Agricultural and Horticultural Chemical Poisonings: Mortality and Morbidity in the United States
Identifieur interne : 000470 ( Istex/Corpus ); précédent : 000469; suivant : 000471Agricultural and Horticultural Chemical Poisonings: Mortality and Morbidity in the United States
Auteurs : Wendy Klein-Schwartz ; Gordon S. SmithSource :
- Annals of Emergency Medicine [ 0196-0644 ] ; 1997.
Abstract
Study objective: To provide a comprehensive analysis of morbidity and mortality from poisoning by agricultural and horticultural chemicals in the United States. Methods: Descriptive analysis of national mortality data, National Hospital Discharge Survey data, and American Association of Poison Control Centers national data for 1985 through 1990. Results: There were 341 fatalities from agricultural and horticultural chemicals over the 6-year period, of which 64% were suicides, 28% were unintentional, and 8% were of undetermined intent. There were 25,418 hospitalizations; 78% were reported to be unintentional. Both deaths and hospitalizations occurred more frequently in males, and rates were higher in nonwhites than in whites. There were 338,170 poison exposures reported to poison centers for fungicides, herbicides, pesticides/insecticides, and rodenticides. Life-threatening manifestations or long-term sequelae occurred in 782 cases, and 97 deaths were reported. Pesticides and insecticides accounted for 72% of the poison center cases and 63% of the fatalities. Although they accounted for only 8% of poison exposures, herbicide deaths were disproportionately high (25%). Conclusion: Conclusion: Poisonings with agricultural and horticultural chemicals are an important public health problem. Prevention efforts need to incorporate the fact that many serious cases, such as paraquat poisonings, are suicidal in nature. [Klein-Schwartz W, Smith GS: Agricultural and horticultural chemical poisonings: Mortality and morbidity in the United States. Ann Emerg Med February 1997;29:232-238.]
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DOI: 10.1016/S0196-0644(97)70274-9
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Agricultural and Horticultural Chemical Poisonings: Mortality and Morbidity in the United States</title><author><name sortKey="Klein Schwartz, Wendy" sort="Klein Schwartz, Wendy" uniqKey="Klein Schwartz W" first="Wendy" last="Klein-Schwartz">Wendy Klein-Schwartz</name></author><author><name sortKey="Smith, Gordon S" sort="Smith, Gordon S" uniqKey="Smith G" first="Gordon S" last="Smith">Gordon S. Smith</name></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:E8BC2C605BCACE6E36A00A40B0FC3F460032FDAD</idno><date when="1997" year="1997">1997</date><idno type="doi">10.1016/S0196-0644(97)70274-9</idno><idno type="url">https://api.istex.fr/document/E8BC2C605BCACE6E36A00A40B0FC3F460032FDAD/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000470</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000470</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Agricultural and Horticultural Chemical Poisonings: Mortality and Morbidity in the United States</title><author><name sortKey="Klein Schwartz, Wendy" sort="Klein Schwartz, Wendy" uniqKey="Klein Schwartz W" first="Wendy" last="Klein-Schwartz">Wendy Klein-Schwartz</name></author><author><name sortKey="Smith, Gordon S" sort="Smith, Gordon S" uniqKey="Smith G" first="Gordon S" last="Smith">Gordon S. Smith</name></author></analytic><monogr></monogr><series><title level="j">Annals of Emergency Medicine</title><title level="j" type="abbrev">YMEM</title><idno type="ISSN">0196-0644</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1997">1997</date><biblScope unit="volume">29</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="232">232</biblScope><biblScope unit="page" to="238">238</biblScope></imprint><idno type="ISSN">0196-0644</idno></series><idno type="istex">E8BC2C605BCACE6E36A00A40B0FC3F460032FDAD</idno><idno type="DOI">10.1016/S0196-0644(97)70274-9</idno><idno type="PII">S0196-0644(97)70274-9</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0196-0644</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Study objective: To provide a comprehensive analysis of morbidity and mortality from poisoning by agricultural and horticultural chemicals in the United States. Methods: Descriptive analysis of national mortality data, National Hospital Discharge Survey data, and American Association of Poison Control Centers national data for 1985 through 1990. Results: There were 341 fatalities from agricultural and horticultural chemicals over the 6-year period, of which 64% were suicides, 28% were unintentional, and 8% were of undetermined intent. There were 25,418 hospitalizations; 78% were reported to be unintentional. Both deaths and hospitalizations occurred more frequently in males, and rates were higher in nonwhites than in whites. There were 338,170 poison exposures reported to poison centers for fungicides, herbicides, pesticides/insecticides, and rodenticides. Life-threatening manifestations or long-term sequelae occurred in 782 cases, and 97 deaths were reported. Pesticides and insecticides accounted for 72% of the poison center cases and 63% of the fatalities. Although they accounted for only 8% of poison exposures, herbicide deaths were disproportionately high (25%). Conclusion: Conclusion: Poisonings with agricultural and horticultural chemicals are an important public health problem. Prevention efforts need to incorporate the fact that many serious cases, such as paraquat poisonings, are suicidal in nature. [Klein-Schwartz W, Smith GS: Agricultural and horticultural chemical poisonings: Mortality and morbidity in the United States. Ann Emerg Med February 1997;29:232-238.]