Cancer mortality rates by detailed occupation among US working-age adults between 2020 and 2023: a population-based...

Despite overall reductions in high-income countries, cancer mortality rates for some cancer types are rising among working-age adults. This study aimed to generate cancer mortality rates by sex, cancer type, and detailed occupation among working-age adults in the USA.

Cancer deaths (ICD-10 codes C00-C99) from 2020 to 2023 among adults aged 20-64 years were obtained from Mortality Multiple Cause of Death data from the US National Center for Health Statistics and the National Vital Statistics System, and categorised by sex, occupation, age, and year, using 459 detailed US Census 2010 occupation codes and 23 major occupation groups. Population estimates by sex, age, year, and occupation were obtained from the annual American Community Survey and Decennial Censuses. Average annual, age-adjusted cancer mortality rates and 95% confidence intervals (CI) by sex, occupation, and 22 main cancer sites were tabulated and displayed in forest plots.

The study was conducted from March 15, 2022, to August 27, 2025. Among 450 453 total cancer deaths, the average annual age-adjusted cancer mortality rate per 100 000 working-age US residents was 55·2 (95% CI 54·9-55·5) among males and 49·1 (48·8-49·4) among females. The highest overall mortality rates per 100 000 by detailed occupations shared across both sexes were fishing and hunting workers, with rates of 167·4 (95% CI 152·4-183·7) for males and 143·9 (99·1-204·6) for females; mining machine operators with rates of 126·6 (114·6-139·7) for males and 127·0 (65·7-235·8) for females; funeral directors with rates of 112·7 (87·9-148·7) for males and 152·8 (111·9-206·6) for females; animal trainers with rates of 117·3 (97·2-140·6) for males and 110·5 (92·6-130·8) for females; and dietitians and nutritionists with rates of 111·4 (83·8-145·8) for males and 105·6 (96·1-116·0) for females. 18 of 428 occupations accounted for 26·7% (66 521) of all male cancer deaths, and two of 377 occupations accounted for 6·5% (13 113) of all female cancer deaths.

US cancer mortality rates among working-age adults vary substantially by sex, occupation, and cancer site, suggesting workplace-related exposures beyond carcinogens. These findings highlight the need to study how working conditions, structural inequities, and health-care access influence cancer mortality risk by occupation.

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