Dataset Information

The prevalence of esophageal cancer after caustic and pesticide ingestion: A nationwide cohort study.

ABSTRACT: Habits such as smoking and alcohol drinking and existing esophageal malfunction are considered the main risk factors for esophageal carcinogenesis. Caustic ingestion of acidic or alkaline agents or strong irritants can induce severe esophageal corrosive injury and increase esophageal cancer risk. We studied the relationship between esophageal carcinoma and acute detergent or pesticide poisoning by using nationwide health insurance data. Methodology/Principle findings: We compared a pesticide/detergent intoxication cohort (N = 21,840) and an age- and gender-matched control cohort (N = 21,840) identified from the National Health Insurance Research Database between 2000 and 2011. We used the multivariable Cox proportional model to determine esophageal carcinoma risk. The overall incidence density of esophageal cancer was 1.66 per 10,000 person-years in the comparison cohort and 4.36 per 10,000 person-years in the pesticide/detergent intoxication cohort. The corresponding adjusted hazard ratio (HR) for esophageal cancer was 2.33 (95% confidence interval [CI] = 1.41-3.86) in the pesticide/detergent intoxication cohort compared with the control cohort. Patients with corrosive and detergent intoxication did not have a higher risk of esophageal cancer (adjusted HR = 0.98, 95% CI = 0.29-3.33) than those without pesticide/detergent intoxication. However, patients with pesticide intoxication had a significantly higher risk of esophageal cancer (adjusted HR = 2.52, 95% CI = 1.52-4.18) than those without pesticide/detergent intoxication. Conclusion: In the present study, after adjusting for conventional risk factors, we observed that pesticide intoxication could exert substantial effects through increased esophageal cancer risk. However, patients with detergent intoxication may not have an increased risk of esophageal cancer.

SUBMITTER: Mu HW

PROVIDER: S-EPMC7771858 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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The prevalence of esophageal cancer after caustic and pesticide ingestion: A nationwide cohort study.

Mu Han-Wei HW Chen Chun-Hung CH Yang Kai-Wei KW Pan Chi-Syuan CS Lin Cheng-Li CL Hung Dong-Zong DZ

PloS one 20201229 12

Habits such as smoking and alcohol drinking and existing esophageal malfunction are considered the main risk factors for esophageal carcinogenesis. Caustic ingestion of acidic or alkaline agents or strong irritants can induce severe esophageal corrosive injury and increase esophageal cancer risk. We studied the relationship between esophageal carcinoma and acute detergent or pesticide poisoning by using nationwide health insurance data. Methodology/Principle findings: We compared a pesticide/det ...[more]

PMID: 33373373

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Project description:ImportanceCaustic ingestion in adults may result in death or severe digestive sequelae. The scarcity of nationwide epidemiological data leads to difficulties regarding the applicability of their analysis to less specialized centers, which are nevertheless largely involved in the emergency management of adverse outcomes following caustic ingestion.ObjectiveTo assess outcomes associated with caustic ingestion in adults across a nationwide prospective database.Design, settings, and participantsAdult patients aged 16 to 96 admitted to the emergency department for caustic ingestion between January 2010 and December 2019 were identified from the French Medical Information System Database, which includes all patients admitted in an emergency setting in hospitals in France during this period.ExposureEsophageal caustic ingestion.Main outcomes and measuresThe primary end point was in-hospital patient outcomes following caustic ingestion. Multivariate analysis was performed to assess independent predictors of in-hospital morbidity and mortality.ResultsAmong 22 657 226 patients admitted on an emergency outpatient basis, 3544 (0.016%) had ingested caustic agents and were included in this study. The median (IQR) age in this population was 49 (34-63) years, and 1685 patients (48%) were women. Digestive necrosis requiring resection was present during the primary hospital stay in 388 patients with caustic ingestion (11%). Nonsurgical management was undertaken in 3156 (89%). A total of 1198 (34%) experienced complications, and 294 (8%) died. Pulmonary complications were the most frequent adverse event, occurring in 869 patients (24%). On multivariate analysis, predictors of mortality included old age, high comorbidity score, suicidal ingestion, intensive care unit admission during management, emergency surgery for digestive necrosis, and treatment in low-volume centers. On multivariate analysis, predictors of morbidity included old age, higher comorbidity score, intensive care unit admission during management, and emergency surgery for digestive necrosis.Conclusions and relevanceIn this study, referral to expert centers was associated with improved early survival after caustic ingestion. If feasible, low-volume hospitals should consider transferring patients to larger centers instead of attempting on-site management.

