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. 2025 Feb 5;25(1):458.
doi: 10.1186/s12889-025-21328-z.

Cancer mortality and sectors of employment: a cohort study in Italy

Stefania Massari  1 , Lisa Bauleo  2 , Claudio Gariazzo  3 , Paola Michelozzi  4 , Luca Dei Bardi  4   5   6   7 , Nicolas Zengarini  8 , Sara Maio  9 , Massimo Stafoggia  4 , Marina Davoli  4 , Giovanni Viegi  9   10 , Giulia Cesaroni  4 , Alessandro Marinaccio  3 ; BIGEPI Collaborative Group
Collaborators, Affiliations

Cancer mortality and sectors of employment: a cohort study in Italy

Stefania Massari et al. BMC Public Health. .

Abstract

Background: Cancer is a multifactorial disease. The large impact of occupational exposure on the burden of cancer continues to be a paramount public health concern that deserves more attention. The study aims to evaluate cancer-specific mortality risk in relation to sectors of employment.

Methods: We used a cohort from the Rome Longitudinal Study (ROL) and linked it with the National Social Insurance Agency (INPS) database to obtain working histories. We considered the longest duration of employment in a sector as a proxy of exposure, and insurance activities as the reference category. A Cox regression adjusted model was used to examine the associations between cancer-specific causes of death and the sector of employment in men and women. A similar analysis was performed considering the length of employment (≤ 10 years versus ≥ 10 years).

Results: The study population comprised 910,559 (52% of the total population of the cohort after linkage with INPS) 30 + yr employees (53% men and 47% women) followed for a total period of approximately 7 million years. The outcomes confirmed some well-known associations (e.g. lung and pleura in construction, pleura in paper and printing, and lung in wood and leather) and suggested possible high-risk sectors that have not yet been thoroughly investigated. In men we observed an increased mortality risk for stomach cancer in the printing and paper industry (HR = 1.69, 95% CI:1.11-2.57) as well as for stomach and lung cancer in cleaning activities (HR = 1.98, 95% CI:1.13-3.49 and HR = 1.55, 95% CI:1.22-1.98, respectively). Among women, there was an elevated mortality risk in the cleaning industry for all malignant cancers (HR = 1.15, 95% CI:1.03-1.29), liver cancer (HR = 1.94, 95% CI:1.08-3.48) and cancer of the lympho-hematopoietic tissue (HR = 1.65, 95% CI:1.09-2.50).

Conclusions: The results showed an increased risk of cancer death in some traditional industrial sectors compared to the reference category of insurance activities such as construction and wood and leather products and limited evidence in sectors like cleaning, accommodation and food services and hairdressing. The adopted method proved to be effective in monitoring occupational risks and activating proper prevention initiatives and further insights.

Keywords: Administrative data; Hazard ratio; Occupational epidemiology; Routinely collected health data; Social security statistics; Work-related cancer.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethics approval and consent to participate are deemed unnecessary according to the National Statistics Program (PSN 2020–2022) which grants prior authorization with the force of law of the Italian Data Protection Authority (Legislative decree No. 322 of 1989, art. 13 e art. 6-bis, comma 1-bis) for statistical works of public interest based on administrative data. Ethics approval and consent to participate are extended to all participants of the study. Consent for publication: Not applicable for administrative data. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Duration of employment (in years) by sector and gender. Rome 2011–2019
Fig. 2
Fig. 2
Age-standardized mortality rates (per 10,000) for cancer mortality (ICD9 140–208) by sector and gender (vertical lines refer to age-standardized mortality rates in insurance activities, dashed for women and continuous for men; dots for women and diamonds for men). Rome 2011–2019
See this image and copyright information in PMC

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