Mortality from nervous system diseases and cancer in agriculture workers: a case-control study in Italy

Abstract Background Population working or living in agriculture settings may experience important exposure to pesticides and other agents. Some health effects associated with them are well known (e.g. skin cancer due to solar radiation) while for others (e.g., neurological diseases and lymphoid, hematopoietic and related tissue cancers) additional epidemiological evidence is needed. We aim to investigate mortality for neurological diseases and cancer in workers employed in agriculture in Italy. Methods We performed a case-control study based on countrywide Italian mortality data 2005–2018 linked with National Social Insurance data to retrieve information on working histories. Adjusted cancer specific mortality odds ratios (MOR) were calculated. We modelled occupational exposure as “ever/never been employed” in agriculture, using the service sectors as reference. Analysis was stratified for gender and length of employment. Results About 64,000 workers employed in agriculture were analyzed in comparison with a control group of 107,000 workers of the service sector. We found elevated risk in agriculture workers for mortality from spinal muscular atrophy (MOR 1.26, 95% CI: 1.03–1.56; 261 deaths) and Parkinson’s disease (PD) (MOR 1.16, 95% CI:1.00-1.34; 742 deaths). As for cancer mortality, positive associations were found for non-follicular lymphoma (NFL) (MOR 1.59, 95% CI: 1.03–2.46; 82 deaths), multiple myeloma (MM) (MOR 1.42, 95% CI: 1.22–1.65; 546 deaths) and myeloid leukemia (ML) (MOR 1.36, 95% CI:1.16–1.60; 474 deaths), as well as for stomach (MOR 1.30, 95% CI:1.20–1.41; 1,732 deaths), prostate (MOR 2.03, 95% CI:1.85–2.24, 1,582 deaths), and brain and central nervous system cancer (MOR 1.30, 95% CI:1.13–1.50, 601 deaths). PD, NFL and ML, as well as cancers of skin, connective and soft tissue, prostate and brain were found to involve mainly men. Conclusions Long-term employment in agriculture was demonstrated associated with several health risks, some of which could be explained by exposure to pesticides. Although the use of the different agronomic categories of pesticides has been changed over time and some active ingredients were prohibited or limited, their health effects remain of concern for their large use, demanding for further focused investigations and preventive measures.