</div></front></TEI><istex><corpusName>elsevier</corpusName><author><json:item><name>Wendy Klein-Schwartz PharmD, MPH*</name></json:item><json:item><name>Gordon S Smith MB, ChB, MPH‡</name></json:item></author><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>Study objective: To provide a comprehensive analysis of morbidity and mortality from poisoning by agricultural and horticultural chemicals in the United States. Methods: Descriptive analysis of national mortality data, National Hospital Discharge Survey data, and American Association of Poison Control Centers national data for 1985 through 1990. Results: There were 341 fatalities from agricultural and horticultural chemicals over the 6-year period, of which 64% were suicides, 28% were unintentional, and 8% were of undetermined intent. There were 25,418 hospitalizations; 78% were reported to be unintentional. Both deaths and hospitalizations occurred more frequently in males, and rates were higher in nonwhites than in whites. There were 338,170 poison exposures reported to poison centers for fungicides, herbicides, pesticides/insecticides, and rodenticides. Life-threatening manifestations or long-term sequelae occurred in 782 cases, and 97 deaths were reported. Pesticides and insecticides accounted for 72% of the poison center cases and 63% of the fatalities. Although they accounted for only 8% of poison exposures, herbicide deaths were disproportionately high (25%). Conclusion: Conclusion: Poisonings with agricultural and horticultural chemicals are an important public health problem. Prevention efforts need to incorporate the fact that many serious cases, such as paraquat poisonings, are suicidal in nature. [Klein-Schwartz W, Smith GS: Agricultural and horticultural chemical poisonings: Mortality and morbidity in the United States. Ann Emerg Med February 1997;29:232-238.]</abstract><qualityIndicators><score>6.218</score><pdfVersion>1.3</pdfVersion><pdfPageSize>612 x 828 pts</pdfPageSize><refBibsNative>true</refBibsNative><keywordCount>0</keywordCount><abstractCharCount>1599</abstractCharCount><pdfWordCount>3614</pdfWordCount><pdfCharCount>25554</pdfCharCount><pdfPageCount>7</pdfPageCount><abstractWordCount>217</abstractWordCount></qualityIndicators><title>Agricultural and Horticultural Chemical Poisonings: Mortality and Morbidity in the United States</title><pii><json:string>S0196-0644(97)70274-9</json:string></pii><genre><json:string>research-article</json:string></genre><serie><pages><last>242</last><first>229</first></pages><language><json:string>unknown</json:string></language><title>NIOSH publication no. 92-105</title></serie><host><volume>29</volume><pii><json:string>S0196-0644(05)X7076-7</json:string></pii><pages><last>238</last><first>232</first></pages><issn><json:string>0196-0644</json:string></issn><issue>2</issue><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><title>Annals of Emergency Medicine</title><publicationDate>1997</publicationDate></host><categories><wos><json:string>science</json:string><json:string>emergency medicine</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>clinical medicine</json:string><json:string>emergency & critical care medicine</json:string></scienceMetrix></categories><publicationDate>1997</publicationDate><copyrightDate>1997</copyrightDate><doi><json:string>10.1016/S0196-0644(97)70274-9</json:string></doi><id>E8BC2C605BCACE6E36A00A40B0FC3F460032FDAD</id><score>0.045236193</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/E8BC2C605BCACE6E36A00A40B0FC3F460032FDAD/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/E8BC2C605BCACE6E36A00A40B0FC3F460032FDAD/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/E8BC2C605BCACE6E36A00A40B0FC3F460032FDAD/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Agricultural and Horticultural Chemical Poisonings: Mortality and Morbidity in the United States</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>©1997 Mosby, Inc.</p></availability><date>1997</date></publicationStmt><notesStmt><note>From the Maryland Poison Center, University of Maryland School of Pharmacy*; and the Center for Injury Research, The Johns Hopkins School of Hygiene and Public Health‡, Baltimore, Maryland.</note><note>Reprint no.47/1/79099</note><note>Address for reprints: Wendy Klein-Schwartz, PharmD, MPH, Maryland Poison Center, 20 North Pine Street, Baltimore, Maryland 21201</note><note type="content">Table 1: Agricultural and horticultural chemical poisonings resulting in death, hospitalization, or poison center consultation, 1985–1990.</note><note type="content">Table 2: Agricultural and horticultural chemical poisonings by specific chemical group for unintentional injury deaths, all hospitalizations, and all poison center reports, 1985–1990.</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Agricultural and Horticultural Chemical Poisonings: Mortality and Morbidity in the United States</title><author xml:id="author-1"><persName><forename type="first">Wendy</forename><surname>Klein-Schwartz</surname></persName><roleName type="degree">PharmD, MPH*</roleName></author><author xml:id="author-2"><persName><forename type="first">Gordon S</forename><surname>Smith</surname></persName><roleName type="degree">MB, ChB, MPH‡</roleName></author></analytic><monogr><title level="j">Annals of Emergency Medicine</title><title level="j" type="abbrev">YMEM</title><idno type="pISSN">0196-0644</idno><idno type="PII">S0196-0644(05)X7076-7</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1997"></date><biblScope unit="volume">29</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="232">232</biblScope><biblScope unit="page" to="238">238</biblScope></imprint></monogr><idno type="istex">E8BC2C605BCACE6E36A00A40B0FC3F460032FDAD</idno><idno type="DOI">10.1016/S0196-0644(97)70274-9</idno><idno type="PII">S0196-0644(97)70274-9</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1997</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Study objective: To provide a comprehensive analysis of morbidity and mortality from poisoning by agricultural and horticultural chemicals in the United States. Methods: Descriptive analysis of national mortality data, National Hospital Discharge Survey data, and American Association of Poison Control Centers national data for 1985 through 1990. Results: There were 341 fatalities from agricultural and horticultural chemicals over the 6-year period, of which 64% were suicides, 28% were unintentional, and 8% were of undetermined intent. There were 25,418 hospitalizations; 78% were reported to be unintentional. Both deaths and hospitalizations occurred more frequently in males, and rates were higher in nonwhites than in whites. There were 338,170 poison exposures reported to poison centers for fungicides, herbicides, pesticides/insecticides, and rodenticides. Life-threatening manifestations or long-term sequelae occurred in 782 cases, and 97 deaths were reported. Pesticides and insecticides accounted for 72% of the poison center cases and 63% of the fatalities. Although they accounted for only 8% of poison exposures, herbicide deaths were disproportionately high (25%). Conclusion: Conclusion: Poisonings with agricultural and horticultural chemicals are an important public health problem. Prevention efforts need to incorporate the fact that many serious cases, such as paraquat poisonings, are suicidal in nature. [Klein-Schwartz W, Smith GS: Agricultural and horticultural chemical poisonings: Mortality and morbidity in the United States. Ann Emerg Med February 1997;29:232-238.]