Mortality and Health Outcomes in North Carolina Communities Located in Close Proximity to Hog Concentrated Animal Feeding Operations

BACKGROUND Life expectancy in southeastern North Carolina communities located in an area with multiple concentrated animal feeding operations (CAFOs) after adjusting for socioeconomic factors remains low. We hypothesized that poor health outcomes in this region may be due to converging demographic, socioeconomic, behavioral, and access-to-care factors and are influenced by the presence of hog CAFOs. METHODS We studied mortality, hospital admissions, and emergency department (ED) usage for health conditions potentially associated with hog CAFOs—anemia, kidney disease, infectious diseases, and low birth weight (LBW)—in North Carolina communities located in zip codes with hog CAFOs (Study group 1), in zip codes with > 215hogs/km2 (Study group 2), and without hog CAFOs (Control group). We compared cause-specific age-adjusted rates, the odds ratios (ORs) of events in multivariable analyses (adjusted for 6 co-factors), and the changes of ORs relative to the distance to hog CAFOs. RESULTS Residents from Study groups 1 and 2 had higher rates of all-cause mortality, infant mortality, mortality of patients with multimorbidity, mortality from anemia, kidney disease, tuberculosis, and septicemia, and higher rates of ED visits and hospital admissions for LBW infants than the residents in the Control group. In zip codes with > 215hogs/km2, mortality ORs were 1.50 for anemia (P < 0.0001), 1.31 for kidney disease (P < 0.0001), 2.30 for septicemia (P < 0.0001), and 2.22 for tuberculosis (P = 0.0061). LIMITATIONS This study included a lack of individual measurements on environmental contaminants, biomarkers of exposures and co-factors, and differences in residential and occupational locations. CONCLUSION North Carolina communities located near hog CAFOs had higher all-cause and infant mortality, mortality due to anemia, kidney disease, tuberculosis, septicemia, and higher hospital admissions/ED visits of LBW infants. Although not establishing causality with exposures from hog CAFOs, our findings support the need for future studies to determine factors that influence these outcomes, as well as the need to improve screening and diagnostic strategies for these diseases in North Carolina communities adjacent to hog CAFOs.

[1]  M. Barton.  Impact of antibiotic use in the swine industry. , 2014, Current opinion in microbiology.

[2]  S. Wing,et al.  Intensive livestock operations, health, and quality of life among eastern North Carolina residents. , 2000, Environmental health perspectives.

[3]  Carrie Hribar.  Understanding concentrated animal feeding operations and their impact on communities , 2010 .

[4]  L. Price,et al.  Livestock-Associated Methicillin and Multidrug Resistant Staphylococcus aureus Is Present among Industrial, Not Antibiotic-Free Livestock Operation Workers in North Carolina , 2013, PloS one.

[5]  P. Minchella,et al.  Complex anemia in tuberculosis: the need to consider causes and timing when designing interventions. , 2015, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[6]  Yuji Sato,et al.  Anemia as a risk factor for all-cause mortality: obscure synergic effect of chronic kidney disease , 2017, Clinical and Experimental Nephrology.

[7]  Steve Wing,et al.  Air Pollution, Lung Function, and Physical Symptoms in Communities Near Concentrated Swine Feeding Operations , 2011, Epidemiology.

[8]  K. Kilburn.  Exposure to Reduced Sulfur Gases Impairs Neurobehavioral Function , 1997, Southern medical journal.

[9]  A. Stanković,et al.  Effects of air pollution on red blood cells in children , 2008 .

[10]  D. Heederik,et al.  Lung function and chronic respiratory symptoms of pig farmers: focus on exposure to endotoxins and ammonia and use of disinfectants. , 1995, Occupational and environmental medicine.

[11]  E. Carrera,et al.  Anemia and chronic kidney disease are potential risk factors for mortality in stroke patients: a historic cohort study , 2010, BMC nephrology.

[12]  Raj Chetty,et al.  The Association Between Income and Life Expectancy in the United States, 2001-2014. , 2016, JAMA.

[13]  K. Kilburn.  Human Impairment from Living near Confined Animal (Hog) Feeding Operations , 2012, Journal of environmental and public health.

