Health Outcomes

The AHS regularly links the cohort to State Vital Statistics and Cancer Registries to update mortality from all causes and cancer incidence. Other health endpoints are collected by self-report in periodic follow-up questionnaires. Specific health endpoints of interest are confirmed through additional participant contact, review of medical records, and, as required, clinical exam.

Table 2a: Applicator Post-enrollment (Incident only) Malignant Cancer Cases by Site and Data Collection Progress 1,2,3,4,5,6
Cancer Site Total with Cancer Completed Phase II QX
N=60,137		 Completed Phase III QX
N=44,129		 Completed Phase IV QX
N=42,331		 Completed Phase V QX
N=32,177		 Returned Buccal Sample
N=34,988		 Returned Dietary History QX
N=35,011
Bladder 565 496 368 390 240 328 314
Brain 88 72 47 45 19 44 44
Breast 85 76 60 61 44 38 38
Bronchus and Lung 857 739 457 435 157 405 395
Colon 669 568 399 395 233 343 311
Head and Neck 101 85 60 61 35 48 45
Kidney and Renal Pelvis 409 343 252 274 176 212 200
Leukemia 331 274 197 196 121 180 157
Liver and Intrahepatic Bile Ducts 85 79 50 49 28 39 42
Melanoma 592 507 383 411 296 302 285
Mesothelioma 20 17 15 12 4 11 10
Multiple Myeloma 175 155 99 94 55 96 91
NHL 833 716 513 541 354 506 426
Oral 236 207 155 148 101 125 127
Ovary 11 11 7 5 2 3 3
Pancreas 235 204 138 136 63 97 100
Prostate 3,755 3,201 2,546 2,538 1,848 2,306 1,852
Rectum and Rectosigmoid Junction 261 231 152 149 101 137 130
Stomach 114 103 68 57 31 63 61
Thyroid Gland 90 74 60 63 43 41 29
Uterine 13 13 9 9 6 5 4
Other 784 690 486 471 295 420 405
All 10,309 8,861 6,521 6,540 4,252 5,749 5,069

1 Cancer counts are based on complete registry data through 2022 for Iowa cases and through 2022 for North Carolina cases.

2 Subjects previously diagnosed with cancer at a different site are included.

3 Buccal cell receipts represent progress through 2014.

4 The 'Other' category includes in-situ bladder cancers.

5 SEER Site Recode ICD-O-3 (1/27/2003) Definition used for classifying cancers.

6 NHL is defined based on the SEER site recode.

Table 2b: Spouse Post-enrollment (Incident only) Malignant Cancer Cases by Site and Data Collection Progress 1,2,3,4,5,6
Cancer Site Total with Cancer Completed Phase II QX
N=60,137		 Completed Phase III QX
N=44,129		 Completed Phase IV QX
N=42,331		 Completed Phase V QX
N=32,177		 Returned Buccal Sample
N=34,988		 Returned Dietary History QX
N=35,011
Bladder 92 81 70 52 39 53 58
Brain 66 57 41 40 26 43 42
Breast 1,928 1,618 1,405 1,257 938 1,134 1,086
Bronchus and Lung 372 324 215 198 94 198 212
Colon 360 310 241 217 137 205 217
Head and Neck 11 8 5 6 3 5 4
Kidney and Renal Pelvis 133 108 100 83 61 68 68
Leukemia 114 94 83 70 39 59 56
Liver and Intrahepatic Bile Ducts 36 33 31 17 11 20 22
Melanoma 269 225 191 175 139 127 146
Mesothelioma 4 3 3 3 2 2 2
Multiple Myeloma 83 66 60 62 39 43 40
NHL 395 325 279 270 178 234 216
Oral 85 73 60 58 41 47 49
Ovary 148 121 96 94 48 76 79
Pancreas 129 101 85 75 34 57 60
Prostate 14 12 9 12 9 8 8
Rectum and Rectosigmoid Junction 97 81 70 61 40 54 56
Stomach 42 34 30 29 17 23 24
Thyroid Gland 152 132 104 91 78 85 83
Uterine 489 420 353 321 226 239 267
Other 418 360 281 246 156 210 240
All 5,437 4,586 3,812 3,437 2,355 2,990 3,035

1 Cancer counts are based on complete registry data through 2022 for Iowa cases and through 2022 for North Carolina cases.