</p></abstract></profileDesc><revisionDesc><change when="1996-07-18">Modified</change><change when="1997">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/E8BC2C605BCACE6E36A00A40B0FC3F460032FDAD/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier doc found" wicri:toSee="Elsevier, no converted or simple article"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 5.0.1//EN//XML" URI="art501.dtd" name="istex:docType"><istex:entity SYSTEM="gr1" NDATA="IMAGE" name="gr1"></istex:entity><istex:entity SYSTEM="gr2" NDATA="IMAGE" name="gr2"></istex:entity></istex:docType><istex:document><article docsubtype="fla" xml:lang="en"><item-info><jid>YMEM</jid><aid>79099</aid><ce:pii>S0196-0644(97)70274-9</ce:pii><ce:doi>10.1016/S0196-0644(97)70274-9</ce:doi><ce:copyright type="full-transfer" year="1997">Mosby, Inc.</ce:copyright></item-info><ce:floats><ce:table id="tab1" colsep="0" rowsep="0" frame="topbot"><ce:label>Table 1</ce:label><ce:caption><ce:simple-para>Agricultural and horticultural chemical poisonings resulting in death, hospitalization, or poison center consultation, 1985–1990.</ce:simple-para></ce:caption><tgroup cols="4"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><tbody><row rowsep="1"><entry></entry><entry namest="col2" nameend="col4"><ce:bold>No. of Cases (%)</ce:bold></entry></row><row rowsep="1"><entry><ce:bold>Cause of Poisoning</ce:bold></entry><entry><ce:bold>NMD</ce:bold></entry><entry><ce:bold>NHDS</ce:bold></entry><entry><ce:bold>AAPCC TESS</ce:bold></entry></row><row rowsep="1"><entry>Unintentional</entry><entry>97 (28.4)</entry><entry>19,753 (77.7)</entry><entry>327,599 (96.9)</entry></row><row rowsep="1"><entry>Suicide</entry><entry>217 (63.6)</entry><entry>4,458 (17.5)</entry><entry>7,848 (2.3)<ce:sup>*</ce:sup></entry></row><row rowsep="1"><entry>Undetermined</entry><entry>27 (7.9)</entry><entry>1,207 (4.7)</entry><entry>2,723 (.8)<ce:sup>†</ce:sup></entry></row><row rowsep="1"><entry>Homicide</entry><entry>—<ce:sup>‡</ce:sup></entry><entry>—<ce:sup>‡</ce:sup></entry><entry>—<ce:sup>§</ce:sup></entry></row><row rowsep="1"><entry><ce:bold>Total</ce:bold></entry><entry><ce:bold>341 (100)</ce:bold></entry><entry><ce:bold>25,418 (100)</ce:bold></entry><entry><ce:bold>338,170 (100)</ce:bold></entry></row><row rowsep="1"><entry namest="col1" nameend="col4"><ce:sup>*</ce:sup>Includes all intentional cases (suicides, abuse, misuse, and intentional unknown).</entry></row><row rowsep="1"><entry namest="col1" nameend="col4"><ce:sup>†</ce:sup>Includes adverse reactions, other, and unknown.</entry></row><row rowsep="1"><entry namest="col1" nameend="col4"><ce:sup>‡</ce:sup>Homicides are not included in NMD and NHDS data because no E-code exists for homicides with pesticides; a single code covers all poisoning homicides.</entry></row><row><entry namest="col1" nameend="col4"><ce:sup>§</ce:sup>Homicides would be included under "other" in poison center data, but it is impossible to obtain a count.</entry></row></tbody></tgroup></ce:table><ce:table id="tab2" colsep="0" rowsep="0" frame="topbot"><ce:label>Table 2</ce:label><ce:caption><ce:simple-para>Agricultural and horticultural chemical poisonings by specific chemical group for unintentional injury deaths, all hospitalizations, and all poison center reports, 1985–1990.</ce:simple-para></ce:caption><tgroup cols="5"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><tbody><row rowsep="1"><entry namest="col1" nameend="col3"></entry><entry namest="col4" nameend="col5"><ce:bold>Poison Center</ce:bold></entry></row><row rowsep="1"><entry><ce:bold>Chemical</ce:bold></entry><entry><ce:bold>Unintentional Injury Deaths (NMD)<ce:sup>*</ce:sup></ce:bold></entry><entry><ce:bold>All Hospitalizations (NHDS)<ce:sup>†</ce:sup></ce:bold></entry><entry><ce:bold>All Deaths</ce:bold></entry><entry><ce:bold>All Cases</ce:bold></entry></row><row rowsep="1"><entry><ce:bold>Fumigants</ce:bold></entry><entry>7</entry><entry>NA</entry><entry>NA</entry><entry>NA</entry></row><row rowsep="1"><entry><ce:bold>Fungicides</ce:bold></entry><entry>4</entry><entry>—<ce:sup>‡</ce:sup></entry><entry>3</entry><entry>7,500</entry></row><row rowsep="1"><entry namest="col1" nameend="col5"><ce:bold>Herbicides</ce:bold></entry></row><row rowsep="1"><entry>Paraquat and diquat</entry><entry>NA</entry><entry>NA</entry><entry>13</entry><entry>1,317</entry></row><row rowsep="1"><entry>Chlorophenoxy compound</entry><entry>NA</entry><entry>NA</entry><entry>4</entry><entry>9,255</entry></row><row rowsep="1"><entry>Other</entry><entry>NA</entry><entry>NA</entry><entry>7</entry><entry>16,515<ce:sup>§</ce:sup></entry></row><row rowsep="1"><entry>Total</entry><entry>12</entry><entry>—<ce:sup>‡</ce:sup></entry><entry>24</entry><entry>27,087</entry></row><row rowsep="1"><entry namest="col1" nameend="col5"><ce:bold>Pesticides/Insecticides</ce:bold></entry></row><row rowsep="1"><entry>Organophosphate</entry><entry>26</entry><entry>8,491<ce:sup>∥</ce:sup></entry><entry>38</entry><entry>57,889</entry></row><row rowsep="1"><entry>Carbamate</entry><entry>1</entry><entry>—<ce:sup>∥</ce:sup></entry><entry>4</entry><entry>28,433</entry></row><row rowsep="1"><entry>Chlorinated hydrocarbon</entry><entry>6</entry><entry>1,526</entry><entry>6</entry><entry>21,611</entry></row><row rowsep="1"><entry>Arsenic</entry><entry>0</entry><entry>2,795<ce:sup>¶</ce:sup></entry><entry>4</entry><entry>6,234</entry></row><row rowsep="1"><entry>Other/Unknown</entry><entry>10</entry><entry>14,393<ce:sup>‡</ce:sup></entry><entry>9</entry><entry>128,894<ce:sup>#</ce:sup></entry></row><row rowsep="1"><entry>Total</entry><entry>43</entry><entry>24,410</entry><entry>61</entry><entry>243,061</entry></row><row rowsep="1"><entry namest="col1" nameend="col5"><ce:bold>Rodenticides</ce:bold></entry></row><row rowsep="1"><entry>Strychnine</entry><entry>NA</entry><entry>188</entry><entry>4</entry><entry>869</entry></row><row rowsep="1"><entry>Anticoagulants</entry><entry>NA</entry><entry>NA</entry><entry>2</entry><entry>52,699</entry></row><row rowsep="1"><entry>Other</entry><entry>NA</entry><entry>NA</entry><entry>3</entry><entry>6,954<ce:sup>§</ce:sup></entry></row><row rowsep="1"><entry>Total</entry><entry>13</entry><entry>188<ce:sup>‡</ce:sup></entry><entry>9</entry><entry>60,522</entry></row><row rowsep="1"><entry><ce:bold>Others</ce:bold></entry><entry>18</entry><entry>0</entry><entry>0</entry><entry>0</entry></row><row rowsep="1"><entry><ce:bold>Total</ce:bold></entry><entry><ce:bold>97</ce:bold></entry><entry><ce:bold>27,393</ce:bold></entry><entry><ce:bold>97</ce:bold></entry><entry><ce:bold>338,170</ce:bold></entry></row><row rowsep="1"><entry namest="col1" nameend="col5">NA, data not available in data source specified.