Data Insight: Health and healthcare use among farmers in Wales: Insights from linked administrative data

This Data Insight by ADR UK fellow Dr Claire Hargreaves demonstrates how linking agricultural and health administrative data can be used to better understand the health of farming populations. Using the Administrative Data | Agricultural Research Collection (AD|ARC) dataset linked with national healthcare datasets in the SAIL Databank, we provide one of the first national-level overviews of primary and secondary healthcare use among farmers in Wales, including the conditions they are diagnosed with and the underlying causes of death.

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Farming is a vital sector of the Welsh economy and rural communities, but the nature of agricultural work can present unique challenges for health and wellbeing of both farmers and their families. Farms are often located in rural or remote areas where access to services may be limited, and the work itself can be physically demanding, with long hours and many farmers working alone. Previous research^1,2,3 has highlighted the potential health impacts associated with these conditions, including both physical and mental health challenges among farming populations.

Recent surveys have highlighted growing concerns about the health and wellbeing of people working in agriculture. The 2021 Big Farming Survey⁴, which covered farming communities in England and Wales, reported that 36% of people in the farming community were probably or possibly experiencing depression, while more than half of women reported mild, moderate or severe anxiety. Physical health issues were also common: over half of respondents reported experiencing pain or discomfort, one in four reported mobility problems, and 21% said health issues affected their ability to carry out usual tasks. Similarly, the Farmers Weekly “Level the Field” campaign survey⁵ found that around half of respondents live with a physical health condition, injury or disability, with musculoskeletal conditions frequently reported and pain often described as a routine part of farm work. Research focusing specifically on women in agriculture has also highlighted wellbeing challenges, with a recent study⁶ reporting that over one-third of women respondents had low mental wellbeing and around 60% reported experiencing loneliness.

Although an increasing body of research highlights health and wellbeing challenges within farming communities, it relies predominantly on self-reported and survey-based measures. Far less is known at a population level about farmers’ patterns of healthcare access or the clinical conditions they present with.

What we found

Who are the farmers in this study? Characteristics of farmers included in the analysis

The cohort, of 18,450 adults, was predominantly male, with 72% of farmers recorded as male and 28% as female. In 2011, the average (mean) age of male farmers was 54.1 years, compared with 59.8 years for female farmers. The age distribution of the cohort by gender is shown in Figure 1. Overall, a higher proportion of male farmers are represented in the younger age categories, while female farmers are more concentrated in the older age groups. 

The cohort is ethnically homogeneous, with 99.9% of individuals recording their ethnicity as White. In terms of educational attainment, 37% reported having no formal qualifications, while 34% reported secondary education (GCSE or equivalent). A further 12% reported post-16 education (A-level or equivalent) and 12% held a degree or higher qualification, while 6% reported other qualifications, including vocational, work-related or foreign qualifications. 

Most farmers in the cohort live in Mid and South West Wales (62%), followed by North Wales (28%) and South East Wales (10%). Household deprivation was measured using Census 2011 indicators capturing disadvantage across four dimensions: education, employment, health and disability, and housing. These measures indicate that one in five farm households are deprived in two or more dimensions, with deprivation most commonly recorded in the health and disability dimension (36%), followed by education (29%), housing (11%), and employment (4%). 

In terms of farm type, the majority of farmers are associated with grazing livestock farms (56%), followed by mixed farms (20%) and dairy farms (12%), while smaller proportions are associated with cereals and general cropping (1%), specialist pigs or poultry (1%), horticulture (less than 1%), or other farm types (3%). Most farm households report no additional labour on the farm, with 77% reporting that no other household family members work on the farm and 89% reporting no non-family members working on the farm.

How many farmers received a GP diagnosis, and for which conditions? Primary care diagnoses recorded between 2011 and 2024

This section examines the annual proportion of farmers receiving a GP diagnosis between 2011 and 2024. Diagnoses are grouped using high-level GP Read code chapters to provide an overview of the most common conditions recorded in primary care. Figure 2 shows the average proportion of farmers who had diagnoses recorded by each chapter, averaged across the study period. The most frequently recorded diagnoses were musculoskeletal conditions (15%), followed by respiratory (12%), skin (11%), and nervous system and sense organ conditions (10%).

Across all diagnosis types, a higher proportion of female farmers received a GP diagnosis compared to males (Figure 3). Musculoskeletal conditions were the most common for both groups, affecting 19% of female farmers and 14% of male farmers. 