[14]  S. Bullers.  Environmental Stressors, Perceived Control, and Health: The Case of Residents Near Large-Scale Hog Farms in Eastern North Carolina , 2005 .

[15]  J. Burkholder,et al.  Impacts of Waste from Concentrated Animal Feeding Operations on Water Quality , 2006, Environmental health perspectives.

[16]  J. Kahn,et al.  Yield of community-based tuberculosis targeted testing and treatment in foreign-born populations in the United States: A systematic review , 2017, PloS one.

[17]  B. Adamcik,et al.  Veterinarian perception of the intentional misuse of veterinary medications in humans: a preliminary survey of Idaho-licensed practitioners. , 2002, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[18]  S. Wing,et al.  Air Pollution from Industrial Swine Operations and Blood Pressure of Neighboring Residents , 2011, Environmental health perspectives.

[19]  Z. Li,et al.  Low first‐trimester hemoglobin and low birth weight, preterm birth and small for gestational age newborns , 2007, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[20]  W. Sanderson,et al.  Asthma and Farm Exposures in a Cohort of Rural Iowa Children , 2004, Environmental health perspectives.

[21]  M. Stauffer,et al.  Prevalence of Anemia in Chronic Kidney Disease in the United States , 2014, PloS one.

[22]  J. Farrar,et al.  Antimicrobial resistance in humans, livestock and the wider environment , 2015, Philosophical Transactions of the Royal Society B: Biological Sciences.

[23]  K M Thu,et al.  Public health concerns for neighbors of large-scale swine production operations. , 2002, Journal of agricultural safety and health.

[24]  P. Gluckman,et al.  Early developmental conditioning of later health and disease: physiology or pathophysiology? , 2014, Physiological reviews.

[25]  J. Lejeune,et al.  Zoonoses: an occupational hazard for livestock workers and a public health concern for rural communities. , 2010, Journal of agricultural safety and health.

[26]  S. Marshall,et al.  Race, Poverty, and Potential Exposure of Middle-School Students to Air Emissions from Confined Swine Feeding Operations , 2005, Environmental health perspectives.

[27]  S. Wing,et al.  Environmental injustice in North Carolina's hog industry. , 2000, Environmental health perspectives.

[28]  S. Schiffman,et al.  Potential Health Effects of Odor from Animal Operations, Wastewater Treatment, and Recycling of Byproducts , 2000, Journal of agromedicine.

[29]  S. Wing,et al.  Community Health and Socioeconomic Issues Surrounding Concentrated Animal Feeding Operations , 2006, Environmental health perspectives.

[30]  S. Marshall,et al.  Asthma Symptoms Among Adolescents Who Attend Public Schools That Are Located Near Confined Swine Feeding Operations , 2006, Pediatrics.

[31]  D. Mahoney,et al.  Zinc-induced anemia and neutropenia in an adolescent. , 2000, The Journal of pediatrics.

[32]  D. Lackland,et al.  Low birth weights contribute to high rates of early-onset chronic renal failure in the Southeastern United States. , 2000, Archives of internal medicine.

[33]  S. Wing,et al.  Concentrated swine feeding operations and public health: a review of occupational and community health effects. , 2000, Environmental health perspectives.

[34]  L. Burmeister,et al.  Asthma prevalence and morbidity among rural Iowa schoolchildren. , 2004, The Journal of allergy and clinical immunology.

[35]  L. Band,et al.  The potential impact of flooding on confined animal feeding operations in eastern North Carolina. , 2002, Environmental health perspectives.

[36]  B. Perdue,et al.  North Carolina Department of Health and Human Services Division of Health Service Regulation Mental Health Licensure and Certification , 2009 .

[37]  D. Levy,et al.  Surveillance for waterborne-disease outbreaks--United States, 1997-1998. , 2000, MMWR. CDC surveillance summaries : Morbidity and mortality weekly report. CDC surveillance summaries.

[38]  L. Price,et al.  Multidrug-Resistant and Methicillin-Resistant Staphylococcus aureus (MRSA) in Hog Slaughter and Processing Plant Workers and Their Community in North Carolina (USA) , 2014, Environmental health perspectives.

[39]  S. Skerfving,et al.  Cadmium in blood and urine--impact of sex, age, dietary intake, iron status, and former smoking--association of renal effects. , 2002, Environmental health perspectives.