Occupational insecticide exposure and risk of non-Hodgkin lymphoma: A pooled case-control study from the InterLymph Consortium

Int J Cancer. 2021 Nov 15;149(10):1768-1786. doi: 10.1002/ijc.33740. Epub 2021 Jul 29.


Evidence for the human health effects of pesticides is needed to inform risk assessment. We studied the relationship between occupational insecticide use and risk of non-Hodgkin lymphoma (NHL) by pooling data from nine case-control studies participating in the InterLymph Consortium, including 7909 cases and 8644 controls from North America, the European Union and Australia. Insecticide use was coded using self-report or expert assessment, for insecticide groups (eg, organophosphates, pyrethroids) and active ingredients (eg, malathion, permethrin). Associations with insecticides were estimated using logistic regression to produce odds ratios (ORs) and 95% confidence intervals (CI) for all NHL and NHL subtypes, with adjustment for study site, demographic factors and use of other pesticides. Occupational insecticide use, overall, was not associated with risk of NHL. Use of organophosphate insecticides was associated with increased risk of all NHL and the subtype follicular lymphoma, and an association was found with diazinon, in particular (ever use: OR = 2.05, 95%CI: 1.24-3.37). The carbamate insecticide, carbaryl, was associated with risk of all NHL, and the strongest associations were found with T-cell NHL for ever-use (OR = 2.44, 95%CI: 1.13-5.28) and longer duration (>8 years vs never: OR = 2.90, 95%CI: 1.02-8.25). There was no association of NHL with other broad groups of insecticides, including organochlorines and pyrethroids, and some inverse associations were estimated in relation to historical DDT use. Our findings contribute to the totality of evidence available to help inform risk decisions by public health and regulatory agencies of importance given continued, widespread use of organophosphate and carbamate insecticides.

Keywords: chronic lymphocytic leukemia; insecticide; multiple myeloma; non-Hodgkin lymphoma; pesticide.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Australia
  • Case-Control Studies
  • European Union
  • Female
  • Humans
  • Insecticides / poisoning*
  • Lymphoma, Non-Hodgkin / diagnosis*
  • Lymphoma, Non-Hodgkin / etiology
  • Lymphoma, Non-Hodgkin / prevention & control
  • Male
  • Middle Aged
  • North America
  • Occupational Diseases / diagnosis*
  • Occupational Diseases / etiology
  • Occupational Diseases / prevention & control
  • Occupational Exposure / adverse effects*
  • Occupational Exposure / analysis
  • Occupational Health / statistics & numerical data*
  • Odds Ratio
  • Risk Assessment / methods
  • Risk Assessment / statistics & numerical data
  • Risk Factors


  • Insecticides