</entry></row><row rowsep="1"><entry namest="col1" nameend="col5"><ce:sup>*</ce:sup>Does not include 217 suicides and 27 poisoning fatalities of undetermined intent for which a specific chemical agent was not reported.</entry></row><row rowsep="1"><entry namest="col1" nameend="col5"><ce:sup>†</ce:sup>Weighted sample estimates based on N-codes from 150 cases; numbers in individual cells may be unreliable. Figures include adverse effects from therapeutic use.</entry></row><row rowsep="1"><entry namest="col1" nameend="col5"><ce:sup>‡</ce:sup>Fungicides, herbicides, nonstrychnine rodenticides, and other/unspecified pesticides are included under Pesticides/Insecticides: Other/Unknown.</entry></row><row rowsep="1"><entry namest="col1" nameend="col5"><ce:sup>§</ce:sup>Arsenic is also included under Herbicides: Other and Rodenticides: Other.</entry></row><row rowsep="1"><entry namest="col1" nameend="col5"><ce:sup>∥</ce:sup>Organophosphate and carbamate poisonings totaled 8,491 hospitalizations.</entry></row><row rowsep="1"><entry namest="col1" nameend="col5"><ce:sup>¶</ce:sup>Includes arsenic-based rodenticides, herbicides, and pesticides; N-code does not differentiate between agrichemical and nonagrichemical sources.</entry></row><row><entry namest="col1" nameend="col5"><ce:sup>#</ce:sup>Includes combinations of listed insecticides.</entry></row></tbody></tgroup></ce:table></ce:floats><head><ce:article-footnote><ce:label>☆</ce:label><ce:note-para>From the Maryland Poison Center, University of Maryland School of Pharmacy<ce:sup>*</ce:sup>; and the Center for Injury Research, The Johns Hopkins School of Hygiene and Public Health<ce:sup>‡</ce:sup>, Baltimore, Maryland.</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>☆☆</ce:label><ce:note-para>Reprint no.<ce:bold>47/1/79099</ce:bold></ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>★</ce:label><ce:note-para><ce:bold>Address for reprints:</ce:bold> Wendy Klein-Schwartz, PharmD, MPH, Maryland Poison Center, 20 North Pine Street, Baltimore, Maryland 21201</ce:note-para></ce:article-footnote><ce:title>Agricultural and Horticultural Chemical Poisonings: Mortality and Morbidity in the United States</ce:title><ce:author-group><ce:author><ce:given-name>Wendy</ce:given-name><ce:surname>Klein-Schwartz</ce:surname><ce:degrees>PharmD, MPH<ce:sup>*</ce:sup></ce:degrees></ce:author><ce:author><ce:given-name>Gordon S</ce:given-name><ce:surname>Smith</ce:surname><ce:degrees>MB, ChB, MPH<ce:sup>‡</ce:sup></ce:degrees></ce:author></ce:author-group><ce:date-received day="12" month="2" year="1996"></ce:date-received><ce:date-revised day="18" month="7" year="1996"></ce:date-revised><ce:date-accepted day="1" month="9" year="1996"></ce:date-accepted><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para><ce:bold>Study objective:</ce:bold> To provide a comprehensive analysis of morbidity and mortality from poisoning by agricultural and horticultural chemicals in the United States. <ce:bold>Methods:</ce:bold> Descriptive analysis of national mortality data, National Hospital Discharge Survey data, and American Association of Poison Control Centers national data for 1985 through 1990. <ce:bold>Results:</ce:bold> There were 341 fatalities from agricultural and horticultural chemicals over the 6-year period, of which 64% were suicides, 28% were unintentional, and 8% were of undetermined intent. There were 25,418 hospitalizations; 78% were reported to be unintentional. Both deaths and hospitalizations occurred more frequently in males, and rates were higher in nonwhites than in whites. There were 338,170 poison exposures reported to poison centers for fungicides, herbicides, pesticides/insecticides, and rodenticides. Life-threatening manifestations or long-term sequelae occurred in 782 cases, and 97 deaths were reported. Pesticides and insecticides accounted for 72% of the poison center cases and 63% of the fatalities. Although they accounted for only 8% of poison exposures, herbicide deaths were disproportionately high (25%). <ce:bold>Conclusion:</ce:bold> Conclusion: Poisonings with agricultural and horticultural chemicals are an important public health problem. Prevention efforts need to incorporate the fact that many serious cases, such as paraquat poisonings, are suicidal in nature. [Klein-Schwartz W, Smith GS: Agricultural and horticultural chemical poisonings: Mortality and morbidity in the United States. <ce:italic>Ann Emerg Med</ce:italic> February 1997;29:232-238.]</ce:simple-para></ce:abstract-sec></ce:abstract></head><body><ce:sections><ce:section><ce:section-title>INTRODUCTION</ce:section-title><ce:para>Poisoning with pesticides and other agricultural and horticultural chemicals is a preventable public health problem worldwide, especially in developing countries. Globally, these chemicals cause 20,000 fatalities and 1 million serious unintentional poisonings annually; suicide attempts produce an additional 2 million hospitalizations.<ce:cross-refs refid="bib1 bib2"><ce:sup>1,2</ce:sup></ce:cross-refs> Because many of these poisonings occur in developing countries with incomplete recordkeeping, it is believed that the magnitude of the problem is greatly underestimated.<ce:cross-ref refid="bib3"><ce:sup>3</ce:sup></ce:cross-ref></ce:para><ce:para>Poisoning with pesticides and other agricultural and horticultural chemicals is also a problem in the United States, and here too the magnitude of the problem is not well defined<ce:cross-ref refid="bib4"><ce:sup>4</ce:sup></ce:cross-ref> and has not been evaluated systematically on a national level. Most attention has been focused on the development of local surveillance systems to identify specific work-related exposures.<ce:cross-refs refid="bib4 bib5"><ce:sup>4,5</ce:sup></ce:cross-refs> Little is known about the health risks associated with agricultural and horticultural chemical exposures, whether they occur at work, in the home, or in suicide attempts.</ce:para><ce:para>This descriptive study provides a comprehensive analysis of morbidity and mortality from poisonings with pesticides and other agricultural or horticultural chemicals in the United States.</ce:para></ce:section><ce:section><ce:section-title>MATERIALS AND METHODS</ce:section-title><ce:para>National mortality data (NMD) and National Hospital Discharge Survey (NHDS) data for 1985 through 1990 were extracted from CDC Wonder/PC, Version 2.0 (Center for Disease Control and Prevention). CDC Wonder is an online public health information system through which national databases may be queried.