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Occupational variation in incidence of bladder cancer: a comparison of population-representative cohorts from Nordic countries and Canada
  1. Kishor Hadkhale1,
  2. Jill MacLeod2,
  3. Paul A Demers2,3,4,
  4. Jan Ivar Martinsen5,
  5. Elisabete Weiderpass5,6,7,8,
  6. Kristina Kjaerheim5,
  7. Elsebeth Lynge9,
  8. Pär Sparen8,
  9. Laufey Tryggvadottir10,11,
  10. M Anne Harris2,3,12,
  11. Michael Tjepkema13,
  12. Paul A Peters14,
  13. Eero Pukkala1,15
  1. 1 Department of Epidemiology, Faculty of Social Sciences, University of Tampere, Tampere, Finland
  2. 2 Occupational Cancer Research Centre, Toronto, Canada
  3. 3 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  4. 4 CAREX Canada, Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
  5. 5 Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
  6. 6 Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
  7. 7 Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
  8. 8 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  9. 9 Center for Epidemiology and Screening, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
  10. 10 Icelandic Cancer Registry, Reykjavik, Iceland
  11. 11 Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  12. 12 School of Occupational and Public Health, Ryerson University, Toronto, Canada
  13. 13 Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
  14. 14 Department of Sociology and Economics, University of New Brunswick Fredericton Campus, New Brunswick, Canada
  15. 15 Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
  1. Correspondence to Dr Kishor Hadkhale; kishor.hadkhale{at}


Objectives The objective of this study was to compare occupational variation of the risk of bladder cancer in the Nordic countries and Canada.

Methods In the Nordic Occupational Cancer study (NOCCA), 73 653 bladder cancer cases were observed during follow-up of 141.6 million person-years. In the Canadian Census Health and Environment Cohort (CanCHEC), 8170 cases were observed during the follow-up of 36.7 million person-years. Standardised incidence ratios with 95% CI were estimated for 53 occupations in the NOCCA cohort and HR with 95% CIs were estimated for 42 occupations in the CanCHEC.

Results Elevated risks of bladder cancer were observed among hairdressers, printers, sales workers, plumbers, painters, miners and laundry workers. Teachers and agricultural workers had reduced risk of bladder cancer in both cohorts. Chimney-sweeps, tobacco workers and waiters had about 1.5-fold risk in the Nordic countries; no risk estimates for these categories were given from the CanCHEC cohort.

Conclusion We observed different occupational patterns in risk of bladder cancer in Nordic countries and Canada. The only occupation with similarly increased risk was observed among sales workers. Differences in smoking across occupational groups may explain some, but not all, of this variation.

  • Canada
  • Nordic countries
  • occupational groups
  • risk
  • urinary bladder neoplasms

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  • Contributors KH, JM, PAD and EP designed, analysed and prepared the manuscript. KH, JIM, EW, KK, EL, PS, LT and EP are responsible for NOCCA and JM and PAD are responsible for CanCHEC cohorts. KH, JM, PAD, JIM, EW, KK, EL, PS, LT, MAH, MT, PAP and EP revised, reviewed, provided critical feedbacks and approved the manuscript for final submission.

  • Funding This work was supported by funding from the Nordic Cancer Union. The CanCHEC analysis was funded by a grant from the Ontario Workplace Safety and Insurance Board Research Advisory Council (#11024) and supported by the Ontario Ministry of Labour and the Canadian Cancer Society Research Institute. Linkage of the 1991 Canadian Census to the Canadian Cancer Registry was funded by the Canadian Institute for Health Information, Health Canada and Statistics Canada. This research was supported by funds to the Canadian Research Data Centre Network from the Social Science and Humanities Research Council, the Canadian Institute for Health Research, the Canadian Foundation for Innovation and Statistics Canada. Although the research and analysis are based on data from Statistics Canada, the opinions expressed do not represent the views of Statistics Canada or the Canadian Research Data Centre Network.

  • Competing interests None declared.

  • Ethics approval Prior approval was obtained and no additional approval was needed for this specific study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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