An unattended finding: associations of An unattended finding: associations of agricultural airborne pesticide vapors agricultural airborne pesticide vapors
attaining inhabited areas with attaining inhabited areas with respiratory symptoms of 7–11 years old children respiratory symptoms of 7–11 years old children
in Heves county, Hungaryin Heves county, Hungary
M. J. VarróM. J. Varró11, Z. Virágh, Z. Virágh11, Gy. Gombkötõ, Gy. Gombkötõ22, M. Szeremi, M. Szeremi22, P. Rudnai, P. Rudnai11
11Fodor József National Center for Public Health,Fodor József National Center for Public Health, National Institute of Environmental Health; Budapest, Hungary; National Institute of Environmental Health; Budapest, Hungary;
22National Public Health and Medical Officer Service,National Public Health and Medical Officer Service,Institute of Heves County; Eger, HungaryInstitute of Heves County; Eger, Hungary NCPH NIEH NCPH NIEH
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INTRODUCTION 1.INTRODUCTION 1.
Nat. Inst. Environ. HealthNat. Inst. Environ. Health
Fodor József Nat. Center Publ. Health,Fodor József Nat. Center Publ. Health,
(formerly: Nat. Inst. Hyg.,)(formerly: Nat. Inst. Hyg.,)
Budapest, HungaryBudapest, Hungary
Nat. Publ. Health & Med. Officer ServiceNat. Publ. Health & Med. Officer Service
series of series of
highly uniform highly uniform
environmental epidemiologic surveys environmental epidemiologic surveys
among 7–11 y childrenamong 7–11 y children
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INTRODUCTION 2.INTRODUCTION 2.
1995/961995/96 CESAR - international survey CESAR - international survey
- - 5 towns, N=37205 towns, N=3720
- questionnaire- questionnaire
- physical examination- physical examination
- spirometry- spirometry
- measures of outdoor air pollutants - measures of outdoor air pollutants
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INTRODUCTION 2.INTRODUCTION 2.
QuestionnaireQuestionnaire
- health endpoints- health endpoints
- indoor environmental factors- indoor environmental factors
- other influencing factors- other influencing factors
Main findingMain finding
- respiratory symptoms - respiratory symptoms
& yearly average cc PM& yearly average cc PM
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INTRODUCTION 3.INTRODUCTION 3.
19971997 12 towns,12 towns, N=6221 N=6221
19981998 6 towns, 6 towns, N=1768N=1768
19991999 3 towns, 3 towns, N=1579N=1579
2000 2000 6 counties, 6 counties, N=2354N=2354
20012001 Heves county,Heves county, N=2540N=2540
20022002 Budapest 2 distr.+1 suburban,Budapest 2 distr.+1 suburban, N=567N=567
... arised:
agricultural airborne pesticide sprays
do attain inhabited areas (no report)
Highly significant associations
with health endpoints
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INTRODUCTION 4.INTRODUCTION 4.
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OBJECTIVEOBJECTIVE
To evaluate the associations To evaluate the associations
of pesticide spraysof pesticide sprays
with respiratory symptoms with respiratory symptoms
- of 7–11- of 7–11 year old children year old children
- in 40 - in 40 villages of an area of Heves county villages of an area of Heves county
- in 2001- in 2001
Allergic symptomsAllergic symptoms
- house dust - house dust
- pollen- pollen
- animal hair, feather- animal hair, feather
- food- food
- medicine- medicine
- other- other
- diagnosis: by a doctor?- diagnosis: by a doctor?
METHODS 1.METHODS 1.
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Neurotic symptoms:Neurotic symptoms:
at least two ofat least two of
- lack of appetite- lack of appetite
- fatigue- fatigue
- headache- headache
- irritability- irritability
- anxiety- anxiety
METHODS 2.METHODS 2.
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Head mucosal symptoms:Head mucosal symptoms:
at least one ofat least one of
- conjunctivitis- conjunctivitis
- blocked nose- blocked nose
- sinusitic complaints- sinusitic complaints
- earache- earache
METHODS 3.METHODS 3.
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Bronchitic symptomsBronchitic symptoms
regular coughregular cough
- in autumn-winter- in autumn-winter
- mornings- mornings
- days/nights- days/nights
- daily, >3 months- daily, >3 months
- with sputum- with sputum
METHODS 4.METHODS 4.
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Asthmatic symptomsAsthmatic symptoms
- in the last 12 months- in the last 12 months
- wheezing- wheezing
- dry cough at night - dry cough at night
- asthma- asthma
- ever diagnosed by a doctor- ever diagnosed by a doctor
METHODS 5.METHODS 5.