<ce:cross-ref refid="bib6"><ce:sup>6</ce:sup></ce:cross-ref> NMD figures were obtained from the underlying cause of death data set for the US population. Hospitalization information was obtained from the NHDS data set, which provides a nationally representative sample of patients discharged from noninstitutional, short-stay hospitals, excluding federal hospitals, located in the 50 states and the District of Columbia.</ce:para><ce:para>The 1985–1990 NMD and NHDS data were searched with the use of external cause of injury codes (ICD E-codes) for poisoning by agricultural and horticultural chemicals.<ce:cross-ref refid="bib7"><ce:sup>7</ce:sup></ce:cross-ref> These include unintentional poisoning by agricultural and horticultural chemical and pharmaceutical preparations other than plant foods and fertilizers (E-863), suicides/ suicide attempts (E-950.6), and undetermined whether unintentional or purposely inflicted (E-980.7). It is not possible to differentiate homicides caused by pesticide poisoning. The search strategies included the entire US population, all ages, races, and states or regions. For the NMD, counts and rates were obtained by E-code, age, race, and gender. For the NHDS data, national estimates were obtained based on weighted sample estimates for number of hospitalizations, number of days, length of stay, E-code, age, race, and sex. Data were also obtained for all appropriate nature of injury codes (ICD N-codes)<ce:cross-ref refid="bib7"><ce:sup>7</ce:sup></ce:cross-ref> that correspond to the E-code groups used: arsenic (N-985.1), strychnine (N-989.1), chlorinated hydrocarbons (N-989.2), organophosphates and carbamates (N-989.3), and other pesticides not elsewhere classified (N-989.4). Counts of specific agricultural and horticultural chemicals responsible for unintentional deaths were obtained with the use of fourth-digit ICD codes, which provide more specific detail.</ce:para><ce:para>The third database investigated was the American Association of Poison Control Centers Toxic Exposure Surveillance System (AAPCC TESS). AAPCC TESS data on fungicides, herbicides, pesticides, and rodenticides were extracted from the 1985 through 1990 annual reports.<ce:cross-refs refid="bib8 bib9 bib10 bib11 bib12 bib13"><ce:sup>8-13</ce:sup></ce:cross-refs> AAPCC TESS data include cases managed through poison centers that arise either from or outside of health care facilities. The population base varies from year to year as the number of poison centers reporting to the system changes. For fatalities, a chemical was considered responsible for the death if it was the primary substance listed. Data extracted were limited by published tables and included age categories (younger than 6 years, 6 through 17 years, and 18 years and older), reason (unintentional, intentional, adverse reaction), number treated in a health care facility, and outcome (major, death). A major outcome was defined as a poisoning resulting in life-threatening signs or symptoms or in significant residual disability (eg, repeated seizures, respiratory compromise requiring intubation, ventricular tachycardia with hypotension).<ce:cross-ref refid="bib14"><ce:sup>14</ce:sup></ce:cross-ref></ce:para><ce:para>Data from the three data sets were examined for the same time period (1985–1990) using summary statistics. Rates were calculated from census estimates for the US population and for subgroups of the population. Because there are no patient identifiers in the data sets used, it was not possible to control for redundancy. Examination of the sample in the NHDS data revealed only one in-hospital death that would also have been counted in the NMD.</ce:para></ce:section><ce:section><ce:section-title>RESULTS</ce:section-title><ce:para>The NMD included 341 deaths from poisonings with agricultural and horticultural chemicals during the 6-year period (Table 1). The number of deaths varied from 45 to 75, with a mean of 57 per year. Suicides were responsible for 63.6% of deaths; 28.4% were unintentional. The median age group was 45 to 54 years, and the largest number of cases occurred in those 25 to 34 years of age. Only 17 cases (5.0%) occurred in children younger than 5 years of age (Figure 1). There were no deaths among children 10 to 14 years old and only one death among those aged 5 to 9 years. There were 41 deaths among elderly persons; the fatality rate for adults 75 years of age or older was .06 per 100,000 persons, twice the rate of adults aged 25 to 74 years. The fatality rates for adults 25 to 34 years of age and for those 35 to 44 years of age were both .03 per 100,000 population. These rates should be interpreted with caution because the numbers in all age groups are relatively small. <ce:float-anchor refid="tab1"></ce:float-anchor><ce:display><ce:figure><ce:label>Figure 1</ce:label><ce:caption><ce:simple-para>Age distribution of deaths from agricultural and horticultural chemical poisonings in the United States, 1985–1990 (National Mortality Data).</ce:simple-para></ce:caption> <ce:link locator="gr1"></ce:link></ce:figure></ce:display></ce:para><ce:para>The NMD showed that deaths occurred three times more often in males (n=258) than in females (n=83). There were more fatalities in whites (n=272) than in blacks (n=54) or in those of other races (n=15), although the rates were higher in general among nonwhites (.03 per 100,000) than among whites (.02 per 100,000). The leading groups of chemicals responsible for unintentional deaths were organophosphates (27%), rodenticides (13%), and herbicides (12%), as shown in Table 2. Data on specific chemicals are not available for suicides and deaths of undetermined intent because of the lack of specific E-codes. <ce:float-anchor refid="tab2"></ce:float-anchor></ce:para><ce:para>The NHDS data are derived from a representative sample of hospitals in the United States. For poisonings with agricultural and horticultural chemicals, the NHDS data are based on only 138 cases over the 6-year period. The data are presented here but must be interpreted with caution, especially for the individual subgroups.