ORIGINAL RESEARCH
Glyphosate Use Predicts Healthcare Utilization
for ADHD in the Healthcare Cost and Utilization
Project net (HCUPnet):
A Two-Way Fixed-Effects Analysis
Keith Fluegge1, Kyle Fluegge1,2
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1Institute of Health and Environmental Research, Cleveland, Ohio, 44118 USA
2Case Western Reserve University School of Medicine, Department of Epidemiology & Biostatistics,
Cleveland, OH USA 44106-7281
Submission date: 2015-12-01
Final revision date: 2016-02-09
Acceptance date: 2016-02-09
Publication date: 2016-07-22
Pol. J. Environ. Stud. 2016;25(4):1489-1503
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ABSTRACT
There has been considerable international study on the etiology of rising mental disorders, such as
ADHD, in human populations. As glyphosate is the most commonly used herbicide in the world, we sought
to test the hypothesis that glyphosate use in agriculture may be a contributing environmental factor to the
increase in healthcare utilization among individuals with diagnosed ADHD.
State estimates for glyphosate use and nitrogen fertilizer use were obtained from the USGS. We queried
the Healthcare Cost and Utilization Project net (HCUPNET) for state-level hospitalization discharge
diagnosis data on all patients for all-listed ADHD cases from 2007 to 2010. The least squares dummy
variable (LSDV) method and within the method using two-way fixed effects was used to elucidate the
relationship between glyphosate use and all-listed ADHD hospital discharge diagnoses.
A 1-kg increase in glyphosate use in one year positively predicts state-level all-listed ADHD discharge
diagnoses the following year (coefficient = 5.54E-08, p<.01). A study of the effects of urbanization on the
relationship between glyphosate use and ADHD indicates that the relationship is marginally significantly
positive in urban U.S. counties (p<.025). Furthermore, total glyphosate use is strongly associated with total
farm use of nitrogen fertilizers from 1992 to 2006 (p<.001).
Glyphosate use is a significant predictor of state healthcare utilization for ADHD, with the effect
concentrated in urban U.S. counties. We draw upon the econometric results to propose unique and exploratory
mechanisms, borrowing principles from soil and atmospheric sciences, for how glyphosate-based herbicides
may be contributing to the rise of ADHD in all populations.