Pesticide use and fatal injury among farmers in the Agricultural Health Study

  • Jenna K. Waggoner
  • Paul K. Henneberger
  • Greg J. Kullman
  • David M. Umbach
  • Freya Kamel
  • Laura E. Beane Freeman
  • Michael C. R. Alavanja
  • Dale P. Sandler
  • Jane A. Hoppin
Original Article



To assess whether pesticide use practices were associated with injury mortality among 51,035 male farmers from NC and IA enrolled in the Agricultural Health Study.


We used Cox proportional hazards models adjusted for age and state to estimate fatal injury risk associated with self-reported use of 49 specific pesticides, personal protective equipment, specific types of farm machinery, and other farm factors collected 1–15 years preceding death. Cause-specific mortality was obtained through linkage to mortality registries.


We observed 338 injury fatalities over 727,543 person-years of follow-up (1993–2008). Fatal injuries increased with days/year of pesticide application, with the highest risk among those with 60+ days of pesticide application annually [hazard ratio (HR) = 1.87; 95% confidence interval (CI) = 1.10, 3.18]. Chemical-resistant glove use was associated with decreased risk (HR = 0.73; 95% CI = 0.58, 0.93), but adjusting for glove use did not substantially change estimates for individual pesticides or pesticide use overall. Herbicides were associated with fatal injury, even after adjusting for operating farm equipment, which was independently associated with fatal injury. Ever use of five of 18 herbicides (2,4,5-T, paraquat, alachlor, metribuzin, and butylate) were associated with elevated risk. In addition, 2,4-D and cyanazine were associated with fatal injury in exposure–response analyses. There was no evidence of confounding of these results by other herbicides.


The association between application of pesticides, particularly certain herbicides, and fatal injuries among farmers should be interpreted cautiously but deserves further evaluation, with particular focus on understanding timing of pesticide use and fatal injury.


Pesticides Mortality Wounds and injuries 



Agricultural Health Study


Confidence interval


Hazard ratio



The authors thank Stuart Long for assistance with data analysis. This work was supported by the Association of Schools of Public Health/Centers for Disease Control Fellowship program; the National Institute for Occupational Safety and Health and the Intramural Research Program of the National Institutes of Health, National Institute of Environmental Health Sciences (Z01-ES049030) and the National Institutes of Health National Cancer Institute (Z01-CP010119).

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag (outside the USA) 2012

Authors and Affiliations

  • Jenna K. Waggoner
    • 1
    • 2
  • Paul K. Henneberger
    • 1
  • Greg J. Kullman
    • 1
  • David M. Umbach
    • 3
  • Freya Kamel
    • 2
  • Laura E. Beane Freeman
    • 4
  • Michael C. R. Alavanja
    • 4
  • Dale P. Sandler
    • 2
  • Jane A. Hoppin
    • 2
  1. 1.Division of Respiratory Disease StudiesNIOSH, CDC, DHHSMorgantownUSA
  2. 2.Epidemiology BranchNIEHS, NIH, DHHSResearch Triangle ParkUSA
  3. 3.Biostatistics BranchNIEHS, NIH, DHHSResearch Triangle ParkUSA
  4. 4.Division of Cancer Epidemiology and GeneticsNCI, NIH, DHHSRockvilleUSA

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