SUBJECTS AND METHODS

Fatalities

Farm work related fatalities from 1990 to 1996 were available for analysis using CAISP protocols⁹ from all Canadian provinces. Sources of information included: provincial coroner’s offices, police, government agencies including Vital Statistics, and occupational health and safety associations.

Hospitalisations

Confidentiality agreements have been established with all provinces for access to hospital separation data through provincial agencies. The data collection protocol¹⁰ and the CAISP program underwent ethical review, as required.

Agricultural injuries were identified using ICD-9 E-codes.¹¹ Hospital discharge records were searched using mechanism and location of occurrence of injury codes. Where there was more than one admission due to readmission or transfer, only the main treatment record was used. After receiving permission to obtain medical chart data for individual cases from the chief executive officer (or equivalent), hospital staff verified specific information contained in the discharge records and added information about the injury events to standard abstraction forms.

Initial hospital discharge records and supplemental data were available for all but two provinces (Nova Scotia and Newfoundland/Labrador) for the five fiscal years of 1990 to 1994. Agricultural machinery injuries were initially defined as those where the E-code 919.0 (injuries caused by agricultural machinery) was listed on the hospital discharge record. Non-machinery agricultural injuries included those where: (1) a location of injury code indicated a farm or ranch as the location of injury (the fifth digit of the E-code was 1); (2) the accident location code (E849.1) indicated a farm and the E-code was other than 919.0; or (3) a special location code indicated a farm work location.

Data analysis

Gender differences in fatalities and injuries were examined by comparison of proportions using χ² analyses and by calculation of sex ratios (defined as the number of events for males relative to females). As the actual population at risk could not be conclusively identified, rates of injury were not calculated. Data management and analyses were done using standard statistical packages: Microsoft Access/Excel, version 6.0, Redmond, WA; SPSS version 10.0; SPSS, Chicago, IL.

RESULTS

Fatalities

There were pronounced gender differences in the number of farm related fatalities and their circumstances. Over the six year period of 1990 to 1996 there were approximately 11 times as many agriculture related fatalities in males compared to females (655 and 61, respectively). Fatalities involving farm machinery were not evenly distributed (p<0.05), either by sex or among age groups (table 1). A large proportion of fatalities (39%) were observed in men over 60 years of age, compared with 12% among women.

The two most common machinery mechanisms of fatal injuries for males were roll-overs (32%) and being run-over (20%), while for females the order was reversed (p<0.05): run-over (45%) and roll-over (24%). Tractors were involved in 65% and 69% of all fatalities for men and women respectively. For males, the two most common causes were for being struck by an object (33%) and animals (14%). Only 19 female fatalities were attributed to non-machinery causes over the seven year period; 37% were due to animals and 32% to being struck by an object.

Analysis by relationship of the deceased to the owner/operator showed significant gender differences. For males, 50% were owner/operators, 10% were children of the owner/operator, and 10% involved hired workers. For females, the largest categories of fatalities were of children of the owner/operator (30%) and spouses of the owner/operator (23%), with no males reported as spouses); only 7% of the female fatalities were of owner/operators. Visitors were known to be involved in only 2% of fatalities for both sexes.

Hospitalisations

Gender differences were apparent in the age distribution for injuries requiring hospitalisation (p<0.05; table 2). For hospitalised agricultural machinery injuries, the average ratio of males to females was 9:1. The highest proportion of injuries was found for females under 10 years of age (18%), which contrasted with boys (6%), who had the lowest number of injuries for any 10 year age group of males. The highest ratio of males to females (39:1) occurred for those 70 years of age and over who were hospitalised for machinery related injuries. This pattern is in marked contrast to non-machinery hospitalisations, where the sex ratio shows only slight variation by age.

Men 15–59 years of age had a greater percentage of hospitalisation injuries due to being caught in or entangled in machinery (table 3). Tractors were the most common farm machinery involved in hospitalisation injuries for both males and females at 28% each. The distribution of non-machinery injury causes of hospitalisations show more pronounced differences (p<0.05) according to age group and sex. Females age 60 and above had a relatively higher percentage of injuries by falls. In general, animals were the most common cause of non-machinery related injuries, accounting for one half of injuries for females under 60 years of age. For females, 65% of the animal related injuries were caused by horses and 30% by cows, which contrasts to 38% and 56% respectively for males.

Comparison of main diagnoses according to age group and sex (data not shown) showed a higher percentage of fractures (52%) for females 60 years or older, in comparison to 40% for males in this age group. Males had a consistently higher percentage of lacerations.

