Abstract
IntroductionPesticide poisoning is an important public health problem worldwide. The study aimed to determine the risk of all-cause and cause-specific inpatient mortality and to identify prognostic factors for inpatient mortality associated with unintentional insecticide and herbicide pesticide poisonings.MethodsWe performed a retrospective cohort study of 3,986 inpatients recruited at hospitalization between 1999 and 2008 in Taiwan. We used the International Classification of Disease, 9th ed., Clinical Modification external causes of injury codes to classify poisoning agents into accidental poisoning by insecticides and herbicides. Comparisons in mortality rates were made between insecticide poisoning patients and herbicide poisoning patients by using the Cox proportional hazards models to estimate multivariable-adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs).ResultsThere were 168 deaths during 21,583 person-days of follow-up evaluation (7.8 per 1,000 person-days). The major causes of mortality for insecticide poisonings were the toxic effect of organophosphate and coma, and the major causes of mortality for herbicide poisonings were the toxic effect of other pesticides and the toxic effect of organophosphate. The mortality for herbicide exposure was fourfold higher than that for insecticide exposure. The factors associated with inpatient mortality were herbicide poisonings (HR = 4.58, 95% CI 3.29 to 6.37) and receiving mechanical ventilation treatment (HR = 3.85, 95% CI 2.73 to 5.42).ConclusionsWe demonstrated that herbicides stand out as the dominant agent for poisoning-related fatalities. The control of and limiting access to herbicide agents and developing appropriate therapeutic regimens, including emergency care, should be priorities.
Highlights
Pesticide poisoning is an important public health problem worldwide
With the development of modern agriculture, patients are increasingly exposed to new types of insecticides and herbicides
Because the most common type of insecticide in Taiwan is organophosphate insecticide (OP) [1], we excluded patients who presented with poisoning with organochlorine compounds (E863.0) (n = 27) or carbamates (E863.2) (n = 97), poisoning by a mixture of insecticides (E863.3) (n = 170), or poisoning by other and unspecified insecticides (E863.4) (n = 1197), fungicides (E863.6) (n = 9), rodenticides (E863.7) (n = 238), fumigants (E863.8) and other and unspecified agricultural and horticultural chemicals and pharmaceutical preparations other than plant foods and fertilizers (E863.9) (n = 508)
Summary
Pesticide poisoning is an important public health problem worldwide. The study aimed to determine the risk of all-cause and cause-specific inpatient mortality and to identify prognostic factors for inpatient mortality associated with unintentional insecticide and herbicide pesticide poisonings. Pesticide poisoning is a significant public health problem worldwide. The most common type of pesticide in Taiwan is organophosphate pesticides (OP) [1], and glyphosphate and paraquat are the two types of herbicides that are used most frequently [2]. The most frequent cause of poisoning was pesticides (29.3%). Paraquat and organophosphate exposures were the two leading causes of death [4]. These studies were based on information collected in telephone interviews on the topic of poisoning exposures. Previous studies were of limited sample size and were largely based on one or few healthcare facilities
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