ArticleAmerican journal of epidemiology2013
The healthy worker effect in cancer incidence studies.
Article in American journal of epidemiology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
28 citing papers in PubMed, 2 syntheses or guidelines pooled it, 74 citations in OpenAlex.
- Non-cancer mortality among firefighters: a meta-analytic review of heart disease, stroke, respiratory disease, liver disease, accidents, and suicide.Frontiers in public health · 2026Pooled it
- Health Effects of Occupational and Environmental Exposures to Nuclear Power Plants: A Meta-Analysis and Meta-Regression.Current environmental health reports · 2024Pooled it
- Role of pain and anxiety in mediating relationships between donation history and vasovagal reaction symptoms in blood donors in England.Transfusion · 2026Article
- Global, regional, and national burden of tracheal, bronchus, and lung cancer attributable to polycyclic aromatic hydrocarbons occupational expose from 1990 to 2021: worsening or improving?BMC public health · 2025Article
- Healthy worker hire and survivor effects in a cohort of medical radiation workers.International journal of epidemiology · 2024Article
- Evaluation of mortality among Marines, Navy personnel, and civilian workers exposed to contaminated drinking water at USMC base Camp Lejeune: a cohort study.Environmental health : a global access science source · 2024Article
- Exposure to polycyclic aromatic hydrocarbons, volatile organic compounds, and tobacco-specific nitrosamines and incidence of esophageal cancer.Journal of the National Cancer Institute · 2024Article
- A prospective cohort study of presenteeism and increased risk of unemployment among Japanese workers during the COVID-19 pandemic.Journal of occupational health · 2024Article
- A 15-year follow-up study of mortality in a pooled cohort of World Trade Center rescue and recovery workers.Environmental research · 2023Article
- Cancer risk and mortality among firefighters: a meta-analytic review.Frontiers in oncology · 2023Article
- Body Composition and Fitness Characteristics of Firefighters Participating in a Health and Wellness Program: Relationships and Descriptive Data.International journal of environmental research and public health · 2022Article
- Lung cancer incidence among world trade center rescue and recovery workers.Cancer medicine · 2022Article
- Fit (and Healthy) for Duty: Blood Lipid Profiles and Physical Fitness Test Relationships from Police Officers in a Health and Wellness Program.International journal of environmental research and public health · 2022Article
- Cancer incidence in sites potentially related to occupational exposures: 58 years of follow-up of firefighters in the Norwegian Fire Departments Cohort.Scandinavian journal of work, environment & health · 2022Article
- Cancer Incidence in World Trade Center Rescue and Recovery Workers: 14 Years of Follow-Up.Journal of the National Cancer Institute · 2022Article
- PFAS and cancer, a scoping review of the epidemiologic evidence.Environmental research · 2021Article
- Associations of job-related hazards and personal factors with occupational injuries at continuous miner worksites in underground coal mines: a matched case-control study in Indian coal mine workers.Industrial health · 2020Article
- Survival advantage of cohort participation attenuates over time: results from three long-standing community-based studies.Annals of epidemiology · 2020Article
- Risk for unemployment at 10 years following cancer diagnosis among very long-term survivors: a population based study.Journal of cancer survivorship : research and practice · 2020Article
- Cancer incidence in the Agricultural Health Study after 20 years of follow-up.Cancer causes & control : CCC · 2019Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Use of the general population as a reference might cause serious underestimation of the risk of cancer in working populations because of the healthy worker effect. Using incidence rates, we studied how this underestimation varied according to subtypes of cancer by comparing a large cohort of randomly selected Norwegian workers hired between 1981 and 2003 (n = 366,114) with the general Norwegian population. The cohort was linked to the Cancer Registry of Norway, including all new cancer cases (n = 11,271) reported up to 2003. We found marked potential for the healthy worker effect for overall cancer incidence in male workers (standardized incidence ratio (SIR) = 0.91, 95% confidence interval: 0.89, 0.93) but not in female workers (SIR = 0.99, 95% confidence interval: 0.95, 1.03). A statistically significantly lower incidence was found among men for cancers of the head and neck (SIR = 0.78), lung (SIR = 0.81), prostate (SIR = 0.93), kidney (SIR = 0.83), and bladder (SIR = 0.77) and for leukemia (SIR = 0.80), whereas an increased incidence was found for malignant melanoma among both men (SIR = 1.09) and women (SIR = 1.29) and for ovarian cancer in women (SIR = 1.32). Depending on the type of cancer being studied, marked potential exists for both underestimation and overestimation of cancer risk when the general population is used as the reference for studies of worker populations.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.