bs_bs_banner
Aust. J. Rural Health (2012) 20, 131–137
Original Article Cardiovascular risk factors and psychological distress in Australian farming communities ajr_1273
131..137
Susan Brumby, RN, RM, DipFarmM’Ment, GDipWomen’sStuds, MHM,1,2 Ananda Chandrasekara, BSc(Hons), MSc, RMO (SLMC), PhD, RNutr,1,2 Scott McCoombe, BSc(Hons), PhD,1,2 Peter Kremer, BA, BSc(Hons), GradDipMntl HlthSc, PhD, GradCertHghrEd,3 and Paul Lewandowski, BSc(Hons), PhD, GradCertHghrEd, RNutr2 1
National Centre for Farmer Health, Western District Health Service, Hamilton, and Schools of Medicine and 3Psychology, Deakin University, Geelong, Victoria, Australia
2
Abstract Objective: To examine the prevalence of cardiovascular disease (CVD) risk factors, psychological distress and associations between physical and mental health parameters within a cohort of the Australian farming community. Design: Cross-sectional descriptive study. Setting: Farming communities across Australia. Participants: Data of men (n = 957) and women (n = 835) farmers from 97 locations across Australia were stratified into categories based on National Cholesterol Education Program guidelines. Main outcome measure(s): Prevalence of and interrelationship between overweight, obesity, dyslipidaemia, hypertension, diabetes risk and psychological distress. Results: There was a higher prevalence of overweight (42.5%, 95% confidence interval (CI), 34.2–50.8), obesity (21.8%, 95% CI, 18.3–25.3), abdominal adiposity (38.4% 95% CI, 24.5–52.5), hypertension (54.0%, 95% CI, 34.4–73.5) and diabetes risk (25.3%, 95% CI, 17.7–36.7) in the farming cohort compared with national data. There was also a positive significant association between the prevalence of psychological distress and obesity, abdominal adiposity, body fat percentage and metabolic syndrome in older (age ⱖ 50 years) participants. Conclusions: This study group of farming men and women exhibited an increased prevalence of CVD risk factors and co-morbidities. The findings indicate a positive association between psychological distress and risk Correspondence: Clinical Associate Professor Susan Brumby, National Centre for Farmer Health, Western District Health Service, Hamilton, Victoria 3300, Australia. Email: susan.
[email protected] Accepted for publication 25 February 2012.
for developing CVD, particularly in the older farmers. If the younger cohort were to maintain elevated rates of psychological distress, then it is foreseeable that the next generation of farmers could experience poorer physical health than their predecessors. KEY WORDS: obesity, mental health, farmer, cardiovascular disease.
Introduction The ‘agrarian myth’ that farmers live an idealistic life on the land, and are healthier and happier than ‘city folk’ is far from reality. Farm men and women work long hours in hazardous, stressful and physically demanding work environments.1 Recent studies indicate that rural Australians experience higher rates of lifestyle disease and certain cancers compared with those living in metropolitan regions.2 Further, dispelling the ‘agrarian myth’, farming men confront higher rates of cardiovascular deaths, suicide and certain cancers when compared with both rural and urban populations.3 Farm men and women face higher mental health burdens because of social isolation, socioeconomic constraints, increased alcohol intake and lack of exercise than urban counterparts, and are an increasingly aged workforce.4,5 Compounding this bleak picture is an exacerbation of co-morbidities because of environmental and climatic rigours including drought, flood and bushfire.4 Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide.6 The occurrence of CVD relates strongly to lifestyle and modifiable physiological factors. Brackbill et al. estimated that farmers and other US workers suffered disproportionately from certain chronic diseases and impairments such as CVD, arthritis and amputation.7
© 2012 The Authors Australian Journal of Rural Health © National Rural Health Alliance Inc.
doi: 10.1111/j.1440-1584.2012.01273.x
132
S. BRUMBY ET AL.
What is already known on this subject: • A growing body of evidence indicates that rural Australians experience higher rates of lifestyle disease than those living in metropolitan regions. • Rural Australians face a higher mental health burden because of social isolation, socioeconomic constraints, poor diet, increased alcohol intake, suboptimal sleep, lack of exercise, and higher rates of obesity and diabetes than their urban counterparts. • In-depth studies focusing on the prevalence of cardiovascular disease (CVD) factors and how these relate to psychological distress in Australian farming men and women have not previously been reported.
What this study adds: • There is a higher prevalence of CVD risk factors and psychological distress in the farming community compared with national averages. • Psychological distress is strongly associated with abdominal obesity and other co-morbidities of CVD among the study population. • Elevated levels of psychological distress in younger farmers could lead to risk of increase in CVD-associated morbidities over the next decade.
It is documented that socially isolated groups are at higher risk of poor physical and mental health, particularly where access to health services is limited.8 It is reasonable to assume that such scenarios are applicable to Australian farming populations. Metabolic syndrome is a combination of risk factors leading to CVD, including abdominal obesity, atherogenic dyslipidaemia, raised blood pressure, insulin resistance, glucose intolerance, pro-inflammatory state and prothrombotic state.9 Metabolic syndrome is a major public health issue and has reached epidemic proportions among certain communities.10 With higher rates of poor mental health11 and lifestyle diseases12 in rural Australia, there is a need to identify disproportionately affected communities to facilitate targeted prevention and treatment strategies. This paper explores the prevalence of CVD risk factors and their associations with mental health within a cohort of the Australian farming community.
