Associations between pneumonia and residential distance to livestock farms over a five-year period in a large population-based study

Abstract

In a recent study of electronic health records (EHR) of general practitioners in a livestock-dense area in The Netherlands in 2009, associations were found between residential distance to poultry farms and the occurrence of community-acquired pneumonia (CAP). In addition, in a recent cross-sectional study in 2494 adults in 2014/2015 an association between CAP and proximity to goat farms was observed. Here, we extended the 2009 EHR analyses across a wider period of time (2009–2013), a wider set of health effects, and a wider set of farm types as potential risk sources. A spatial (transmission) kernel model was used to investigate associations between proximity to farms and CAP diagnosis for the period from 2009 to 2013, obtained from EHR of in total 140,059 GP patients. Also, associations between proximity to farms and upper respiratory infections, inflammatory bowel disease, and (as a control disease) lower back pain were analysed. Farm types included as potential risk sources in these analyses were cattle, (dairy) goats, mink, poultry, sheep, and swine. The previously found association between CAP occurrence and proximity to poultry farms was confirmed across the full 5-year study period. In addition, we found an association between increased risk for pneumonia and proximity to (dairy) goat farms, again consistently across all years from 2009 to 2013. No consistent associations were found for any of the other farm types (cattle, mink, sheep and swine), nor for the other health effects considered. On average, the proximity to poultry farms corresponds to approximately 119 extra patients with CAP each year per 100,000 people in the research area, which accounts for approximately 7.2% extra cases. The population attributable risk percentage of CAP cases in the research area attributable to proximity to goat farms is approximately 5.4% over the years 2009–2013. The most probable explanation for the association of CAP with proximity to poultry farms is thought to be that particulate matter and its components are making people more susceptible to respiratory infections. The causes of the association with proximity to goat farms is still unclear. Although the 2007–2010 Q-fever epidemic in the area probably contributed Q-fever related pneumonia cases to the observed additional cases in 2009 and 2010, it cannot explain the association found in later years 2011–2013.

Morbidity Rates in an Area with High Livestock Density: A Registry-Based Study Including Different Groups of Patients with Respiratory Health Problems

“…Nevertheless, contrary to the study of van Dijk et al [15], we found no significant differences in the prevalence of chronic bronchitis/bronchiectasis for the years 2014-2016, despite the generally higher rates in the livestock dense areas. The current results are also consistent with analyses using individual estimates of exposure to different livestock types in relation to primary care-registered data, showing an increased prevalence of pneumonia with higher livestock density [9,14,16]. This was also the case for studies including self-reported outcome assessments [29,30], despite that prevalence estimates based on self-reported questionnaires can deviate from those extracted from medical records [31,32].…”

“…More specifically, the prevalence of primary care-registered pneumonia and other lower respiratory tract infections, as well as chronic bronchitis, was found to be consistently higher in livestock dense areas compared to areas with low livestock density [14,15]; a higher prevalence of nonrespiratory conditions such as atopic eczema was also observed in both young children and adults [14]. Analyses in the same area including individual estimates of livestock exposure in relation to primary care-registered data have also demonstrated that living near goat and/or poultry farms is a risk factor for pneumonia [9,14,16] and also Q-fever [9,14]. Other findings also indicate a possible impact of livestock exposure on the health status of patients with compromised respiratory health; these showed increased respiratory symptoms and more exacerbations among chronic obstructive pulmonary disease (COPD) patients residing in livestock dense areas [17,18], while livestock exposure was also associated with respiratory symptoms in patients with overlapping diagnoses of asthma and COPD [19].These previous findings reflect the need for regular health-monitoring in areas with high livestock density.…”

Risk of pneumonia among residents living near goat and poultry farms during 2014-2016

“…In two studies investigating cases of pneumonia in relation to proximity to goat farms, a significantly elevated incidence of the disease was also found near poultry farms [9, 12]. A similar association between pneumonia and proximity to poultry was recently reported in Pennsylvania, USA [16], yet in two other studies in the Netherlands, those associations were not significant and positive in only some of the analyses [5, 11].…”

“…Conversely, persons that have COPD and live close to livestock farms were found to have increased COPD exacerbation [7, 8]. Recently, an increased risk of pneumonia was observed in the Netherlands among residents living close to goat and poultry farms [9–12].…”

Chronic Q Fever with Vascular Involvement: Progressive Abdominal Pain in a Patient with Aortic Aneurysm Repair in the United States

“…Inquiries about potential animal exposures are important, but explicit exposure is often absent. Since Coxiella burnetii transmission often occurs via the air (up to kilometers from infected animal), the diagnosis of chronic Q fever with vascular involvement should be considered in any case of aortitis/mycotic aneurysm and periaortic abscess of unknown etiology [9–11].…”