1Department of Occupational and Environmental Medicine, Chonnam National University Medical School and Chonnam National University Hwasun Hospital, Hwasun, Korea
2National Institute of Agricultural Sciences, Rural Development Administration, Jeonju, Korea
3Department of Occupational and Environmental Medicine, Chonnam National University Hospital, Gwangju, Korea
4Department of Occupational and Environmental Medicine, Chosun University Hospital, Gwangju, Korea
5Department of Preventive Medicine, Gyeongsang National University College of Medicine, Jinju, Korea
6Department of Occupational and Environmental Medicine, Soonchunhyang University Gumi Hospital, Gumi, Korea
7Department of Occupational and Environmental Medicine, Institute of Medical Science, Gyeongsangnamdo Environmental Health Center, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
8Department of Preventive Medicine, Dongguk University College of Medicine, Gyeongju, Korea
Copyright © 2024 The Korean Society for Preventive Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Conflict of Interest
The authors have no conflicts of interest associated with the material presented in this paper.
Funding
This study was supported by a grant from the National Institute of Agricultural Sciences, Rural Development Administration, Republic of Korea (No. RS-2022-RD010387).
Author Contributions
Conceptualization: Song H, Park WJ, Park KS. Data curation: Kim H, Cho S, Jung S, Jung I. Formal analysis: Song H, Jung W. Funding acquisition: Jung W, Park KS. Methodology: Yoon SY. Project administration: Park KS, Song H, Yoo SJ. Writing – original draft: Kim H, Jung S, Jung I, Yoon SY. Writing – review & editing: Park WJ, Jung W, Cho S, Song H, Park KS, Sung JH, Yoo SJ.
Year | No. of places of agricultural business1 | No. of farm workers1 | No. of people in whom occupational disease was approved (death) | No. of CCVDs approved for occupational diseases (death) | Incidence rate of occupational CCVDs (%) |
---|---|---|---|---|---|
2021 | 20 302 | 78 999 | 38 (2) | 6 (2) | 0.008 |
2020 | 19 382 | 78 940 | 46 (3) | 5 (3) | 0.006 |
2019 | 18 785 | 79 482 | 43 (3) | 9 (2) | 0.011 |
2018 | 17 449 | 83 540 | 45 (4) | 4 (3) | 0.005 |
2017 | 15 452 | 76 033 | 26 (1) | 0 (0) | 0.000 |
2016 | 14 954 | 80 990 | 28 (1) | 2 (1) | 0.002 |
2015 | 12 350 | 68 697 | 28 (2) | 3 (2) | 0.004 |
2014 | 10 871 | 61 681 | 26 (2) | 2 (1) | 0.003 |
Study | Country | Epidemiological indicator | Database | Summary |
---|---|---|---|---|
Kang et al., 2022 [10] | Korea | SPR | National Health Insurance Sharing Service | Among females, the SPR of diseases of the circulatory system was higher in farmers (24 498.8 per 100 000) than in non-farmers (23 957.1 per 100 000) |
Lee et al., 2020 [11] | Korea | SIR | National Health Insurance Service | Age-adjusted incidence per 1000 person-years; Farmers: 0.766 for MI and and 0.559 for stroke; Controls: 0.585 for MI and 0.321 for stroke; Farmers had a higher age-adjusted incidence of MI and stroke |
Zhao et al., 2019 [12] | Spain | Excessive mortality rate | Population census | There was an excess mortality of 22.3% from cardiovascular diseases in farmers |
Lee et al., 2016 [13] | Korea | SMR | National Employment Insurance | The highest SMR was for agricultural, forestry, and fishery workers; The SMRs per 100 000 were high for IHD (25.8), cerebrovascular disease (42.9), and diseases of the circulatory system in males and IHD in females (7.1) |
Wada et al., 2016 [14] | Japan | SMR | Ministry of Health, Labour, and Welfare of Japan | The relative risks for stroke and IHD mortality were 2.75 (95% CI, 1.96 to 3.87) and 2.55 (95% CI, 1.90 to 3.42) in the agriculture industry; The reference group was sales |
Robinson et al., 2015 [15] | US | SMR | NIOSH National Occupational Mortality Surveillance | After adjusting for smoking, the SMR of acute MI was higher in farmers, agricultural worker occupations, and in the wholesale farm supplies, agricultural chemicals, and agricultural crop industries |
