Chronic Kidney Disease Among Agricultural Workers in Taiwan: A Nationwide Population-Based Study

Che-Jui Chang; Hsiao-Yu Yang

doi:10.1016/j.ekir.2023.09.004

Chronic Kidney Disease Among Agricultural Workers in Taiwan: A Nationwide Population-Based Study

Kidney Int Rep. 2023 Sep 9;8(12):2677-2689. doi: 10.1016/j.ekir.2023.09.004. eCollection 2023 Dec.

Authors

Che-Jui Chang^{1

2}, Hsiao-Yu Yang^{1

3

4

5}

Affiliations

¹ Institute of Occupational and Environmental Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan.
² Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
³ Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan.
⁴ Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁵ Population Health and Welfare Research Center, National Taiwan University College of Public Health, Taipei, Taiwan.

Abstract

Introduction: Chronic kidney disease (CKD) in agricultural communities is a significant public health issue. We aimed to investigate the epidemiology of CKD among Taiwanese farmers and its association with outdoor heat exposure.

Methods: A nested case-control study was conducted on participants in the National Adult Health Examination (NAHE) from 2012 to 2018. The farming occupation was identified through National Health Insurance data. The primary outcomes of interest were the development of CKD, defined as a decreased estimated glomerular filtration rate (eGFR) with diagnosis by physicians, and CKD of undetermined etiology (CKDu), defined as CKD excluding common traditional etiologies. We calculated the county-wide average ambient temperature from a climate reanalysis dataset (ERA5-Land). All CKD cases were matched 1:2 to non-CKD participants by age and biological sex. We estimated the odds ratios (ORs) of CKD and CKDu for farmers and changes in mean ambient temperature (°C) before the examination.

Results: We identified 844,412 farmers and 3,750,273 nonfarmers. Among 24.9% of farmers and 7.4% of nonfarmers with reduced kidney function, only 1 in 7 received a diagnosis of CKD. The farming occupation was independently predictive of CKDu (OR = 1.09, 95% confidence interval [CI] = 1.001-1.18) but not CKD. Increased ambient temperature (°C) was associated with a higher risk of CKD (OR = 1.023, 95% CI = 1.017-1.029), with particularly strong associations observed among middle-aged participants and diabetics.

Conclusions: Taiwanese farmers might have a higher risk of developing CKDu. Outdoor heat exposure is associated with the development of CKD, and middle-aged participants and those with diabetes are more vulnerable than the general population.

Keywords: East Asia; chronic kidney disease of undetermined etiology; farmers; health administrative data; heat stress; meteorological data.