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Hemoglobin levels among male agricultural workers: analyses from the Demographic and Health Surveys to investigate a marker for chronic kidney disease of uncertain etiology
Authors: Yuzhou Lin, Siyu Heng, Shuchi Anand, Sameer K. Deshpande, and Dylan S. Small
Source: Journal of Occupational & Environmental Medicine, 2021; DOI: 10.1097/JOM.0000000000002703
Topic(s): Employment
Rural-urban differentials
Country: More than one region
  Multiple Regions
Published: DEC 2022
Abstract: Background Chronic kidney disease of uncertain etiology (CKDu) has been found at high frequency in several lowland agricultural areas. Whether CKDu occurs in other countries with large agricultural populations remains uncertain, primarily due to lack of systematic data on kidney function. Hemoglobin (Hgb) levels are an ancillary marker for kidney dysfunction. We estimate the causal effect of agricultural work on Hgb level in men. A causal effect may indicate the presence of CKDu. Methods We use Demographic and Health Surveys (DHS) data from seven African and Asian countries to estimate the causal effect of agricultural work on altitude-adjusted Hgb levels after adjusting for seven measured confounders. To assess potential bias due to unmeasured socioeconomic differences, we use multiple control groups that differ in non-agricultural occupation. We conduct sensitivity analyses to assess the robustness of our causal conclusions to unmeasured confounding. Results Data were available for 41,180 agricultural workers and 55,705 non-agricultural workers. On average, Hgb levels were 0.09 g/dL lower among agricultural workers compared to matched controls. Significant effects were observed in Ethiopia, India, Lesotho, and Senegal, with effects from 0.07 to 0.30 g/dL lower hemoglobin among agricultural workers. Conclusions We find evidence that men engaged in agricultural work in four of the seven countries studied have modestly lower Hgb levels compared with comparable men. Since underlying kidney disease could be a potential explanation for this finding, our data support consideration to integrating kidney function assessments within DHS surveys and other population-based surveys.