋白质、脂肪和肉类摄入的热量较多，而水果和蔬菜摄入的热量较少。
爱荷华州农民因某些癌症导致的死亡风险仍然较高，特别值得关注的是，自1970年以来前列腺癌和结肠癌的风险似乎在增加。
