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. 2015 Nov;143(Pt A):68-82.
doi: 10.1016/j.envres.2015.09.027. Epub 2015 Oct 8.

Pesticide exposure and hepatocellular carcinoma risk: A case-control study using a geographic information system (GIS) to link SEER-Medicare and California pesticide data

Trang VoPham  1 , Maria M Brooks  2 , Jian-Min Yuan  3 , Evelyn O Talbott  4 , Darren Ruddell  5 , Jaime E Hart  6 , Chung-Chou H Chang  7 , Joel L Weissfeld  8
Affiliations

Pesticide exposure and hepatocellular carcinoma risk: A case-control study using a geographic information system (GIS) to link SEER-Medicare and California pesticide data

Trang VoPham et al. Environ Res. 2015 Nov.

Abstract

Background: Hepatocellular carcinoma (HCC), the most common type of primary liver cancer, is associated with low survival. U.S. studies examining self-reported pesticide exposure in relation to HCC have demonstrated inconclusive results. We aimed to clarify the association between pesticide exposure and HCC by implementing a novel data linkage between Surveillance, Epidemiology, and End Results (SEER)-Medicare and California Pesticide Use Report (PUR) data using a geographic information system (GIS).

Methods: Controls were frequency-matched to HCC cases diagnosed between 2000 and 2009 in California by year, age, race, sex, and duration of residence in California. Potential confounders were extracted from Medicare claims. From 1974 to 2008, pounds (1 pound represents 0.45 kg) of applied organophosphate, organochlorine, and carbamate pesticides provided in PURs were aggregated to the ZIP Code level using area weighting in a GIS. ZIP Code exposure estimates were linked to subjects using Medicare-provided ZIP Codes to calculate pesticide exposure. Agricultural residents were defined as living in ZIP Codes with a majority area intersecting agricultural land cover according to the 1992, 2001, and 2006 National Land Cover Database (NLCD) rasters. Multivariable conditional logistic regression was used to estimate the association between pesticide exposure and HCC.

Results: Among California residents of agriculturally intensive areas, previous annual ZIP Code-level exposure to over 14.53 kg/km(2) of organochlorine pesticides (75(th) percentile among controls) was associated with an increased risk of HCC after adjusting for liver disease and diabetes (adjusted odds ratio [OR] 1.87, 95% confidence interval [CI] 1.17, 2.99; p=0.0085). ZIP Code-level organochlorines were significantly associated with an increased risk of HCC among males (adjusted OR 2.76, 95% CI 1.58, 4.82; p=0.0004), but not associated with HCC among females (adjusted OR 0.83, 95% CI 0.35, 1.93; p=0.6600) (interaction p=0.0075).

Conclusions: This is the first epidemiologic study to use GIS-based exposure estimates to study pesticide exposure and HCC. Our results suggest that organochlorine pesticides are associated with an increase in HCC risk among males but not females.

Keywords: Case-control study; Epidemiology; Geographic information system; Liver cancer; Pesticide.

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Figures

Fig. 1
Fig. 1
Eligibility criteria applied to first cancer hepatocellular carcinoma cases in California diagnosed from 2000 to 2009 using SEER-Medicare.
Fig. 2
Fig. 2. National Land Cover Database (NLCD) agricultural land cover in California in 1992, 2001, and 2006
ZIP Codes with a majority area intersecting agricultural land cover in any year (right) were used to select SEER-Medicare cases and controls with an opportunity for pesticide exposure examined in the subgroup analysis (California residents of agriculturally intensive areas).
See this image and copyright information in PMC

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