</ce:para><ce:para>The number of hospitalizations caused by agricultural and horticultural chemicals during the study period was estimated to be 25,418 (4,236 annually). E-codes are mandated for poisoning hospitalizations (unlike other injuries), enabling intent to be determined. Most hospitalizations (77.7%) were the result of unintentional poisoning, suicide attempts accounted for 17.5%, and cause was not determined in 4.7% (<ce:cross-ref refid="tab1">Table 1</ce:cross-ref>). The estimated number of hospital days was 86,930, with an average stay of 3.4 days. The median age group for hospitalized patients was 15 to 24 years (Figure 2). The male/female ratio was 2.7:1. Most hospitalized patients were white (15,077), followed by blacks (6,163) and those of Asian, other, or unknown race (4,178). However, the hospitalization rates were higher in blacks (3.5 per 100,000) and in other races (8.2 per 100,000) than in whites (1.2 per 100,000). <ce:display><ce:figure><ce:label>Figure 2</ce:label><ce:caption><ce:simple-para>Age distribution of hospitalizations for agricultural and horticultural chemical poisonings in the United States, 1985–1990 (NHDS data).</ce:simple-para></ce:caption> <ce:link locator="gr2"></ce:link></ce:figure></ce:display></ce:para><ce:para>Information on the specific chemicals responsible for all hospitalizations regardless of intent were searched by N-code (<ce:cross-ref refid="tab2">Table 2</ce:cross-ref>) because E-codes provide specific chemical groups only for unintentional poisonings. Detailed information on fungicides, herbicides, and rodenticides is unavailable because these chemicals are lumped under N-989.4 (other pesticides, not elsewhere classified). The number of hospitalizations identified by N-code (27,393) is greater than those identified by E-code, in part because adverse effects during therapeutic use are not included in the E-codes searched, and some N-codes do not differentiate between agrichemical and nonagrichemical sources. Also, there may be some underreporting of E-codes, although 93% of poisonings have an E- code, compared with only 50% of injuries overall.</ce:para><ce:para>The AAPCC TESS data reported 338,170 poison exposures to fungicides, herbicides, pesticides/insecticides, and rodenticides from 1985 through 1990 (<ce:cross-refs refid="tab1 tab2">Tables 1 and 2</ce:cross-refs>). During this period, the number of poison centers increased, and coverage of the US population increased from 47.6% to 76.8%.<ce:cross-refs refid="bib8 bib9 bib10 bib11 bib12 bib13"><ce:sup>8-13</ce:sup></ce:cross-refs> Extrapolating the yearly figures to include the entire US population, the total number of exposures to these chemicals reported to poison centers is estimated to be 540,171 over the 6-year period. Most exposures (327,599) were classified as unintentional; there were only 7,848 intentional exposures and 1,729 adverse reactions (which are included under undetermined intent in <ce:cross-ref refid="tab1">Table 1</ce:cross-ref>). Overall, 88,212 patients (26.1%) were treated in a health care facility.</ce:para><ce:para>Children younger than 6 years of age were involved in 192,332 exposures (56.9%). Adults (18 years of age or older) accounted for 114,796 exposures (33.9%), and those aged 6 through 17 years accounted for the remaining 25,756 (7.6%). The outcome was major (life-threatening or residual disability) in 782 cases, and there were 97 fatalities (including unintentional, suicides, and other/unknown) for which the agricultural chemical was the primary substance (Table 3). <ce:display><ce:table colsep="0" rowsep="0" frame="topbot"><ce:label>Table 3</ce:label><ce:caption><ce:simple-para>Agricultural and horticultural chemical consultations, American Association of Poison Control Centers Toxic Exposure Surveillance System, 1985–1990.</ce:simple-para></ce:caption><tgroup cols="5"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><tbody><row rowsep="1"><entry><ce:bold>Chemical</ce:bold></entry><entry><ce:bold>Total</ce:bold></entry><entry><ce:bold>No. Treated in HCF (%)</ce:bold></entry><entry><ce:bold>No. Major Effect (%)<ce:sup>*</ce:sup></ce:bold></entry><entry>No. Deaths (CFR%)</entry></row><row rowsep="1"><entry>Fungicide</entry><entry>7,500</entry><entry>1,926 (25.7)</entry><entry>14 (.19)</entry><entry>3 (.04)</entry></row><row rowsep="1"><entry>Herbicide</entry><entry>27,087</entry><entry>8,319 (30.7)</entry><entry>53 (.20)</entry><entry>24 (.09)</entry></row><row rowsep="1"><entry>Pesticide/Insecticide</entry><entry>243,061</entry><entry>58,852 (24.2)</entry><entry>658 (.27)</entry><entry>61 (.02)</entry></row><row rowsep="1"><entry>Rodenticide</entry><entry>60,522</entry><entry>19,115 (31.6)</entry><entry>57 (.09)</entry><entry>9 (.01)</entry></row><row rowsep="1"><entry namest="col1" nameend="col5"><ce:bold>HCF,</ce:bold> health care facility; <ce:bold>CFR%,</ce:bold> case fatality rate (deaths/exposures).</entry></row><row><entry namest="col1" nameend="col5"><ce:sup>*</ce:sup>Major effect is defined as a poisoning resulting in life-threatening signs or symptoms or in significant residual disability.</entry></row></tbody></tgroup></ce:table></ce:display></ce:para><ce:para>Two of the insecticide-related fatalities involved coingestion of another agricultural or horticultural chemical (anticoagulant rodenticide in one case; unknown herbicide in the other). An additional eight deaths involved exposure to an agricultural or horticultural chemical as a secondary substance. Nine of the 97 deaths occurred in persons younger than 18 years of age, 8 of whom were children aged 6 years or younger; all involved pesticides/insecticides. The ninth was a suicide with diquat in a 16-year-old. Most of the fatalities (67%) were suicides, 23% were unintentional, and 10% were other or unspecified. The comparable figures for the NMD were 64%, 28%, and 8%, respectively. The unintentional fatalities reported by the AAPCC TESS were further divided into 11 unintentional general (which included most unintentional exposures in children), 5 environmental (passive, nonoccupational exposures from air, water, or soil contamination), 4 misuse, and 2 occupational.</ce:para><ce:para>Children younger than 6 years of age were exposed mainly to pesticides/insecticides and rodenticides (66.2 % and 27.8% of exposures in this age group, respectively). These young children were involved in 88.5% of all reported rodenticide exposures; however, there were no pediatric rodenticide fatalities. Pesticides/insecticides accounted for 79.2% of adult poisonings reported to poison centers and 60.2% of the adult fatalities. Herbicides accounted for 13.6% of poisonings and 26.1% of deaths in adults.