Most diagnosis categories remained relatively stable over time (see Appendix 1 for annual proportions by diagnosis type). However, annual proportion of diagnoses for mental and behavioural disorders increased steadily from 4% in 2011 to 7% in 2024, with similar patterns observed across genders and a more pronounced increase in recent years across most age groups (Figure 4). Diagnoses for circulatory conditions also increased, from 6% in 2011 to 9% in 2024, with higher proportions observed in older age groups (Figure 5). While some increases are expected given the ageing cohort, the sharper rises seen in recent years across age groups suggest additional factors may be contributing to these trends.

How many farmers use secondary healthcare services? Hospital admissions, emergency care and outpatient use recorded between 2011 and 2024

This section examines the annual proportion of farmers accessing secondary healthcare services between 2011 and 2024, including elective and emergency hospital admissions, all and urgent emergency department attendances and outpatient appointments. As shown in Figure 6, the annual proportion of farmers accessing each type of secondary healthcare service increased over the study period. A temporary decrease in utilisation was observed across all services during the COVID-19 period, after which levels returned to pre-pandemic trends.

The largest increase was seen in outpatient appointments, where the annual proportion of farmers attending rose from 30% in 2011 to 42% in 2024. This upward trend was observed across all age groups, with attendance generally increasing with age. A reduction in outpatient attendance during the COVID-19 period was seen consistently across all age groups before returning to previous trends. 

The annual proportion of emergency department (ED) attendance also increased over time, rising from 9% to 13% overall. Figure 7 shows proportions of ED attendances across age groups; the youngest (18–29) and oldest (60+) age groups, had the highest annual proportions of attendance throughout the study period. This pattern is consistent with findings from a study using 50 years of health and safety data on farm fatalities in Northern Ireland¹⁰, which identified a U-shaped relationship between age and the likelihood of fatality, with the highest incidence among older farmers but younger farmers also more likely to experience fatality on the farm than middle-aged farmers. Although this evidence comes from a different UK nation and relates specifically to fatalities rather than emergency department use, it is still relevant in suggesting that risks may be elevated at both ends of the age distribution in farming populations. All other age groups showed similar patterns, increasing from around 8–9% in 2011 to 11–12% in 2024. When focusing specifically on urgent emergency department attendances, the largest increase was observed among the 60+ age group, rising from 4% to 9%, while other age groups showed more gradual increases from 2–3% to 4–5% over the same period.

The annual proportion of inpatient hospital admissions also showed gradual increases across the study period. Elective hospital admissions rose from 11% in 2011 to 14% in 2024, with similar increasing trends observed across all age groups and higher proportions generally seen in older age groups. Emergency hospital admissions increased from 7% to 11% overall; however, the pattern by age group differed. The 60+ age group consistently had markedly higher proportions than all other groups, increasing from 9% in 2011 to 15% in 2024. In contrast, the 18–29 and 30–39 age groups remained relatively stable at around 3–4%, while the 40–49 and 50–59 age groups showed moderate increases from around 3% in 2011 to approximately 6% in 2024. Overall, these findings indicate a steady increase in secondary healthcare utilisation among farmers during the observation window, alongside a short-term reduction in service use during the pandemic, with the highest levels of use generally observed among older farmers.

What are the main reasons farmers are admitted to hospital as an emergency? Main diagnoses for emergency hospital admissions recorded between 2011 and 2023

This analysis examines the main diagnoses recorded for emergency hospital admissions among farmers between 2011 and 2023 (2024 was excluded due to expected incompleteness of clinical codes). The primary reason for admission was defined using the first diagnosis code recorded for the first episode within each person hospital spell and mapped to ICD-10 chapters. The five most commonly recorded primary reasons for admissions, although proportionately low (Figure 8), were symptoms, signs and abnormal clinical and laboratory findings not elsewhere classified (Chapter 18), diseases of the circulatory system (Chapter 9), injury, poisoning and certain other consequences of external causes (Chapter 19), diseases of the respiratory system (Chapter 10) and diseases of the digestive system (Chapter 11). These findings should be interpreted in the context of an ageing cohort. 

The proportion of farmers with emergency admissions for circulatory diseases increased from 1.0% in 2011 to 1.7% in 2023, while respiratory diseases increased from 0.5% to 1.2%, with a reduction between 2019 and 2021 during the COVID-19 period. Differences were also observed across age groups. The 50–59 and 60+ age groups showed an upward trajectory in emergency admissions for circulatory diseases from 2019 onwards, with the 60+ age group consistently experiencing higher proportions of circulatory-related admissions compared with younger groups. Similarly, the 60+ age group had higher proportions of respiratory-related emergency admissions throughout the study period. In contrast, injury and digestive-related emergency admissions showed minor variation across age groups.