Lee et al., 2010 [16] | Korea | SPR | Korean National Health and Nutrition Examination Survey | No significant differences in CCVDs prevalence were identified among agricultural workers |
Sjögren et al., 2003 [17] | Sweden | SMR | Swedish National Censuses | Livestock workers had a slightly higher SMR for IHD than all gainfully employed; The SMR for male workers was 1.06 (95% CI, 0.95 to 1.18); The SMR for female workers was 1.10 (95% CI, 0.98 to 1.23); Agricultural workers had lower SMRs |
Risk factors | Hazards | Detailed description1 | Reference |
---|---|---|---|
Air pollution | PM | Increased the cerebrovascular disease risk (HR, 1.18; 95% CI, 1.09 to 1.28) among farmers with exposure to annual average PM2.5 concentrations of 54 μg/m3 or greater; Increased risk of cardiovascular mortality (HR, 1.87; 95% CI, 1.04 to 3.36) among male farmers | [18,19] |
Chemicals | Volatile organic compounds | Using a powered sprayer inside a greenhouse: EL 6.0-19.4 mg/m3 | [20] |
Dust | PM | Rice straw input work: EL 26.34 mg/m3 | [20] |
Gas | Carbon monoxide | Using a powered sprayer inside a greenhouse: EL 4.6-352.0 ppm | [20] |
Medical vulnerability | Difficulty in accessing medical institutions | Accessibility to local CCVD centers: the average adjusted mortality rate in vulnerable areas significantly higher at 1.51±0.48 for CVD and 1.54±0.21 for cerebrovascular disease (p<0.05). | [21,22] |
Noise | Time-weighted average, 8 hr | Tractor without cabin: EL 95.0±3.3 dB(A); Harvesters, grain dryers, brush mowers, or chainsaws: EL≥100 dB(A) | [23,24] |
Pesticides | Farmers with experience using pesticides | Acute pesticide poisoning experience rate: 7.0-86.7%; Pesticide concentrations ranged from 0.20 to 12.12 ng/mL in the blood; Pesticides (chlorpyrifos, coumaphos, carbofuran, metalaxyl, pendimethalin, and trifluralin) pesticides evaluated were significantly associated with MI, which all had odds ratios >1.7 among female farmers; In a cohort of 7557 Japanese-Americans, a positive association was observed between CVD incidence and high levels of pesticide exposure (HR, 1.46; p = 0.009) | [25-27] |
Physical load | Musculoskeletal burden factors | Prevalence of occupational musculoskeletal disorders: total 4.4%; male 3.7%; female: 5.2%; Rate of complaints of musculoskeletal symptoms: 81.9%; Farmers vs. non-farmers: 72.4 vs 49.8%; Prevalence of physician-diagnosed musculoskeletal disorders: farmers (72.4%) and non-farmers (49.8%) | [28,29] |
Stress, mental | Financial difficulties, pesticide exposure, climate variabilities/ drought, and poor physical health/past injuries | A systematic review of 167 articles on farmers’ mental health: psychological health disturbances were more common in farmers and farm workers; Outcomes included loss of self-esteem, withdrawal from social/community activity, relationship breakdown, hopelessness, nervousness, inability to function in occupational roles, feelings of suffocation, fatigue, insomnia, violence involving loss of control, and substance abuse | [30] |
Temperature | Cold and hot | Both low and high temperature increase the risk of stroke mortality; Heatwaves and global warming are significant risk factors for CVD; Working inside a greenhouse: EL temperature 50°C, humidity exceeds 90%, and the temperature difference between inside and outside is 23°C | [24,31,32] |
Vibration | Frequency weighted acceleration, 8 hr | Agricultural machinery causes whole-body and local vibrations; Rice harvesting using a combine: EL 4.07 m/s2 | [20,24] |
Working hours, overwork | Long working hours | The daily working hours of Korean farmers are 10 hr 35 min and 11 hr 11 min for males and females respectively, which is one of the highest in the world | [29] |
CCVD, cardio-cerebrovascular disease; PM, particulate matter; PM2.5, particulate matter with a diameter of less than 2.5 μg/m3; HR, hazard ratio; CI, confidence interval; CVD, cardiovascular disease; EL, exposure levels; MI, myocardial infarction.
