ArticleInternational journal of epidemiology2024
Healthy worker hire and survivor effects in a cohort of medical radiation workers.
Article in International journal of epidemiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 2 of them syntheses that pooled it.
What it found
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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
4 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Assessing the Carcinogenic Potential of Jet Fuels: A Fit-for-Purpose Systematic Literature Review.Journal of occupational and environmental medicine · 2026Pooled it
- Confounding and the healthy worker survivor effect in studies of medical radiation workers: a systematic review of methodological approaches.Epidemiology and health · 2026Pooled it
- Occupational radiation exposure and cause-specific mortality in a cohort of Canadian medical workers.International archives of occupational and environmental health · 2026Article
- Association between occupational heat exposure and early renal dysfunction among Chinese petrochemical workers: a combined machine learning and WQS modeling study.Frontiers in public health · 2025Article
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
backgroundThe healthy worker effect may distort the association between exposure and health effects in workers. However, few studies have investigated both the healthy worker hire and survival effects simultaneously, and they are limited to mortality studies in male workers.
methodsWe utilized a data set comprising South Korean diagnostic medical radiation workers registered in the National Dose Registry between 1996 and 2011, and merged it with mortality and cancer incidence data. Standardized mortality ratios (SMRs) and standardized incidence ratios (SIRs) were computed for comparison with the general population. To account for time-varying confounders influenced by prior occupational radiation exposure, we applied g-estimation using structural nested accelerated failure time models and compared the outcomes with those from Weibull regression.
resultsA total of 1831 deaths and 3759 first primary cancer cases were identified among 93 918 workers. Both male (SMR = 0.44; 95% CI: 0.42, 0.46) and female workers (SMR = 0.53; 95% CI: 0.46, 0.60) showed lower mortality rates compared with national rates. In the SIR analysis, male workers exhibited reduced risks of solid cancer whereas female workers had increased risks. The g-estimation-derived hazard ratios (HRs) from radiation exposure exceeded those from Weibull regression estimates for all-cause death (HR = 2.55; 95% CI: 1.97, 3.23) and all-cancer incidence (HR = 1.96; 95% CI: 1.52, 2.55) in male workers whereas female workers showed the opposite results.
conclusionsComprehensive consideration of the healthy worker effect by sex is essential for estimating the unbiased impact of occupational exposure on health outcomes, notably in studies focusing on male mortality.
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