Multimorbidity and complex multimorbidity in Brazilian rural workers.

Glenda Blaser Petarli,Luciane Bresciani Salaroli,Monike Moreto Sant’Anna,Eliana Zandonade,Olívia Maria De Paula Alves Bezerra,Monica Cattafesta,Siew Ann Cheong

doi:10.1371/journal.pone.0225416

Glenda Blaser Petarli, Luciane Bresciani Salaroli + Show 5 more

Open Access

https://doi.org/10.1371/journal.pone.0225416

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Abstract

To estimate the prevalence of multimorbidity and complex multimorbidity in rural workers and their association with sociodemographic characteristics, occupational contact with pesticides, lifestyle and clinical condition. This is a cross-sectional epidemiological study with 806 farmers from the main agricultural municipality of the state of Espírito Santo/Brazil, conducted from December 2016 to April 2017. Multimorbidity was defined as the presence of two or more chronic diseases in the same individual, while complex multimorbidity was classified as the occurrence of three or more chronic conditions affecting three or more body systems. Socio-demographic data, occupational contact with pesticides, lifestyle data and clinical condition data were collected through a structured questionnaire. Binary logistic regression was conducted to identify risk factors for multimorbidity. The prevalence of multimorbidity among farmers was 41.5% (n = 328), and complex multimorbidity was 16.7% (n = 132). More than 77% of farmers had at least one chronic illness. Hypertension, dyslipidemia and depression were the most prevalent morbidities. Being 40 years or older (OR 3.33, 95% CI 2.06-5.39), previous medical diagnosis of pesticide poisoning (OR 1.89, 95% CI 1.03-3.44), high waist circumference (OR 2.82, CI 95% 1.98-4.02) and worse health self-assessment (OR 2.10, 95% CI 1.52-2.91) significantly increased the chances of multimorbidity. The same associations were found for the diagnosis of complex multimorbidity. We identified a high prevalence of multimorbidity and complex multimorbidity among the evaluated farmers. These results were associated with increased age, abdominal fat, pesticide poisoning, and poor or fair health self-assessment. Public policies are necessary to prevent, control and treat this condition in this population.

Highlights

Exposure to dust, toxic chemicals, ultraviolet radiation, noise, and venomous animals in the daily routine of rural work represents potential sources of health problems for farmers [1]
Being 40 years or older, previous medical diagnosis of pesticide poisoning, high waist circumference and worse health self-assessment significantly increased the chances of multimorbidity
The same associations were found for the diagnosis of complex multimorbidity

Summary

Introduction

Toxic chemicals, ultraviolet radiation, noise, and venomous animals in the daily routine of rural work represents potential sources of health problems for farmers [1]. The transformations brought about by the mechanization and modernization of agricultural activities have modified the form of work organization in the field, with direct consequences to the physical and psychological domains, on the lifestyle and food consumption of these workers [2, 3]. This reality, aggravated by the reduced supply of health diagnosis and treatment services in rural areas [4], may increase farmers’ vulnerability to chronic morbidity. Multimorbidity leads to a reduction in quality of life, higher mortality, polypharmacy, and an increase in the need for medical care, affecting health costs, and the productivity and functional capacity of individuals [9]

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