Sunday, October 18, 2009: 5:15 PM
Auditorium (Pennsylvania Convention Center)
Presentation Number: 614
Purpose: Farming has been previously associated with the autoimmune rheumatic diseases (ARD), including rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). The exposure(s) underlying this association are not well-understood, and few studies have directly addressed the role of pesticides, including personal and residential insecticide use. Method: Using data from the Women’s Health Initiative Observational Study (n=76,861, aged 50-79 years), we examined self-reported lifetime personal or commercial residential insecticide use and having lived or worked on a farm in relation to risk of incident ARD, confirmed by use of disease modifying anti-rheumatic drugs at year 3 of follow-up (n=213; 178 with RA only, 27 with SLE only, and 8 with both RA and SLE), and excluding unconfirmed cases. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated by multivariate models adjusting for age and covariates, including race, region, education, occupation, history of smoking, asthma, other autoimmune diseases, co-morbidity, and reproductive factors. Results: Compared with never use, personal insecticide use (mixing or applying) was associated with ARD risk, with stronger associations among those with a greater frequency (age-adjusted HR=2.47; 95%CI 1.51, 4.03 for ≥ 6 times per year) and duration of use (age-adjusted HR=2.07; 95% CI 1.31, 3.25 for ≥ 20 years). Increasing cumulative insecticide use (years X applications) also showed a significant trend of association (p=0.0004) with ARD risk, and these associations persisted after adjusting for farming and covariates. Having lived or worked on a farm was also associated with ARD risk (age-adjusted HR=1.97; 95% CI 1.14, 3.42 for ≥20 years), but the effect size was diminished after adjusting for covariates and insecticide use. Despite the small number of SLE cases, disease-stratified analyses indicated similar associations as seen for RA. In those who had lived or worked on a farm, frequent commercial application to home or garden was also associated with ARD risk, even after adjusting for covariates and personal insecticide use (adjusted HR=2.73; 95%CI 1.1, 6.78 for ≥6 times per year). Long-term commercial residential insecticide exposure was significantly associated with ARD risk regardless of farming history (age-adjusted HR=1.85; 95% CI 1.13, 3.04 for ≥20 years). Conclusion: Insecticide exposure may increase risk of ARD in post-menopausal women. These findings, based on self-report, provide rationale for further investigation of specific personal and environmental insecticide exposures in relation to ARD.
Keywords: environmental factors, rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE)
Disclosure: C. G. Parks, None; B. T. Walitt, None; M. Pettinger, None; J. C. Chen, None; A. de Roos, None; J. Hunt, None; G. Sarto, None; B. V. Howard, None.