2 Subjects previously diagnosed with cancer at a different site are included.

3 Buccal cell receipts represent progress through 2014.

4 The 'Other' category includes in-situ bladder cancers.

5 SEER Site Recode ICD-O-3 (1/27/2003) Definition used for classifying cancers.

6 NHL is defined based on the SEER site recode.

Table 3: Cause Specific Mortality of AHS Cohort, 1994-2021
Cause Frequency Percent Cumulative Frequency Cumulative Percent
Accidents 1,107 4.84 1,107 4.84
Cancer 6,584 28.79 7,691 33.63
Cerebrovascular Disease 1,181 5.16 8,872 38.79
Diabetes Mellitus 580 2.54 9,452 41.33
Heart Disease 6,098 26.66 15,550 67.99
Respiratory Disease 1,922 8.40 17,472 76.39
Other 5,399 23.61 22,871 100.00
Table 4a: Conditions Reported by Questionnaire, among AHS Private Applicators and Spouses
Incident Cases3
Condition1 Questionnaire2 Total Applicators Spouses
Allergy and respiratory     N N
Asthma P1E&F&S, P3, P4, P5 1,959 952 1,007
Chronic Bronchitis P1F&S, P3, P4 1,352 744 608
COPD P3, P4, P5 2,521 1,739 782
Emphysema P1F&S, P3, P4, P5 1,127 832 295
Eczema P1F&S, P2 356 186 170
Farmer's Lung P1F&S, P3, P4, P5 623 623 47
Idiopathic pulmonary fibrosis P4 133 95 38
Sleep Apnea P5 4,977 1,414 3,563
Autoimmune        
Crohn’s disease4 P5 86 45 41
Inflammatory Bowel Disease4 P1F&S, P2 278 135 143
Lupus/SLE P1F&S, P2Fe, P3, P4, P5 154 52 102
Multiple sclerosis P1F&S, P2, P3, P5 158 69 89
Psoriasis P2 309 189 120
Rheumatoid Arthritis P1F&S, P2Fe, P3, P4, P5 2,748 1,585 1,163
Scleroderma5 P2Fe, P5 59 22 37
Sarcoidosis5 P3, P4, P5 138 66 72
Thyroid (any) P1F&S, P2, P3, P4, P5 6,907 2,668 4,239
Ulcerative colitis4 P5 232 103 129
Sjögren’s syndrome P2Fe, P3, P4, P5 172 42 139
Cardiovascular and metabolic        
Arrhythmia P1F&S, P2, P3, P5 6,305 3,870 2,435
Diabetes P1E&F&S, P2, P3, P4, P5 8,194 5,274 2,920
High blood pressure P1F&S, P2, P3, P4, P5 19,979 11,766 8,213
Myocardial Infarction P1F&S, P2, P3, P4, P5 4,508 3,491 1,017
Stroke P1F&S, P3, P4, P5 2,262 1,461 801
Heart Failure P4, P5 2,609 1,861 748
Eye disease        
Cataracts P1F&S, P2 3,759 3,410 3,759
Detached retina P1F&S, P2 214 470 214
Glaucoma P1F&S, P2 500 986 500
Macular degeneration P1F&S, P2, P3 1,092 739 1,092
Infections        
Shingles P1F&S, P3, P5 5,253 2,510 2,743
Kidney        
Kidney failure P1F&S, P2 176 121 55
Kidney stones P1F&S, P2, P4, P5 4,187 3,013 1,174
Neurologic and psychiatric        
Depression P1E&F&S, P3, P4, P5 3,715 1,556 2,159
Parkinson's disease P1E&F&S, P2, P3, P4, P5 824 628 196
Unintentional injury and poisoning        
Head Injury P1F&S, P2, P4 9,266 7,156 2,110
Head Injury KO P2, P3, P4 3,016 2,229 787
Pesticide poisoning P1F&S, P3, P4 101 82 19
P=Phase; P1 (1993-1997); P2 (1999-2003); P3 (2005-2010); P4 (2013-2015); P5 (2019-2021). P1 and P2 questionnaires varied by applicator/spouse/female gender as specified: P1E=Enrollment; P1F=Take-Home (Farmer); P1S=Phase 1 Spouse, P2Fe=Phase 2 Females; P3-P5 spouses and applicators received same questionnaires.
Table 4b: Self-reported Prevalent and Incident Disease Diagnoses Reported in AHS Private Applicators and Spouses
Total Cases Incident Cases
Condition Questionnaire Prevalent Incident Applicators Spouses
Allergy and respiratory       N2 N2
Asthma P1E&F&S, P3, P4, P5 5,092 1,959 952 1,007
