Abstract
In the Netherlands, an association was found between the prevalence of pneumonia and living near goat and poultry farms in 2007–2013. This association then led to regulatory decisions to restrict the building of new goat farms and to reduce emissions of poultry farms. Confirmation of these results, however, is required because the period of previous analyses overlapped a Q-fever epidemic in 2007–2010. To confirm the association, we performed a population-based study during 2014–2016 based on general practitioner (GP) data. Electronic medical records of 90,183 persons were used to analyze the association between pneumonia and the population living in the proximity (within 500–2000 m distance) of goat and poultry farms. Data were analyzed with three types of logistic regression (with and without GP practice as a random intercept and with stratified analyses per GP practice) and a kernel model to discern the influence of different statistical methods on the outcomes. In all regression analyses involving adults, a statistically significant association between pneumonia and residence within 500 meters of goat farms was found (odds ratio [OR] range over all analyses types: 1.33–1.60), with a decreasing OR for increasing distances. In kernel analyses (including all ages), a population-attributable risk between 6.0 and 7.8% was found for a distance of 2000 meters in 2014–2016. The associations were consistent across all years and robust for mutual adjustment for proximity to other animals and for several other sensitivity analyses. However, associations with proximity to poultry farms are not supported by the present study. As the causes of the elevated pneumonia incidence in persons living close to goat farms remain unknown, further research into potential mechanisms is required for adequate prevention.
Highlights
The evidence regarding the influence of livestock farming on the health of persons living near such farms is mounting [1,2,3,4,5]
The evidence for this association resulted from several analyses on a large dataset of electronic medical records (2007–2013) of general practitioners’ (GP) patients living in the Dutch provinces Noord-Brabant and Limburg and on a subset of 2,500 of those patients that participated in a medical examination and completed a questionnaire [5, 9,10,11,12,13]
In single-level logistic regression analyses, the association between pneumonia and residence within specified distances to goat farms among adults was statistically significant for all buffers and decreased from 1.60 for the presence of a goat farm within 500 meters to 1.17 for a buffer of 2000 meters
Summary
The evidence regarding the influence of livestock farming on the health of persons living near such farms is mounting [1,2,3,4,5]. An increased risk of pneumonia was observed in the Netherlands among residents living close to goat and poultry farms [9,10,11,12] The evidence for this association resulted from several analyses on a large dataset of electronic medical records (2007–2013) of general practitioners’ (GP) patients living in the Dutch provinces Noord-Brabant and Limburg and on a subset of 2,500 of those patients that participated in a medical examination and completed a questionnaire [5, 9,10,11,12,13]. Potential causes of such elevation remain unclear and it has no clear trace to a single pathogen, as the evidence that microorganisms other than C. burnetii that can both be found in goats and cause pulmonary complications in humans through indirect transmission is limited to case reports [15]
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