Kim Lyerly - CAFOs

H. Kim Lyerly, MD and Julia Kravchenko, MD, PhD Environmental Health Scholars Program

Duke University School of Medicine

A variety of health effects on nearby residents of CAFOs have been reported:

• More depression and fatigue (Schiffman et al, 1995; 2000).

• Stress-mediated impact on immune function: decreased IgA levels

(Avery et al, 2004).

• Children and adults susceptible to asthma (Mirabelli et al., 2006).

• Impaired neurobehavioral function and pulmonary function (Keil et

al, 2011).

• Acute blood pressure increase (Kilburn, 2012).

We wanted to determine the impact of CAFOs on nearby residents, which include children

and the elderly

Data we used:

Health characteristics of NC residents: The State Inpatient Database (H-CUP data on disease-specific hospital admissions), The State Emergency Department Database (H-CUP data on emergency departments visits), Mortality statistics from the NC Center for Health Statistics.

Environmental factors in NC: List of animal operations registered with the NC Division of Water Quality. Ammonia levels in air: ground monitor measurements (the U.S. EPA).

Co-factors to adjust for in our analysis: Demographics (the U.S. Census Bureau). Socioeconomic characteristics (H-CUP data files and the U.S. Census Bureau). Adult smoking prevalence (the Behavioral Risk Factor Surveillance System (BRFSS), CDC).

100 NC Counties Can Be AnalysedStudy Group: 17 NC counties with hog CAFOs selected for analysis (100,000-2,000,000+ Hogs)- 1,488,842 lives

Control Group: 40 NC counties with no registered Hog Farms- 3,733,227 lives

No hog farms<100,000 hogs100,000 – 2,352,741 hogs

Study design We compared health outcomes in populations of 17 CAFO

located NC counties versus and 40 control NC counties We analyzed associations between health outcomes and #

hogs in facilities, and measured airborne ammonia levels○ Analyses were adjusted for:

agetype of health insurancemedian household income (four quartiles for the state, from the

poorest to the wealthiest)smoking prevalence.

No information was requested to identify any individuals (such as a name, SSN or address).

No attempt was made to locate specific hog farm based on ammonia levels in the air.

Characteristics of populations living in 17 CAFO versus 40 non-CAFO counties

Study Group: 17 Counties with >100,000 hogs

Control Group: 40 Counties with no registered hog farms

Total population 1,488,842 3,733,227

Sex: Male 49.2% 48.5%

Female 50.8% 51.5%

Race: White 63.0% 77.5%

Black 30.6% 19.0%

American Indian 4.8% 0.9%

Asian 1.6% 2.6%

Have Hispanic origin 9.2% 8.1%

Age: < 19 years 28.9% 25.8%

20-64 years 59.9% 60.8%

65+ years 11.2% 13.4%

30% increase in ED visits for infectious disease/population:

Increase in ID related ED visits as % of all ED visits (age and income adjusted):

OR 1.17 (CI 1.15-1.19)Increase in hospital admissions (age adjusted):

OR 1.03 (CI 1.01-1.04)

Higher risks of Infectious Diseases (ID) Has Been Reported for Hog Farms Workers and Local Residents

As expected, we confirmed in the CAFO counties:

Kravchenko and Lyerly, unpublished

20% increase in ED visits for Acute Respiratory Disease/population

Increase in respiratory ED visits as % of all ED visits (age and income adjusted): OR 1.16 (1.15-1.17)

Increase hospital admissions (age adjusted):OR 1.06 (CI 1.01-1.10)

An Increase in Respiratory Diseases Has Been Reported for Hog Farms Workers and Local Residents

As expected, we confirmed in the CAFO counties:


30% increase in ED visits for hypertension/population

Increase in cardiovascular disease related ED visits as % of all ED visits (age and income adjusted): OR 1.33 (CI 1.30-1.37)

Increase in hypertension related hospital admissions increased (age adjusted):OR 1.21 (CI 1.17-1.25)

Hypertension, but not a spectrum of cardio- and cerebrovascular diseases had been associated with CAFO

What we found in CAFO counties:


Mortality rates, age group specific

Arterial hypertension Ischemic heart disease

*

* ***

*p<0.05, **p<0.005, ***p<0.0001

Cardiovascular Diseases, Mortality and CAFO

We found an increase in mortality in CAFO counties:


70% increase in ED visits for Type II diabetes/population

Increase in diabetes ED visits as % of all ED visits (age and income adjusted): Diabetes type I: OR 1.37 (CI 1.21-1.56)

Diabetes type II: OR 1.52 (1.04-2.21)

Increase in diabetes hospital admissions (age adjusted):Diabetes type II: OR 1.18 (CI 1.14-1.21)

Diabetes had not previously been associated with CAFO



Diabetes mortality rates, age group specific

*p<0.05**p<0.005***p<0.0001

Diabetes, mortality and CAFOWe found an increase in mortality in CAFO counties:


30% increase in ED visits nephritis/nephrosis/population

Increase in nephritis/nephrosis ED visits as % of all ED visits: OR 1.12 (1.02-1.22)

Increase in nephritis/nephrosis hospital admissions increased:OR 1.18 (CI 1.15-1.21)

Kidney diseases had not been previously associated with CAFO



Mortality rates from genitourinary diseases and renal failure, age group specific.

*p<0.05, **p<0.005, ***p<0.0001

Kidney diseases, mortality and CAFO

Renal failureGenitourinary diseases

We found an increase in mortality in CAFO counties:


Summary of our preliminary findings Populations living in counties with CAFOs (>100,000 pigs) in NC have higher risk for

ED visits, hospitalization, and death for various diseases, as compared to people living in counties without CAFOs: although some of these diseases have been previously associated with CAFO, we report new associations with diseases.

Our study includes the vulnerable, such as children, those with chronic diseases, and the elderly (in contrast to previous studies of workers in CAFO): children and older residents in our study have higher mortality rates and worse health outcomes for certain diseases as compared to healthy residents.

An appreciation of the vulnerable populations living in proximity to CAFOs is needed to gauge their true health impact.

Study team:H. Kim LyerlyJulia KravchenkoPankaj Agarwal

We thank:

Igor Akushevich, SSRI, Duke University Amy Keyworth, Christine Lawson, Evan Kane from the NC Division

of Water Resources John Walker and Jesse Bash from the U.S. EPA

Fred and Alice Stanback for supporting this study.

Sommers BD et al. N Engl J Med 2012;367:1025-1034.

Mortality After State Medicaid Expansions (1997–2007).

Pregnancy and labor/delivery complications

25% increase in ED visits for complications of pregnancy /population

Increase in complications of pregnancy ED visits as % of all ED visits (age and income adjusted):OR 1.30 (CI 1.27-1.32)

Reported:•Excessive nitrate ingestion has been associated with miscarriages and the CDC blamed water contaminated with nitrates from a swine farms for some miscarriages occurred in 1993 and 1994 (Fan, Steinberg, 1996; Kramer et al, 1996).



Neurological disorders

70% increase in ED visits for Epilepsy/population

Increase in Epilepsy ED visits as % of all ED visits (age and income adjusted): OR 1.39 (CI 1.32-1.47)

Increase in hospital admissions (age adjusted):OR 1.17 (1.11-1.22)

Reported:•Occupational exposures to hydrogen sulfide at hog farms can be associated with transitory CNS symptoms (National Research Council, 2003).•Children are particularly susceptible to these neurological effects (Hannah et al, 1991).



Food

Kim Lyerly - CAFOs