</ce:para></ce:section><ce:section><ce:section-title>DISCUSSION</ce:section-title><ce:para>This study provides the first comprehensive analysis of agricultural and horticultural chemical poisoning fatalities, hospitalizations, and poison center cases in the United States. These chemicals accounted for a relatively low percentage of poisoning fatalities; an average of only 57 deaths occurred annually in the United States. However, more than 4,000 hospitalizations were caused by these agrichemicals annually, and they accounted for 4.3% of the 7,830,097 cases reported to poison centers during the study period.</ce:para><ce:para>There are few published studies of agrichemical poisoning in developed countries. A review of pesticide poisoning deaths in England and Wales found that pesticides were responsible for only 1.1% of poisoning deaths (excluding carbon monoxide) over a 44-year period.<ce:cross-ref refid="bib15"><ce:sup>15</ce:sup></ce:cross-ref> Surveillance in South Carolina from 1983 through 1987 found an average of 62.4 hospitalizations per year.<ce:cross-ref refid="bib16"><ce:sup>16</ce:sup></ce:cross-ref> Pesticides were responsible for only .11% of poisoning hospitalizations in Finland from 1987 through 1988.<ce:cross-ref refid="bib17"><ce:sup>17</ce:sup></ce:cross-ref> A study in an emergency service in Spain reported the prevalence of pesticide poisoning as .17% of all emergencies treated.<ce:cross-ref refid="bib18"><ce:sup>18</ce:sup></ce:cross-ref> In California, 970 to 1,372 cases of pesticide exposure (mostly occupational) are reported annually to the California Pesticide Illness Surveillance Program.<ce:cross-ref refid="bib19"><ce:sup>19</ce:sup></ce:cross-ref> A Minnesota regional poison center was consulted on 1,428 cases in 1988 in which a pesticide was the primary substance, accounting for approximately 4.3% of all poisoning cases.<ce:cross-ref refid="bib20"><ce:sup>20</ce:sup></ce:cross-ref></ce:para><ce:para>This study examined three separate data sources, each of which had its own limitations and perspective. The NMD reveal that agrichemical poisoning fatalities occur primarily in adults and that 64% are suicides. However, data on specific chemicals are available only for unintentional deaths. The poison center data set includes information on specific chemicals, regardless of the intent of the poisoning. Most fatalities reported to AAPCC TESS also occurred in adults, and the distribution of intent was very similar to that in the NMD, with 67% of deaths the result of suicides.</ce:para><ce:para>The poison center data are limited by underreporting of fatalities. However, this data set provides a better representation of fatality patterns by specific chemical groups because it includes suicides and poisonings of undetermined cause. Detailed information on substances is not available in NMD for intentional injuries because of the lack of E-codes. Similarly, coding of herbicides, fungicides, rodenticides, and other pesticides under one, nonspecific N-code limits analysis of these poisonings.</ce:para><ce:para>The NHDS data, like the NMD, demonstrate male predominance; in England and Wales, 73% of agrichemical fatalities were suicides, and the male/female ratio was 2.4:1.<ce:cross-ref refid="bib15"><ce:sup>15</ce:sup></ce:cross-ref> Most hospitalizations nationwide appear to result from unintentional poisoning; similar findings were reported for pesticide poisoning hospitalizations during a 16-year period in South Carolina.<ce:cross-ref refid="bib16"><ce:sup>16</ce:sup></ce:cross-ref> It is likely that some unintentional cases are misclassified suicide attempts. Based on study in the United Kingdom of adult admissions for pesticide poisoning, misclassification may be frequent: 38 of 54 admissions (70%) were judged the result of a suicide gesture.<ce:cross-ref refid="bib21"><ce:sup>21</ce:sup></ce:cross-ref> In the US, the median age of patients hospitalized (15 to 24 years) was younger than that of patients who died (45 to 54 years). Hospital discharge data provide little detail on the circumstances of poisonings.</ce:para><ce:para>Minorities may be at higher risk of poisoning by pesticides and other agricultural and horticultural chemicals.<ce:cross-ref refid="bib22"><ce:sup>22</ce:sup></ce:cross-ref> Both mortality and hospitalization rates were higher in blacks and other nonwhites.</ce:para><ce:para>Although the AAPCC TESS data set included only 97 of the 341 fatalities in the NMD for the same period, the distribution of fatalities by cause was similar. Based on the population served by poison centers, the projected total number of agricultural and horticultural chemical exposures in the United States for the 6-year period is estimated to be 540,171. Using NMD for the actual number of deaths (341), the extrapolated overall case fatality rate for these poisonings is .06%.</ce:para><ce:para>Unintentional exposures in children younger than 6 years of age involved mainly pesticides and rodenticides. Although most rodenticide exposures involved children, there were no pediatric rodenticide fatalities. A likely explanation is that children are primarily exposed to the anticoagulant rodenticides, and a single ingestion of anticoagulant rodenticides is unlikely to produce toxicity. Only two of the adult fatalities (both intentional ingestions) were caused by anticoagulants, and one of these involved brodifacoum, a more toxic, long-acting anticoagulant. Children younger than 6 years of age were involved in 52.4% of the pesticide/ insecticide exposures. All eight fatalities in children aged 6 years and younger involved pesticides/insecticides; four were caused by organophosphates.</ce:para><ce:para>Herbicides represent a particularly high risk for serious poisoning and death, accounting for 78% of fatal poisonings in England and Wales.<ce:cross-ref refid="bib15"><ce:sup>15</ce:sup></ce:cross-ref> In our study, herbicides were responsible for 12.4% of the unintentional poisoning deaths in the NMD; they accounted for 8.0% of the poison exposures but 25% of the fatalities in the AAPCC TESS data set. The disproportionately larger percentage of deaths is probably related to the greater toxicity of the herbicides paraquat and diquat, which were involved in half of the herbicide fatalities.</ce:para><ce:para>Because all three data sets are more likely to include acute than chronic toxicity, this study addresses only one aspect of a larger problem. Chronic pesticide toxicity is responsible for numerous adverse outcomes, including cancer, neurotoxicity, and reproductive toxicity.<ce:cross-refs refid="bib23 bib24"><ce:sup>23,24</ce:sup></ce:cross-refs> However, health care providers may not recognize disease resulting from chronic pesticide exposure or may be unfamiliar with the signs and symptoms of poisoning. None of the data sets allows assessment of occupational exposure, yet agricultural workers are the group at highest risk for pesticide poisoning.