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METHODS 6.METHODS 6.
Data entry, - processionData entry, - procession
- Epi Info 6.04d- Epi Info 6.04d
AnalysisAnalysis
- STATA 7.0- STATA 7.0
- bivariate tabulation- bivariate tabulation
- backward logistic models - backward logistic models
Reported symptoms 1. Reported symptoms 1. 7–11 years old children, 7–11 years old children,
Villages, Heves county, Hungary, 2001Villages, Heves county, Hungary, 2001 %%
00
5050
21.821.8 20.320.3
N=1718N=1718 NCPH NIEH NCPH NIEH NPHMOSNPHMOS
Allergic symptomsAllergic symptoms Min. 2 neur. sy.-sMin. 2 neur. sy.-sN=1647N=1647
2525
NN00=2437=2437
N=1819N=1819
74.6%74.6%
N=1471N=1471
Reported symptoms 2. Reported symptoms 2. 7–11 years old children, 7–11 years old children,
Villages, Heves county, Hungary, 2001 Villages, Heves county, Hungary, 2001 %%
00
5050 46.346.3
14.114.1
N=1647N=1647NCPH NIEH NCPH NIEH
NPHMOSNPHMOS
Head mucosalHead mucosal AsthmaticAsthmatic
2525 15.515.5
BronchiticBronchiticN=1623N=1623
Agricultural airborne pesticide sprays Agricultural airborne pesticide sprays attaining inhabited areas attaining inhabited areas
Villages, Heves county, Hungary, 2001Villages, Heves county, Hungary, 2001
No spraysNo sprays SpraysSprays
%%
7575
5050
00
2525
90.890.8
9.29.2
100100
N=1666N=1666NCPH NIEH NCPH NIEH
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82.5%82.5%of the villagesof the villages
(n=40)(n=40)
Agricultural airborne pesticide sprays Agricultural airborne pesticide sprays attaining inhabited areas attaining inhabited areas
Villages, Heves county, Hungary, 2001Villages, Heves county, Hungary, 2001
Vineyard territoriesVineyard territories General agriculturalGeneral agricultural
%%
7575
5050
00
2525 6.16.1
13.913.9
100100
N=1013N=1013NCPH NIEH NCPH NIEH
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93.993.9 86.186.1OR=2.48***OR=2.48***
(95% CI= (95% CI= 1.76–3.44)1.76–3.44)
N=653N=653
No spraysNo sprays SpraysSprays
Agricultural airborne pesticide sprays/ Agricultural airborne pesticide sprays/ inhabited areas and inhabited areas and allergicallergic symptoms symptoms
7–11 years old children, 7–11 years old children, Villages, Heves county, Hungary, 2001Villages, Heves county, Hungary, 2001
%% OR=2.13*** OR=2.13*** (95% CI=1.48–3.07)(95% CI=1.48–3.07)mOR=2.23*** mOR=2.23*** (95% CI=1.48–3.37)(95% CI=1.48–3.37)goodness-of-fit: p=0.69goodness-of-fit: p=0.69
5050
00
2525 20.120.1
34.934.9
7575
N=146N=146 NCPH NIEH NCPH NIEH NPHMOSNPHMOS
N=1451N=1451
No spraysNo sprays SpraysSprays
No spraysNo sprays SpraysSprays
%% OR=2.19*** OR=2.19*** (95% CI=1.51–3.17)(95% CI=1.51–3.17)mOR=2.33*** mOR=2.33*** (95% CI=1.55–3.51)(95% CI=1.55–3.51)goodness-of-fit: p=0.18goodness-of-fit: p=0.18 5050
00
2525
18.618.6
33.333.3
7575
N=144N=144 NCPH NIEH NCPH NIEH NPHMOSNPHMOS
N=1391N=1391
Agricultural airborne pesticide sprays/ Agricultural airborne pesticide sprays/ inhabited areas and inhabited areas and neuroticneurotic symptoms symptoms
7–11 years old children, 7–11 years old children, Villages, Heves county, Hungary, 2001Villages, Heves county, Hungary, 2001
Agricultural airborne pesticide sprays/ Agricultural airborne pesticide sprays/ inhabited areas and inhabited areas and head mucosalhead mucosal sy.-s sy.-s
7–11 years old children, 7–11 years old children, Villages, Heves county, Hungary, 2001Villages, Heves county, Hungary, 2001
%%
OR=1.51* OR=1.51* (95% CI=1.08–2.14)(95% CI=1.08–2.14)
5050
00
2525 45.145.1
55.655.6
7575
N=144N=144 NCPH NIEH NCPH NIEH NPHMOSNPHMOS
N=1391N=1391
No spraysNo sprays SpraysSprays