1 Among various tasks, tasks with a high level of exposure are selected and described.
Year | No. of places of agricultural business |
No. of farm workers |
No. of people in whom occupational disease was approved (death) | No. of CCVDs approved for occupational diseases (death) | Incidence rate of occupational CCVDs (%) |
---|---|---|---|---|---|
2021 | 20 302 | 78 999 | 38 (2) | 6 (2) | 0.008 |
2020 | 19 382 | 78 940 | 46 (3) | 5 (3) | 0.006 |
2019 | 18 785 | 79 482 | 43 (3) | 9 (2) | 0.011 |
2018 | 17 449 | 83 540 | 45 (4) | 4 (3) | 0.005 |
2017 | 15 452 | 76 033 | 26 (1) | 0 (0) | 0.000 |
2016 | 14 954 | 80 990 | 28 (1) | 2 (1) | 0.002 |
2015 | 12 350 | 68 697 | 28 (2) | 3 (2) | 0.004 |
2014 | 10 871 | 61 681 | 26 (2) | 2 (1) | 0.003 |
Study | Country | Epidemiological indicator | Database | Summary |
---|---|---|---|---|
Kang et al., 2022 [10] | Korea | SPR | National Health Insurance Sharing Service | Among females, the SPR of diseases of the circulatory system was higher in farmers (24 498.8 per 100 000) than in non-farmers (23 957.1 per 100 000) |
Lee et al., 2020 [11] | Korea | SIR | National Health Insurance Service | Age-adjusted incidence per 1000 person-years; Farmers: 0.766 for MI and and 0.559 for stroke; Controls: 0.585 for MI and 0.321 for stroke; Farmers had a higher age-adjusted incidence of MI and stroke |
Zhao et al., 2019 [12] | Spain | Excessive mortality rate | Population census | There was an excess mortality of 22.3% from cardiovascular diseases in farmers |
Lee et al., 2016 [13] | Korea | SMR | National Employment Insurance | The highest SMR was for agricultural, forestry, and fishery workers; The SMRs per 100 000 were high for IHD (25.8), cerebrovascular disease (42.9), and diseases of the circulatory system in males and IHD in females (7.1) |
Wada et al., 2016 [14] | Japan | SMR | Ministry of Health, Labour, and Welfare of Japan | The relative risks for stroke and IHD mortality were 2.75 (95% CI, 1.96 to 3.87) and 2.55 (95% CI, 1.90 to 3.42) in the agriculture industry; The reference group was sales |
Robinson et al., 2015 [15] | US | SMR | NIOSH National Occupational Mortality Surveillance | After adjusting for smoking, the SMR of acute MI was higher in farmers, agricultural worker occupations, and in the wholesale farm supplies, agricultural chemicals, and agricultural crop industries |
Lee et al., 2010 [16] | Korea | SPR | Korean National Health and Nutrition Examination Survey | No significant differences in CCVDs prevalence were identified among agricultural workers |
Sjögren et al., 2003 [17] | Sweden | SMR | Swedish National Censuses | Livestock workers had a slightly higher SMR for IHD than all gainfully employed; The SMR for male workers was 1.06 (95% CI, 0.95 to 1.18); The SMR for female workers was 1.10 (95% CI, 0.98 to 1.23); Agricultural workers had lower SMRs |
Risk factors | Hazards | Detailed description |
Reference |
---|---|---|---|
Air pollution | PM | Increased the cerebrovascular disease risk (HR, 1.18; 95% CI, 1.09 to 1.28) among farmers with exposure to annual average PM2.5 concentrations of 54 μg/m3 or greater; Increased risk of cardiovascular mortality (HR, 1.87; 95% CI, 1.04 to 3.36) among male farmers | [18,19] |
Chemicals | Volatile organic compounds | Using a powered sprayer inside a greenhouse: EL 6.0-19.4 mg/m3 | [20] |
Dust | PM | Rice straw input work: EL 26.34 mg/m3 | [20] |