Project description:IntroductionSuicide is a major public health problem in Pakistan, accounting to approximately 19,331 deaths every year. Many are due to consumption of acutely toxic pesticides; however, there is a lack of national suicide data, limiting knowledge and potential for intervention. In this paper, we aimed to review the literature on pesticide self-poisoning in Pakistan to identify the most problematic pesticides in relation to national pesticide regulations.MethodsInformation on the currently registered and banned pesticides was obtained from Ministry of National Food Security and Research while data on pesticide import and use was extracted from FAOSTAT. We searched the following sources for articles and research papers on poisoning in Pakistan: Cumulative Index to Nursing and Allied Health (CINAHL), Google Scholar, Applied Social Sciences Index and Abstracts (ASSIA), Excerpta Medica (EMBASE), National Library of Medicine's MEDLINE (PUBMED), PS102YCHINFO and Pakmedinet.com using the search terms 'self-poisoning', 'deliberate self-harm', 'suicide', 'methods and means of suicide', 'organophosphate', 'wheat pill', 'aluminium phosphide', 'acute poisoning', OR 'pesticides', AND 'Pakistan'.ResultsAs of May 2021, 382 pesticide active ingredients (substances) were registered in Pakistan, of which five were WHO hazard class Ia (extremely hazardous) and 17 WHO hazard class Ib (highly hazardous). Twenty-six pesticides, four formulations, and seven non-registered pesticides had been banned, of which two were WHO class Ia and five Ib. We identified 106 hospital-level studies of poisoning conducted in Pakistan, of which 23 did not mention self-poisoning cases and one reported no suicidal poisoning cases. We found no community or forensic medicine studies. Of 52,323 poisoning cases identified in these papers, 24,546 [47%] were due to pesticides. The most commonly identified pesticide classes were organophosphorus (OP) insecticides (13,816 cases, 56%) and the fumigant aluminium phosphide (3 g 56% tablets, often termed 'wheat pills'; 686 cases, 2.7%). Few studies identified the particular pesticides involved or the resulting case fatality.ConclusionWe found pesticide poisoning to be a major cause of poisoning in Pakistan, with OP insecticides and the fumigant aluminium phosphide the main pesticides identified. Withdrawal of Class I pesticides (as proposed to occur nationally in 2022) and high concentration aluminium phosphide tablets should rapidly reduce suicidal deaths by reducing the case fatality for low-intention poisoning cases. National cause of death data and forensic toxicology laboratory data identifying the pesticides responsible for deaths will be important to assess impacts of the proposed national ban.

Project description:INTRODUCTION:Oesophageal cancer (OC) is one of the most common cancers worldwide and about 50% of all new cases occurred in China. Population-based screening has been conducted in high-risk areas in China since 1970s, however, a few factors have limited the integration of the results from previous studies and the sharing of existing resources, such as the difference in screening methods and protocols, inconsistencies in questionnaires for risk factors investigation, lack of standards for sample collection and incomplete follow-up information. METHODS AND ANALYSIS:The National Cohort of Esophageal Cancer-Prospective Cohort Study of Esophageal Cancer and Precancerous Lesions based on High-Risk Population (NCEC-HRP) is a prospective cohort study of OC screening based on high-risk population in China supported by the National Key R&D Programme. Eight areas located at eastern, central and western China are selected as screening centres to represent three economical-geographical regions. All local residents aged 40-69 years in the selected areas are invited to take endoscopic examination and risk factors investigation unless they meet the exclusion criteria. The recruitment began on June 2017 and a total of 100 000 participants will be enrolled by December 2020 and all subjects will be followed for a long time. This study is designed as open-ended and has broad research aims. Summary statistics for baseline information will be reported after the completion of recruitment. We will develop a series of standards and guidelines for OC screening during the study. An open and shared research platform linked with epidemiological databases and biobank will be built up for further research. ETHICS AND DISSEMINATION:The study is approved by the Ethics Committee of Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (approval number 16-171/1250). The findings of the study will be disseminated through scientific peer-reviewed journals as well as the public via the study website (http://www.ncec-china.cn). TRIAL REGISTRATION NUMBER:ChiCTR-EOC-17010553; Pre-results.

Dataset Information

The prevalence of esophageal cancer after caustic and pesticide ingestion: A nationwide cohort study.

Publications

The prevalence of esophageal cancer after caustic and pesticide ingestion: A nationwide cohort study.

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