Underrepresentation of women in U.S. occupational cohort mortality studies

Reviews of the occupational epidemiology literature between the 1970s and 2010s found that men were more likely than women to be included in studies of occupational exposures and chronic disease. Our objective was to examine a contemporary sample of occupational cohort mortality studies to determine the extent to which women are underrepresented, how sex is used in analyses, and if the representation of women has improved over time. We searched PubMed for U.S. occupational cohort mortality studies published between 2000 and 2022 with cancer or cardiovascular disease mortality outcomes. We identified 176 U.S. cohort analyses meeting inclusion criteria. Among the cohort analyses that reported the sex of participants, 57% included men and women, 42% included men only, and 1% included women only. Sex was most commonly used in statistical analyses to adjust for confounding (69%) and to exclude women from the study population (26%). Between 2000-2004 and 2015-2022, the proportion of cohort analyses including women increased from 48% to 69%. Women remain poorly represented in occupational cohort mortality studies, although over time fewer studies excluded women. Achieving appropriate representation of women in occupational epidemiology research is essential for fully understanding relationships between occupational exposures and health.