%%
OR=1.93** OR=1.93** (95% CI=1.28–2.92)(95% CI=1.28–2.92)
5050
00
2525 14.514.5
24.624.6
7575
N=138N=138 NCPH NIEH NCPH NIEH NPHMOSNPHMOS
N=1382N=1382
Agricultural airborne pesticide sprays/ Agricultural airborne pesticide sprays/ inhabited areas and inhabited areas and bronchiticbronchitic sy.-s sy.-s 7–7–
11 years old children, 11 years old children, Villages, Heves county, Hungary, 2001Villages, Heves county, Hungary, 2001
No spraysNo sprays SpraysSprays
%% OR=1.82** OR=1.82** (95% CI=1.20–2.78)(95% CI=1.20–2.78)
5050
00
2525 13.313.3
21.921.9
7575
N=146N=146 NCPH NIEH NCPH NIEH NPHMOSNPHMOS
N=1450N=1450
Agricultural airborne pesticide sprays/ Agricultural airborne pesticide sprays/ inhabited areas and inhabited areas and asthmaticasthmatic sy.-s sy.-s
7–11 years old children, 7–11 years old children, Villages, Heves county, Hungary, 2001Villages, Heves county, Hungary, 2001
No spraysNo sprays SpraysSprays
DISCUSSION 1.DISCUSSION 1.
Whether it is really possible? Whether it is really possible?
- to check - to check retroretrospectively spectively
- flight documentations - flight documentations
- to check - to check proprospectively spectively
- biological monitoring- biological monitoring
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DISCUSSION 2.DISCUSSION 2.
ChanceChance
- high p-values!- high p-values!
BiasBias
- recall bias?- recall bias?
ConfoundingConfounding
- not probable- not probableNCPH NIEH NCPH NIEH
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SUMMARY 1.SUMMARY 1.
- Pesticide sprays do attain inhabited areas- Pesticide sprays do attain inhabited areas
- Respiratory symptoms- Respiratory symptoms
- 7–11 y children- 7–11 y children
- N=1819 survey questionnaires- N=1819 survey questionnaires
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SUMMARY 2.SUMMARY 2.
- - allergic and neurotic symptomsallergic and neurotic symptoms
- - prevalences: 21.8%, 20.3%prevalences: 21.8%, 20.3%
- pesticide sprays attaining inhabited areas: 9%- pesticide sprays attaining inhabited areas: 9%
- odds ratios: 2.13*** (2.23***), 2.19*** (2.33***)- odds ratios: 2.13*** (2.23***), 2.19*** (2.33***)
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SUMMARY 3.SUMMARY 3.
- head mucosal, bronchitic, asthmatic sy.-s- head mucosal, bronchitic, asthmatic sy.-s
- prevalences: 46.3%, 15.5%, 14.1%- prevalences: 46.3%, 15.5%, 14.1%
- odds ratios: 1.51*, 1.93**, 1.82*- odds ratios: 1.51*, 1.93**, 1.82*
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CONCLUSIONCONCLUSION
Specially designed Specially designed investigationsinvestigations
- environmental health impact- environmental health impact
- pesticide spraying- pesticide spraying
Official measuresOfficial measures
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HUNGARIAN NEHAP SECRETARYHUNGARIAN NEHAP SECRETARYDr. Anna Páldy Dr. Anna Páldy
„„Fodor József” NCPH NIEH Fodor József” NCPH NIEH DEPT. COMMUNITY HEALTHDEPT. COMMUNITY HEALTH
Annamária Mácsik, Tamás Rudnai, Eszter Szabó, Annamária Mácsik, Tamás Rudnai, Eszter Szabó, Renáta Szentmihályi, Györgyi TóthRenáta Szentmihályi, Györgyi Tóth
SCHOOLS, MUNICIPALITIES, HEALTH SERVICESSCHOOLS, MUNICIPALITIES, HEALTH SERVICES directorship of schools, class leaders, maires, directorship of schools, class leaders, maires,
youth and district nursesyouth and district nurses
FAMILIESFAMILIES parents, childrenparents, children
THANKSTHANKS
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Thanks Thanks
for the for the
attentionattention
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