Surveillance of Disease and Injury in Wisconsin Dairy Farmers and Workers

Project Description

Dates: 2012 – current

No practical surveillance mechanism exists that collects information on injuries associated with agricultural activities for most farms in the US. Dairy; Wisconsin’s most important agricultural activity, is no exception.

This surveillance project focuses on injuries in Wisconsin dairy farmers and workers, with particular emphasis on changes in the dairy industry and the effect these changes have on injury patterns.  The goal is to establish an active surveillance process using a recurring survey and linking to electronic health records and various state health data records in order to inform policy and guide interventions designed to reduce the overall burden of injury on this population.


  • Approximately 10% of farmworkers are injured each year, and dairy farmers have an exceptionally high risk of injury. How farmers get injured has been documented previously, but less is known about how distal and socio-environmental risk factors influence injury rates.


  • The study reinforced prior observations that injuries are common amongst dairy farmers and provided insight
    into possible risk factors, like having private health insurance, living off-farm, and not providing safety training to
  • In addition, this study determined that using medical codes for farm injuries can be correlated to certain highrisk
    activities and conditions. Natural language processing to estimate the extent of work-related injuries did not
    improve this process.
  • Overall, the project team developed successful methods to conduct surveillance of agriculturally based injuries
    using electronic health records.


  1. Establish population-based estimates of incidence of injury and illnesses in dairy farmers and workers;
  2. Develop and administer a recurring survey to establish estimates of injury and illness among dairy farmers and workers throughout the state of Wisconsin over time; and
  3. Identify high risk activities and conditions associated with production processes and worker characteristics and track any detectable influence on the frequency of injury or illness in the dairy workforce.
2015 Project Update

surveillance-cowsThe main objective of this project is to establish and maintain a working injury surveillance system among farmers and farm workers in Wisconsin. The initial data collection was completed in Fall 2014. The survey tool is being prepared for a second round of data collection to identify trends in injury exposure on farms. An effective surveillance program is essential to providing data on the effects of safety programs and policies, among other changes over time.

The project is also evaluating the use of Natural Language Processing (NLP), a tool designed to data mine the electronic medical records of patients in the Marshfield Clinic service area to identify farmers and contribute to ongoing surveillance. The tool would allow disease and injury data to be automatically collected reducing the time and material costs of the surveillance project. After initially defining the search parameters, the research team is continuing to explore more fully the use and efficacy of the NLP tool. Specifically, they have compared the rate of disease and injury in two parts of the Marshfield Clinic service area. One area includes many dairy farms and the comparison area is known to contain very few dairy farms. These may be useful to further refine the NLP tool to identify dairy farm workers in the electronic medical records and track rates of injury and disease.


This study will be the first to establish population-based estimates of incidence and prevalence of work-related injuries and illnesses in dairy in Wisconsin.

Project Personnel

Photo of Jeff VanWormer PhD

Jeff VanWormer, PhD

Associate Research Scientist Center for Clinical Epidemiology and Population Health (CCEPH)Marshfield Clinic Research Foundation
Phone: 715-221-6484 Website: View Bio



Photo of Bruce H. Alexander PhD

Bruce H. Alexander, PhD

Division Health & Professor, Founding UMASH Director Environmental Health SciencesUniversity of Minnesota School of Public Health
Photo of Stephen C. Waring DVM, PhD

Stephen C. Waring, DVM, PhD

Senior Research Scientist, Division of Research Essentia Institute of Rural Health
Phone: 218-786-1280

Photo of Kathrine L. Barnes MS, MPH

Kathrine L. Barnes, MS, MPH

Research Specialist National Farm Medicine Center
Phone: 715-221-7150
Photo of David McClure PhD

David McClure, PhD

Clinical Epidemiologist Marshfield Epidemiology Research CenterMarshfield Clinic Research Foundation
Phone: 715-389-3534

Publications and Presentations

  • Keifer, M. et al. (2014). Surveillance of Disease and Injury in Wisconsin Dairy Farmers and Workers, Journal of Agromedicine. 19(2):218-219. https://doi.org/10.1080/1059924X.2014.891486
  • VanWormer, J.J., Barnes, K.L., Waring, S.C., & Keifer, M. (2017). Socio-environmental risk factors for medically-attended agricultural injuries in Wisconsin dairy farmers, International Journal of the Care of the Injured. 48(7):1444-1450. https://doi.org/10.1016/j.injury.2017.05.027
  • Barnes, K. L. (2016). Injury surveillance in a decentralized United States system: Innovative approach to find new hazards, 2015. Safety 2016 Conference, Tampere, Finland.
  • Barnes, K. L. (2016). Safety surveillance in a decentralized United States system: an innovative approach to find emerging hazards, 2015. Epidemiology in Occupational Health Conference (EPICOH), Barcelona, Spain.
  • Barnes, K. L. (2016, June). Injury surveillance in Wisconsin dairy farms. International Society for Agricultural Safety and Health (ISASH) Conference, Lexington, KY, United States.
  • Barnes, K. L., VanWormer, J., Sandburgh, S., McClure, D., Waring, S. C., & Keifer, M. (2016, May 4). Surveillance of disease and injury in Wisconsin dairy farmers and workers. 2016 NORA Symposium, Minneapolis, MN, United States.
  • Keifer, M. (2015, March 17). Farm health and safety. 4th Annual Wisconsin Agribusiness Dinner, Columbus, WI, United States.
  • Keifer, M., Reyes, I.A., Sandberg, S., & Waring, S. (2014, Oct. 19-22). Finding data, in data: Mining terms from electronic medical records for the characterization of dairy worker populations. 7th International SHARP Symposium, Saskatoon, SK, Canada.
  • Keifer, M., Reyes, I.A., Sandberg, S., & Waring, S. (2014, Oct. 19-22). Surveillance of disease and injury in wisconsin dairy farmers and workers. 7th International SHARP Symposium, Saskatoon, SK, Canada.
  • Keifer, M., Sandberg, S., & Waring, S. (2014, Nov. 15-19). Surveillance of disease and injury in Wisconsin dairy farmers and workers. American Public Health Association, 142nd Annual Meeting and Exposition, New Orleans, LA, United States.
  • Sandberg, S. (2014, Oct. 19-22). Surveillance of disease and injury in Wisconsin dairy farmers and workers. 7th International SHARP Symposium, Saskatoon, SK, Canada.

Project News