Chronic Bronchitis P1F&S, P3, P4 3,231 1,352 744 608
COPD P3, P4, P5 285 2,521 1,739 782
Emphysema P1F&S, P3, P4, P5 588 1,127 832 295
Eczema P1F&S, P2 2,723 356 186 170
Farmer's Lung P1F&S, P3, P4, P5 939 623 623 47
Idiopathic pulmonary fibrosis P4 19 133 95 38
Sleep Apnea P5     1,414 3,563
Autoimmune          
Crohn’s disease P5 45 86 45 41
Inflammatory Bowel Disease3 P1F&S, P2 1,020 278 135 143
Lupus/SLE P1F&S, P2Fe, P3, P4, P5 213 154 52 102
Multiple sclerosis P1F&S, P2, P3, P5 173 158 69 89
Psoriasis P2 1,094 309 189 120
Rheumatoid Arthritis P1F&S, P2Fe, P3, P4, P5 3,579 2,748 1,585 1,163
Scleroderma4 P2Fe, P5 32 59 22 37
Sarcoidosis4 P3, P4, P5 76 138 66 72
Thyroid (any) P1F&S, P2, P3, P4, P5 3,531 6,907 2,668 4,239
Ulcerative colitis P5 170 232 103 129
Sjögren’s syndrome P2Fe, P3, P4, P5 57 172 42 139
Cardiovascular and metabolic          
Arrhythmia P1F&S, P2, P3, P5 6,898 6,305 3,870 2,435
Diabetes P1E&F&S, P2, P3, P4, P5 3,638 8,194 5,274 2,920
High blood pressure P1F&S, P2, P3, P4, P5 14,398 19,979 11,766 8,213
Myocardial Infarction P1F&S, P2, P3, P4, P5 2,045 4,508 3,491 1,017
Stroke P1F&S, P3, P4, P5 614 2,262 1,461 801
Heart Failure P4, P5 343 2,609 1,861 748
Eye disease          
Cataracts P1F&S, P2 3,410 3,759 3,410 3,759
Detached retina P1F&S, P2 470 214 470 214
Glaucoma P1F&S, P2 986 500 986 500
Macular degeneration P1F&S, P2, P3 739 1,092 739 1,092
Infections          
Shingles P1F&S, P3, P5 2,397 5,253 2,510 2,743
Kidney          
Kidney failure P1F&S, P2 450 176 121 55
Kidney stones P1F&S, P2, P4, P5 6,311 4,187 3,013 1,174
Neurologic and psychiatric          
Depression P1E&F&S, P3, P4, P5 3,460 3,715 1,556 2,159
Parkinson's disease P1E&F&S, P2, P3, P4, P5 133 824 628 196
Unintentional injury and poisoning          
Head Injury P1F&S, P2, P4 4,176 9,266 7,156 2,110
Head Injury KO P2, P3, P4 4,940 3,016 2,229 787
Pesticide poisoning P1F&S, P3, P4 960 101 82 19
P=Phase; P1 (1993-1997); P2 (1999-2003); P3 (2005-2010); P4 (2013-2015); P5 (2019-2021). P1 and P2 questionnaires varied by applicator/spouse/female gender as specified: P1E=Enrollment; P1F=Take-Home (Farmer); P1S=Phase 1 Spouse, P2Fe=Phase 2 Females; P3-P5 spouses and applicators received same questionnaires.

1 Conditions not shown include those with fewer than 20 incident cases (i.e., ALS, Epilepsy or Seizures), anxiety, female only conditions (e.g., uterine fibroids, eclampsia, gestational diabetes), injury (general and other specific types), other poisoning (lead, solvents), symptoms (joint pain and swelling, allergy, respiratory, neurologic, cognitive).

2 Phase(s) questionnaire that included each condition, including baseline (prevalent case Ns not shown).

3 Incident defined based on reported age greater than enrollment age or first reported diagnosis during follow-up and initial report of no diagnosis; total incident cases shown across phases, with responses combined using "or" statements across all phases in which question was asked. Some cases could be refuted, and numbers do not include confirmatory data based on additional screening data, medication use, or validation data.

4 Inflammatory Bowel Disease = Crohn's and UC (combined in Phases 1 and 2, separate at Phase 5).

5 P1S questionnaire asked one question about either Sarcoidosis or Scleroderma (not shown).