Causes of death among farmers in Wales. Underlying causes of death recorded between 2011 and 2024

Of the 18,450 farmers included in this study, 3,440 died between 2011 and 2024. The three leading causes of death among farmers, as shown in Figure 9, were circulatory diseases, cancer, and respiratory diseases, reflecting the same broad pattern seen in the wider Welsh population¹¹. However, there were some notable differences. While cancer has been the most common underlying cause of death in the general population in Wales since around 2016, circulatory diseases remained the leading cause of death among farmers across most of the observation window, with the exception of a two-year period between 2017 and 2018.

In the early years of the study, circulatory diseases and cancer accounted for similar proportions of deaths, 40% in 2011 and 35% in 2012. Circulatory diseases then increased to 38% in 2013 before declining to an average of around 32% in subsequent years, compared with an average of 29% for cancer. Deaths where the underlying cause was respiratory disease increased from 10% in 2011 to 14% in 2013, remaining relatively stable until a sharp rise to 20% in 2018, likely linked to the severe influenza season and extreme winter weather experienced across the UK during that period¹². The proportion then declined during the COVID-19 pandemic, reaching 7% in 2020, likely reflecting changes in mortality coding practices where COVID-19 was prioritised as the underlying cause of death when recorded on death certificates. Respiratory-related deaths subsequently increased again to around 15% by 2022 and remained broadly stable in the following years.

These patterns should be interpreted in the context of the characteristics of the farming population. Farmers in this study were predominantly older and male — factors associated with higher rates of circulatory disease mortality. In addition, aspects of farming work, such as long working hours, physical demands, financial pressures and potential delays in accessing healthcare, may contribute to cardiovascular risk. Comparisons with the general population should therefore be interpreted with caution, as the farming cohort has an older age structure, which is strongly associated with circulatory disease mortality. Nonetheless, the consistent prominence of circulatory diseases across the study period indicates that they represent an important cause of death among farmers in Wales.

Why it matters

Understanding the health needs of farming populations is important for supporting agricultural and rural communities and ensuring healthcare services are accessible and responsive. In Wales, farmer health and wellbeing is not only a public health issue but also closely linked to wider agricultural and rural policy objectives. Poor physical and mental health can affect farmers’ ability to manage demanding workloads, adapt to regulatory change, invest in new practices, and sustain farm businesses over time. As Welsh agricultural policy increasingly emphasises long-term sustainability, resilience and skills, understanding the health profile of farmers becomes increasingly relevant to achieving these wider goals. Organisations working with farming communities have highlighted barriers to accessing care, including long working hours, geographical isolation, concerns about leaving farms unattended, digital barriers, and stigma around asking for help. Research by Healthwatch North Yorkshire¹⁴ and County Durham¹⁵ also highlighted practical challenges in rural areas, including travel distances, limited transport options and difficulty attending appointments during standard working hours. Together, these factors may delay help-seeking and reduce opportunities for preventative care.

The findings provide new population-level evidence on both primary and secondary healthcare use among farmers. GP data show a substantial burden of musculoskeletal, respiratory and skin conditions, alongside notable levels of mental health and circulatory diagnoses, with increases observed over time for mental and circulatory conditions. The higher proportion of diagnoses among female farmers and rising trends across age groups highlight areas where earlier intervention and targeted support may be beneficial. These findings are particularly relevant in the context of known barriers to accessing care and concerns about delayed presentation in farming communities.

Consistent increases in outpatient attendance, emergency department use, and both elective and emergency hospital admissions were observed over the study period, with temporary declines during the COVID-19 period reflecting wider population trends. Higher levels of healthcare use among older farmers, alongside increases in circulatory and respiratory conditions, are consistent with an ageing cohort but also indicate growing demand for healthcare services within this population. Notably, the youngest (18-29) and oldest (60+) farmers had the highest proportions of emergency department attendance throughout the study period, suggesting that risks may be elevated at both ends of the age distribution, albeit potentially for different reasons.

The data also highlight the conditions most commonly associated with emergency hospital admissions, particularly circulatory and respiratory diseases, injuries and non-specific symptoms. In addition, mortality patterns show that circulatory diseases remain the leading cause of death among farmers, despite cancer being the leading cause in the wider Welsh population. This likely reflects a combination of demographic factors, occupational exposures and potential differences in access to care, and reinforces the importance of prevention, early detection and management of chronic conditions, particularly cardiovascular disease.

More broadly, this analysis demonstrates the value of linking agricultural, demographic and health data to move beyond anecdote and self‑reported evidence. Such evidence can support more joined‑up thinking across agriculture, health and rural policy, helping to identify where preventative action, service redesign or targeted support may reduce inequalities and improve outcomes for farming communities.