Gas | Carbon monoxide | Using a powered sprayer inside a greenhouse: EL 4.6-352.0 ppm | [20] |
Medical vulnerability | Difficulty in accessing medical institutions | Accessibility to local CCVD centers: the average adjusted mortality rate in vulnerable areas significantly higher at 1.51±0.48 for CVD and 1.54±0.21 for cerebrovascular disease (p<0.05). | [21,22] |
Noise | Time-weighted average, 8 hr | Tractor without cabin: EL 95.0±3.3 dB(A); Harvesters, grain dryers, brush mowers, or chainsaws: EL≥100 dB(A) | [23,24] |
Pesticides | Farmers with experience using pesticides | Acute pesticide poisoning experience rate: 7.0-86.7%; Pesticide concentrations ranged from 0.20 to 12.12 ng/mL in the blood; Pesticides (chlorpyrifos, coumaphos, carbofuran, metalaxyl, pendimethalin, and trifluralin) pesticides evaluated were significantly associated with MI, which all had odds ratios >1.7 among female farmers; In a cohort of 7557 Japanese-Americans, a positive association was observed between CVD incidence and high levels of pesticide exposure (HR, 1.46; p = 0.009) | [25-27] |
Physical load | Musculoskeletal burden factors | Prevalence of occupational musculoskeletal disorders: total 4.4%; male 3.7%; female: 5.2%; Rate of complaints of musculoskeletal symptoms: 81.9%; Farmers vs. non-farmers: 72.4 vs 49.8%; Prevalence of physician-diagnosed musculoskeletal disorders: farmers (72.4%) and non-farmers (49.8%) | [28,29] |
Stress, mental | Financial difficulties, pesticide exposure, climate variabilities/ drought, and poor physical health/past injuries | A systematic review of 167 articles on farmers’ mental health: psychological health disturbances were more common in farmers and farm workers; Outcomes included loss of self-esteem, withdrawal from social/community activity, relationship breakdown, hopelessness, nervousness, inability to function in occupational roles, feelings of suffocation, fatigue, insomnia, violence involving loss of control, and substance abuse | [30] |
Temperature | Cold and hot | Both low and high temperature increase the risk of stroke mortality; Heatwaves and global warming are significant risk factors for CVD; Working inside a greenhouse: EL temperature 50°C, humidity exceeds 90%, and the temperature difference between inside and outside is 23°C | [24,31,32] |
Vibration | Frequency weighted acceleration, 8 hr | Agricultural machinery causes whole-body and local vibrations; Rice harvesting using a combine: EL 4.07 m/s2 | [20,24] |
Working hours, overwork | Long working hours | The daily working hours of Korean farmers are 10 hr 35 min and 11 hr 11 min for males and females respectively, which is one of the highest in the world | [29] |
It is estimated that only about 2-3% of all farmers are enrolled in Industrial Accident Compensation Insurance.
CCVD, cardio-cerebrovascular disease; SPR, standardized prevalence rate; SIR, standardized incidence rate; MI, myocardial infarction; IHD, ischemic heart disease; CI, confidence interval; SMR, standardized mortality rate; NIOSH, National Institute for Occupational Safety and Health.
CCVD, cardio-cerebrovascular disease; PM, particulate matter; PM2.5, particulate matter with a diameter of less than 2.5 μg/m3; HR, hazard ratio; CI, confidence interval; CVD, cardiovascular disease; EL, exposure levels; MI, myocardial infarction. Among various tasks, tasks with a high level of exposure are selected and described.