Cardiovascular morbidity and mortality among Swedish farmers and non-farmers : A population-based study

Abstract: All over the world morbidity and mortality rates are unevenly distributed in the populations. From official statistics it has been shown that farmers are more healthy and live longer than the rest of the occupationally active population. It has been shown that this is not due to a healthy workereffect, at least not in Sweden. The difference might be caused by a rural versus urban health gradient or by a difference in exposure to traditional risk factors, socio-economic differences or psychosocial differences.The aims of this study were to explore the effects of a rural versus urban health gradient and possible differences in traditional risk factors, socio-economic or psychosocial factors. The study was designed as a prospective double cohort study performed with a case referent technique. The "cases" mere 1220 male farmers 40-60 years old living in 9 communities and the ''referents'' were 1130 rural and 1087 urban nonfarmers from the general population, matched to the farmers by sex, age and residential areas. 83% of the farmers and 67% of the rural referents participated in a survey in 1990-1991.The reported rate of admission to hospital for all causes combined was 20% lower among farmers than among the rural referents and was lower for all individual causes except for accidents. The results were validated with register data. During eight years of follow up the relative Cardiovascular disease morbidity risk was 38% and 42% higher among rural and urban referents, respectively, than among farmers. The rural versus urban health gradient thus explained approximately 4 per cent units of the cardiovascular morbidity difference. Differences in traditional risk factor exposure explained one third to one half of the farmer-nonfarmer difference in cardiovascular morbidity. When socio-economic and psychosocial factors were taken into account the gap in morbidity rate expanded to approximately 40%.In conclusion farmers had less cardiovascular morbidity than other occupationally active groups. This was only to a moderate extent explained by the rural versus urban health gradient and by differences in traditional risk factor exposure. Socio-economic and psychosocial factors had no explanatory effect.