<ce:cross-refs refid="bib25 bib26"><ce:sup>25,26</ce:sup></ce:cross-refs> The poison center data set includes an occupational category, but this is not available from summary data in the annual reports.</ce:para><ce:para>There are several limitations to this study. The NHDS data are based on a very small sample of cases and therefore may be unreliable. Furthermore, the denominator for the poison center data is poorly defined, because poison centers reporting to the system serve varying percentages of the population from year to year and the center penetrance (defined as the number of human exposure calls divided by the population served by the center) varies markedly among poison centers.</ce:para><ce:para>It is estimated that more than 56,000 potentially toxic agricultural and horticultural exposures requiring poison center consultation occur annually and result in approximately 15,000 health care facility visits, more than 4,000 hospitalizations, and 57 deaths. Most of the fatalities are suicides. Although most hospitalizations occur among younger people and are reported as unintentional, other studies<ce:cross-ref refid="bib21"><ce:sup>21</ce:sup></ce:cross-ref> suggest that many of these may be suicide attempts. Prevention efforts must take into account the fact that many serious poisonings are suicidal.</ce:para><ce:para>Routine analysis of existing data sources such as those examined in this study could provide the basic framework for a national pesticide poisoning surveillance system. As illustrated in <ce:cross-refs refid="tab1 tab2">Tables 1 and 2</ce:cross-refs>, coding inconsistencies between data sets limit strict comparability for all causes. Suggested modifications to existing data sources would include improved coding (eg, E-codes in hospitalization data, more detailed coding to identify specific chemicals) and the inclusion of occupational exposures on hospital discharge data. 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and Horticultural Chemical Poisonings: Mortality and Morbidity in the United States</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Agricultural and Horticultural Chemical Poisonings: Mortality and Morbidity in the United States</title></titleInfo><name type="personal"><namePart type="given">Wendy</namePart><namePart type="family">Klein-Schwartz</namePart><namePart type="termsOfAddress">PharmD, MPH*</namePart><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Gordon S</namePart><namePart type="family">Smith</namePart><namePart type="termsOfAddress">MB, ChB, MPH‡</namePart><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article"></genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1997</dateIssued><dateModified encoding="w3cdtf">1996-07-18</dateModified><copyrightDate encoding="w3cdtf">1997</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Study objective: To provide a comprehensive analysis of morbidity and mortality from poisoning by agricultural and horticultural chemicals in the United States. Methods: Descriptive analysis of national mortality data, National Hospital Discharge Survey data, and American Association of Poison Control Centers national data for 1985 through 1990. Results: There were 341 fatalities from agricultural and horticultural chemicals over the 6-year period, of which 64% were suicides, 28% were unintentional, and 8% were of undetermined intent. There were 25,418 hospitalizations; 78% were reported to be unintentional. Both deaths and hospitalizations occurred more frequently in males, and rates were higher in nonwhites than in whites. There were 338,170 poison exposures reported to poison centers for fungicides, herbicides, pesticides/insecticides, and rodenticides. Life-threatening manifestations or long-term sequelae occurred in 782 cases, and 97 deaths were reported. Pesticides and insecticides accounted for 72% of the poison center cases and 63% of the fatalities. Although they accounted for only 8% of poison exposures, herbicide deaths were disproportionately high (25%). Conclusion: Conclusion: Poisonings with agricultural and horticultural chemicals are an important public health problem. Prevention efforts need to incorporate the fact that many serious cases, such as paraquat poisonings, are suicidal in nature. [Klein-Schwartz W, Smith GS: Agricultural and horticultural chemical poisonings: Mortality and morbidity in the United States. Ann Emerg Med February 1997;29:232-238.]</abstract><note>From the Maryland Poison Center, University of Maryland School of Pharmacy*; and the Center for Injury Research, The Johns Hopkins School of Hygiene and Public Health‡, Baltimore, Maryland.</note><note>Reprint no.47/1/79099</note><note>Address for reprints: Wendy Klein-Schwartz, PharmD, MPH, Maryland Poison Center, 20 North Pine Street, Baltimore, Maryland 21201</note><note type="content">Table 1: Agricultural and horticultural chemical poisonings resulting in death, hospitalization, or poison center consultation, 1985–1990.</note><note type="content">Table 2: Agricultural and horticultural chemical poisonings by specific chemical group for unintentional injury deaths, all hospitalizations, and all poison center reports, 1985–1990.</note><relatedItem type="host"><titleInfo><title>Annals of Emergency Medicine</title></titleInfo><titleInfo type="abbreviated"><title>YMEM</title></titleInfo><genre type="journal">journal</genre><originInfo><dateIssued encoding="w3cdtf">199702</dateIssued></originInfo><identifier type="ISSN">0196-0644</identifier><identifier type="PII">S0196-0644(05)X7076-7</identifier><part><date>199702</date><detail type="volume"><number>29</number><caption>vol.</caption></detail><detail type="issue"><number>2</number><caption>no.</caption></detail><extent unit="issue pages"><start>205</start><end>310</end></extent><extent unit="pages"><start>232</start><end>238</end></extent></part></relatedItem><identifier type="istex">E8BC2C605BCACE6E36A00A40B0FC3F460032FDAD</identifier><identifier type="DOI">10.1016/S0196-0644(97)70274-9</identifier><identifier type="PII">S0196-0644(97)70274-9</identifier><accessCondition type="use and reproduction" contentType="copyright">©1997 Mosby, Inc.</accessCondition><recordInfo><recordContentSource>ELSEVIER</recordContentSource><recordOrigin>Mosby, Inc., ©1997</recordOrigin></recordInfo></mods></metadata></istex></record>Pour manipuler ce document sous Unix (Dilib)
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