Associations between proximity to livestock farms, primary health care visits and self-reported symptoms

BMC Family Practice, Feb 2016

Background Living in a neighbourhood with a high density of livestock farms has been associated with adverse respiratory health effects, but less is known about healthcare utilisation. This study aimed at investigating the associations between livestock exposure and primary health care visits and self-reported symptoms. In addition, we examined the potentially confounding effect of distance from home to general practice. Methods Contact data between 2006 and 2009 were obtained from electronic medical records of 54,777 persons registered within 16 general practices in an area with a high density of livestock farms in the Netherlands. Data on self-reported symptoms were used from a cross-sectional sample of 531 patients in 2010. Livestock presence in a 500 m radius from home was computed using Geographic Information System data. Results In general, livestock exposure was associated with fewer contacts and self-reported symptoms for respiratory and other conditions. The number of poultry within 500 m was positively associated with the number of contacts. A longer distance to general practice was associated with fewer contacts, but did not confound associations. Conclusions People living close to livestock farms less often see their general practitioner and report symptoms.

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Associations between proximity to livestock farms, primary health care visits and self-reported symptoms

Dijk et al. BMC Family Practice Associations between proximity to livestock farms, primary health care visits and self-reported symptoms Christel E. van Dijk 0 Lidwien A. M. Smit 2 Mariette Hooiveld 0 Jan-Paul Zock 0 Inge M. Wouters 2 Dick J. J. Heederik 2 C. Joris Yzermans 0 0 NIVEL, Netherlands Institute for Health Services Research , Utrecht , The Netherlands 1 Centre for Research in Environmental Epidemiology (CREAL) , Barcelona , Spain 2 Utrecht University, Institute for Risk Assessment Sciences, Division Environmental Epidemiology , Utrecht , The Netherlands 3 CIBER Epidemiología y Salud Pública (CIBERESP) , Madrid, Madrid , Spain 4 Universitat Pompeu Fabra (UPF) , Barcelona , Spain Background: Living in a neighbourhood with a high density of livestock farms has been associated with adverse respiratory health effects, but less is known about healthcare utilisation. This study aimed at investigating the associations between livestock exposure and primary health care visits and self-reported symptoms. In addition, we examined the potentially confounding effect of distance from home to general practice. Methods: Contact data between 2006 and 2009 were obtained from electronic medical records of 54,777 persons registered within 16 general practices in an area with a high density of livestock farms in the Netherlands. Data on self-reported symptoms were used from a cross-sectional sample of 531 patients in 2010. Livestock presence in a 500 m radius from home was computed using Geographic Information System data. Results: In general, livestock exposure was associated with fewer contacts and self-reported symptoms for respiratory and other conditions. The number of poultry within 500 m was positively associated with the number of contacts. A longer distance to general practice was associated with fewer contacts, but did not confound associations. Conclusions: People living close to livestock farms less often see their general practitioner and report symptoms. Environmental exposure; Respiratory system; Delivery of health care; Primary health care; Livestock Background Living in a neighbourhood with a high density of livestock farms has been associated with adverse respiratory health effects [ 1–3 ]. Livestock farms are known to contain several compounds, including microbial compounds such as bacteria, endotoxins, fungi, viruses, pathogenic infectious agents, and also particular matter (PM), ammonia, hydrogen sulphide (H2S) and volatile organic compounds [ 4 ]. Through ventilation and diffusion, these compounds may emit to the environment. However, information on exposure levels in the vicinity of livestock farms in general is scarce [ 4 ]. Several studies showed a higher prevalence of wheezing and difficulty in breathing, and lower lung function with increased livestock exposures in residents near farms [ 1–3 ]. However, the association between livestock exposures and the prevalence of respiratory diseases is inconclusive. One study found a lower prevalence of asthma, COPD and allergic rhinitis, one study a higher prevalence of asthma and two studies found no difference in the prevalence of asthma or allergic rhinitis with increased livestock exposures [ 1, 3, 5, 6 ]. The association between exposure to livestock and healthcare utilisation was not examined until now. As areas with a high density of livestock farms are located in rural areas with a lower geographical density of general practices, access to healthcare might be compromised compared to more urban areas as travel time to healthcare providers is increased. Literature with regard to travel time or distance to healthcare and healthcare utilisation points towards decreased healthcare utilisation with increased distance [ 7 ]. Thus, higher respiratory healthcare utilisation due to respiratory health problems with increased livestock exposure may be counterbalanced by lower accessibility of healthcare. In other words, distance to healthcare providers might be an important confounder in the association between exposure to livestock exposures and primary healthcare utilisation. The objective of this study is to illuminate the association between livestock exposure and healthcare utilisation, in terms of contacts in general practice, using data from electronic medical records (EMRs) of general practices of residents living in an area in the Netherlands with a high density of livestock farms. This study addresses the following questions: What is the association between livestock exposure and (respiratory) contacts in general practice? Does distance to general practice confound associations between livestock exposure and (respiratory) contacts? Lower healthcare utilisation could both indicate a lower demand for healthcare and a lower accessibility of healthcare. To be fully certain that possible differences (after adjusting for distance to general practice) represent differences in demand and not accessibility, we additionally analyse (...truncated)


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Christel van Dijk, Lidwien Smit, Mariette Hooiveld, Jan-Paul Zock, Inge Wouters, Dick Heederik, C. Yzermans. Associations between proximity to livestock farms, primary health care visits and self-reported symptoms, BMC Family Practice, 2016, pp. 22, 17, DOI: 10.1186/s12875-016-0421-3