Methods Study population One thousand seven hundred ninety-two consenting adult farming men (n = 957) and women (n = 835) from 97 locations across Australia participated in the Sustainable Farm Families (SFF) program13 between 2003 and 2009. This convenience sample self-identified as having been farming for more than 5 years and aged between 18 and 74 years. Recruitment was undertaken through various agricultural industry or community groups including Farmers Federations, Progress Associations, Best Wool Best Lamb or Dairy farmers groups. All inter-
ested persons were provided with a plain language statement, and written consent was obtained prior to participation. Ethics approval was obtained from South West Multidisciplinary Ethics committee (3/2003). Participants suffering from chronic terminal illnesses, and pregnant or lactating mothers are excluded in this data analysis.
Data collection Demographical, health behaviours and health conditions data were collected using surveys adopted from the Victorian Department of Human Services Service Coordination Tools.14 Individual physical assessment and anthropometric data were undertaken in local community facilities (community halls, sporting clubrooms, local health services) by trained registered nurses. Weight was measured in kilograms to the nearest 0.1 kg using domestic scales. Height was measured to the nearest of 0.5 cm on a portable stadiometer. A body mass index (BMI) of 30 or greater was considered as obese, while overweight (BMI > 25–30), normal (BMI 18 ⱕ 25) and underweight (BMI < 18) categories were assigned based on World Health Organisation definitions.9 Body fat percentage was measured using bioelectrical impedance (Omron Healthcare, Kyoto, Japan). Blood pressure (BP) was measured using manual sphygmomanometers, with hypertension assumed for a systolic BP ⱖ130 mmHg, a diastolic BP ⱖ85 mmHg and/or the use of antihypertensive medications.9 Blood cholesterol and glucose were measured following a 10-hour fast by capillary blood strip (Accutrend GC, Roche Diagnostics, Castle Hill, NSW, Australia; and Optimum Xceed, Abbott Diabetes Care, Doncaster, VIC, Australia). Impaired glucose metabolism was calculated as the prevalence of individuals with either
© 2012 The Authors Australian Journal of Rural Health © National Rural Health Alliance Inc.
133
CARDIO-PSYCHOLOGICAL RISKS IN FARMERS
TABLE 1:
Descriptive baseline data of the farming cohort
Age (years) Weight (kg) BMI (kg m-2) Body fat % Waist circumference (cm)
Men Women Men Women
Fasting blood glucose (mmol L-1) Fasting blood cholesterol (mmol L-1) Systolic BP (mmHg) Diastolic BP (mmHg) Total score (K-10)
n
Range
Mean (⫾ SD)
1792 1792 1792 876† 778† 941†‡ 824†‡ 1788§ 1484§ 1792 1792 1312
18–74 37.0–171.0 14.8–59.9 10.2–46.6 12.4–49.9 69.0–200.0 63–134 3.1–18.9 3.9–8.5 80–210 50–120 10–38
48.9 (10.9) 80.8 (16.2) 27.3 (4.7) 21.1 (5.6) 33.5 (7.1) 99.03 (11.5) 88.4 (12.52) 5.3 (0.8) 5.0 (0.8) 127.9 (16.1) 79.4 (10.2) 15.6 (4.6)
Number of participants (n) varied among parameters from 1792 to 1484 because of exclusions. †Excluded due to not completion of tests; ‡Excluded previously diagnosed hernias; §Excluded as they fell outside the sensitivity range of the measuring devices. BMI, body mass index; BP, blood pressure; SD, standard deviation.
impaired glucose tolerance or impaired fasting glucose (IFG). IFG was assumed if fasting capillary whole blood glucose was ⱖ5.6 mmol L-1 or previous diagnosis of diabetes. The criteria proposed by the National Cholesterol Education Program Adult Treatment Panel III were used to categorise participants with metabolic syndrome.9 Mental health status and body pain status were assessed using Kessler 10 (K-10) questionnaires and Victorian Department of Human Services Service Coordination Tools.14,15 Psychological distress was assumed if the total K-10 score was >15 or if the participant was previously diagnosed with a psychological illness.15
Data preparation and statistical analysis Data analyses were performed using SPSS (version 18) statistical software (SPSS, Chicago, IL, USA). Differences for ages were evaluated using independent sample t-tests. The effect of psychological distress on other clinical conditions was assessed using Pearson’s chisquare (c2) test (two-tailed). Data were age standardised using the age category of 18–74 years of 2009 Australian Demographic Statistics 2009(310.10) report.16
Results Descriptive data analysis of physical characteristics, clinical measurements and biochemical parameters are shown in Table 1. The mean age (⫾ standard deviation (SD)) of participants was 48.9 (10.9) years, with an average BMI (⫾ SD) of 27.3 (4.7) kg m-2. Men participants had an average waist circumference (⫾ SD) of 99.0 (11.4) cm and 21.1% (5.6) body fat. Averages
(⫾ SD) for women participants were 88.4 (12.5) cm and 33.5% (7.1), respectively. Participants had a mean systolic BP (⫾ SD) of 127.9 (16.1) mmHg, mean diastolic BP (⫾ SD) of 79.4 (10.2) mmHg, mean fasting blood cholesterol level (⫾ SD) of 5.0 (0.8) mmol L-1 and fasting blood glucose level (⫾ SD) of 5.3 (0.8) mmol L-1. The mean mental health status score (⫾ SD) was 15.6 (4.6) using the K-10 scale. To minimise the age effect on clinical parameters, participants were stratified into two age groups (aged ⱖ50 years and aged 18 to
