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Original research
Use of permethrin and other pyrethroids and mortality in the Agricultural Health Study
  1. Srishti Shrestha1,
  2. Christine G Parks1,
  3. David M Umbach2,
  4. Jonathan N Hofmann3,
  5. Laura E Beane Freeman3,
  6. Aaron Blair4,
  7. Dale P Sandler1
  1. 1Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
  2. 2Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina, USA
  3. 3Occupational and Environmental Epidemiology Branch, National Cancer Institute, Rockville, Maryland, USA
  4. 4Formerly of Occupational and Environmental Epidemiology Branch, National Cancer Institute, Rockville, Maryland, USA
  1. Correspondence to Dr Dale P Sandler, Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, USA; sandler{at}niehs.nih.gov

Abstract

Objectives Pyrethroid insecticides have been linked with multiple health outcomes. One study reported an association with increased all-cause and cardiovascular mortality. Given the widespread use of pyrethroids, these findings warrant confirmation. We explored associations of permethrin/pyrethroid use with overall and cause-specific mortality among 50 665 licensed pesticide applicators in the Agricultural Health Study.

Methods At enrolment (1993–1997), participants self-reported information on permethrin/pyrethroid use. Information on causes of death came from linkage with death registries through 2016. We used Cox proportional hazards models to estimate HRs and 95% CIs with adjustment for potential confounders.

Results Over an average 21 years of follow-up, 19.6% (9,955) of the cohort died. We found no clear evidence that ever-use of permethrin/pyrethroid was associated with elevated overall mortality or with mortality from most causes examined. There was suggestive evidence, based on a small number of deaths among those exposed, for elevated pyrethroid-associated mortality from some neurological, respiratory and genitourinary diseases in the overall sample and from lung cancer among never-smokers.

Conclusion Although based on mortality, which is also affected by survival, rather than incidence, these findings are biologically plausible, and future investigations in other populations may be warranted.

  • pesticides
  • mortality
  • longitudinal studies
  • farmers

Data availability statement

Data are available on reasonable request. Requests for data, including the data used in this manuscript, are welcome as described on the Study Website (https://www.aghealth.nih.gov/collaboration/process.html). Data requests may be made directly at www.aghealthstars .com; registration is required. The Agricultural Health Study is an ongoing prospective study. The data sharing policy was developed to protect the privacy of study participants and is consistent with study informed consent documents as approved by the NIH Institutional Review Board. DPS is the NIEHS Principal Investigator of the Agricultural Health Study and is responsible for ensuring participant safety and privacy.

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Data availability statement

Data are available on reasonable request. Requests for data, including the data used in this manuscript, are welcome as described on the Study Website (https://www.aghealth.nih.gov/collaboration/process.html). Data requests may be made directly at www.aghealthstars .com; registration is required. The Agricultural Health Study is an ongoing prospective study. The data sharing policy was developed to protect the privacy of study participants and is consistent with study informed consent documents as approved by the NIH Institutional Review Board. DPS is the NIEHS Principal Investigator of the Agricultural Health Study and is responsible for ensuring participant safety and privacy.

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Footnotes

  • Contributors SS and DPS conceptualised and led this analysis. SS led the data analysis and prepared the first draft of the manuscript, which was overseen by DPS. DMU provided statistical help. CGP, LEBF and DPS were involved in data acquisition and study management. SS and DPS accept full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. All the authors were involved in data interpretation, reviewing and editing the manuscript and providing final manuscript approval.

  • Funding This work was supported by the Intramural Research Programme of the National Institute of Health, National Institute of Environmental Health Sciences (Z01-ES-049030) and National Cancer Institute (Z01-CP-010119).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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