DISCUSSION

Differences between males and females were apparent in the patterns of farm related injury. Injuries to males predominated. The highest ratios of male to female injuries were for fatalities and hospitalisations from agricultural machinery, particularly among men over age 60. Overall, we found ratios of males to females of 9:1 and 11:1 respectively for machinery related hospitalisations and fatalities. The extent of these differences in the number of farm injuries between the sexes has been corroborated in other surveys.^12,13 Work related fatalities in the US agricultural sector from 1980 to 1989 showed a more extreme difference (101 deaths for females versus 6610 for males).¹⁴ This result may be misleading if fatalities to females were not recognised as being work related.

The disparity between the sexes in mechanism of injury involving farm machinery most likely reflects differences in exposure. For example, a 1992 Canadian community survey showed that 92% of men drove agricultural machinery, in comparison to 35% of women.³ We found that tractors were involved in the majority of cases, but the leading mechanism of fatality was roll-over for males and run-over for females. The high risk of machinery related fatalities, particularly involving tractors, has been well documented.¹⁵ We found that for non-fatal injuries for both sexes, the leading mechanism of machinery injury requiring hospitalisation was being caught or entangled in machinery.

The lowest sex ratios were for non-machinery causes of hospitalisations; on average for every female injured there were three male injuries. The disparities in prevalence of injury appear to be reduced with decreasing severity of injury. Rivara¹⁶ found that the ratio of male to female farm related deaths was 5.6 in comparison to 2.4 for emergency department injuries.

Causes of non-machinery agricultural fatalities and hospitalisations were age and sex dependent. For females under age 60, a greater percentage of injuries were due to animals, whereas older women had a higher percentage attributable to falls. Studies in Manitoba, Canada and Australia indicate that animals are a common source of farm related injury, particularly among girls.^17,18 Falls are recognised to be a common cause of unintentional non-fatal injury and deaths among females,¹⁹ accounting for almost 90% of deaths in the USA for those over age 65.²⁰ Risk factors for the elderly include visual impairment, and gait and balance disturbances.²¹

A greater percentage of women over age 60 than men were diagnosed with fractures. Degenerative changes with aging, such as osteoporosis may be important factors. The extreme sex ratio of over 60:1 was observed for fatalities caused by agricultural machinery for men age 60 and above. The high risk of injury and death from farming activities among older men has been identified in previous studies^22,23 and attributed to the onset of age related physiological changes, such as slowing of reaction time and more working hours on the farm after retirement. The gender disparity in fatalities may also reflect less participation and hence less exposure among older females.

When considering farm safety the entire family must be taken into account as all are exposed to the work environment.²⁴ Among females, a large percentage of fatalities were observed for children. A Minnesota survey found a more extreme percentage in that over one half of all females who had severe or fatal farm injuries were children under 10 years of age.¹² Hazardous work conditions in agriculture create a unique problem by affecting those not directly employed in farming activities. Children are particularly vulnerable to severe injury or death due to their small bodily size and immature development.

Differences in the extent of exposure to agricultural activities, ergonomic aspects of the agricultural environment in relation to body size and physiology, and variations in the nature of agricultural tasks are likely to contribute to gender and age differences in the patterns of injuries and fatalities. A 1995 Wisconsin study found lower average hours of farm work for women (20 hours versus 50 hours for men)⁶ as did a 1995 study in Ontario, Canada in which 23% of females (versus 62% of males) performed farm work at least 40 hours a week.²⁵ In Canada, over the past two decades there has been an increase in the number of hours per week and weeks per year worked on the farm by women,³ and this pattern would be expected to continue.

A strength of our study was that it was not limited to compensable injuries or to a particular worker subgroup. A further advantage is that national data were collected systematically from hospital sources, with no reliance on volunteer reporting. These two factors provide a broader picture of the extent of injuries attributed to agricultural production. A limitation is the lack of accurate denominator data from which to calculate rates. For instance, Canadian census data on farm populations does not include hired labourers. Furthermore, there is no detailed exposure data available, such as hours of farm work or type of farm, from the fatality and hospitalisation data sources.

Gender is an important factor to consider in the interpretation of fatal and non-fatal farm injuries. As women increasingly participate in all aspects of agricultural production, there is a need to collect, interpret, and disseminate information on agricultural injury that is relevant for both sexes. Cultural and social determinants of gender distinctions in recurrent patterns of injury should be considered in future aetiological and qualitative research. A further recommendation is that farm injury prevention programmes stress gender sensitivity using education, regulation, or engineering approaches.