Health Disparities of Employees in Taiwan with Major Cancer Diagnosis from 2004 to 2015: A Nation- and Population-Based Analysis

Background : Health disparities related to environmental exposure exist in different industries. Cancer is currently a leading cause of morbidity and mortality worldwide. Much remains unknown about the types of work and industries that face the greatest cancer risks. In this study, we aimed to provide the overall and specific cancer incidences among all workers from 2004 to 2015. We also aimed to show the all-cause mortality for all employees with a first-ever cancer diagnosis. Methods : All workers in Taiwan in the labor insurance database in 2004–2015 were linked to the national health insurance databases. The annual overall and specific cancer incidences in 2004–2015 were calculated and stratified by industry and gender. Age-standardized incidence rates were also calculated. Results : A total of 332,575 workers (46.5% male) who had a first-ever cancer diagnosis from 2004–2015 were identified from 16,720,631 employees who provided 1,564,593 person-years of observation. The fishing, wholesale, construction, and building industries were identified as high-risk industries, with at least 5% of employees within them receiving a first-ever cancer diagnosis. Temporal trends of cancer incidences showed a range from 235.5 to 294.4 per 100,000 with an overall upward trend and an increase of 1.3-fold from 2004 to 2015. There were significant increases over that time for breast cancer (25%); colon cancer (8%); lung, bronchial, and tracheal cancers (11%); and oral cancer (1.7%). However, the incidence rates of cervical cancer and liver and intrahepatic cholangiocarcinoma decreased by 11.2% and 8.3%, respectively. Among the 332,575 workers with a first-ever cancer diagnosis, there were 110,692 deaths and a mortality rate of 70.75 per 1000 person-years. Conclusions : The overall incidence of cancer increased over the 10-year study period, probably due to the aging of the working population. High-risk industries are concentrated in the labor-intensive blue-collar class, which is related to aging and socioeconomic status intergradation.