Farming activities and risk of inflammatory bowel disease: a French nationwide population-based cohort study

Pascal Petit, Ariane Leroyer, Sylvain Chamot, Mathurin Fumery, Vincent Bonneterre
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Abstract

Background and Aims Epidemiological data regarding inflammatory bowel disease (IBD) are lacking, in particular for occupationally exposed populations. We investigated whether, among the entire French farm manager (FM) workforce, certain agricultural activities are more strongly associated with IBD than others. Methods Nationwide population-based insurance claims and electronic health records from all FMs that worked at least once over the period 2002-2016 were used (n=1088561, 69% males). The outcome measure was the association between 26 farming activities and the risk of IBD, Crohn’s disease (CD), and ulcerative colitis (UC), measured as hazard ratios (HRs), after adjusting for age, sex, pre-existing medical comorbidities, and farm location. The time to first chronic disease declaration was used as the underlying timescale. A model was generated for every activity and disease, utilizing a reference group comprising all FMs who abstained from the specified activity from 2002 to 2016. Results There were 1752 IBD cases, with 704 CD (40.2%) and 1048 UC (59.8%) cases, respectively. Elevated HRs were observed for fruit arboriculture (HR from 1.17 to 1.52) and dairy farming (HR from 1.22 to 1.46) for all IBD, in crop farming for CD only (HR=1.26 [95CI%: 1.06-1.49]), and in shellfish farming (HR from 2.12 to 2.51) for both CD and IBD. Conclusions Further research regarding specific farming activities and exposures likely to modify the microbiota (e.g., pesticides, pathogens) is required to identify potential occupational risk factors (agricultural exposome) for IBD. Exposure to Mycobacterium avium subspecies paratuberculosis, cryptosporidium, environmental toxins, micro/nanoplastics, and pesticides represents promising research avenues.
农业活动与炎症性肠病风险:一项基于法国全国人口的队列研究
背景和目的 有关炎症性肠病(IBD)的流行病学数据非常缺乏,尤其是对职业暴露人群而言。我们研究了在法国所有农场经理(FM)劳动力中,某些农业活动是否比其他活动更容易导致 IBD。方法 我们使用了 2002-2016 年间至少工作过一次的所有农场主的全国人口保险索赔和电子健康记录(n=1088561,69% 为男性)。结果衡量指标是 26 项农业活动与罹患肠道疾病、克罗恩病(CD)和溃疡性结肠炎(UC)风险之间的关联,以危险比(HRs)表示,并对年龄、性别、原有医疗合并症和农场所在地进行了调整。首次宣布慢性疾病的时间被用作基本时间尺度。利用由 2002 年至 2016 年期间放弃特定活动的所有农场主组成的参照组,为每种活动和疾病生成一个模型。结果 共有 1752 例 IBD 病例,其中 CD 病例 704 例(40.2%),UC 病例 1048 例(59.8%)。在所有 IBD 病例中,果树栽培(HR 值从 1.17 到 1.52)和奶牛养殖(HR 值从 1.22 到 1.46)的 HR 值升高;在作物种植中,仅 CD 病例的 HR 值升高(HR 值=1.26 [95CI%:1.06-1.49]);在贝类养殖中,CD 和 IBD 的 HR 值均升高(HR 值从 2.12 到 2.51)。结论 需要对可能改变微生物群(如杀虫剂、病原体)的特定养殖活动和暴露进行进一步研究,以确定 IBD 的潜在职业风险因素(农业暴露组)。暴露于副结核分枝杆菌、隐孢子虫、环境毒素、微/纳米塑料和杀虫剂是很有前景的研究途径。
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