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Epidemiol Health > Accepted Articles
Epidemiology and Health 2022;e2022109.
DOI: https://doi.org/10.4178/epih.e2022109    [Accepted] Published online Nov 16, 2022.
Non-cancer health risks in firefighters: a systematic review
Jeong Ah Kim1  , Soo Yeon Song1  , Wonjeong Jeong1  , Jae Kwan Jun1,2 
1National Cancer Control Institute, National Cancer Center, Goyang, Korea
2Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
Correspondence  Jae Kwan Jun ,Email: jkjun@ncc.re.kr
Received: Aug 30, 2022  Accepted after revision: Nov 16, 2022
Firefighters are occupationally exposed to hazardous factors which may increase their risk of disease. Non-cancer disease risk in firefighters has not been systematically examined. This systematic review aimed at identifying non-cancer disease risk in firefighters and determining whether a risk difference exists according to job characteristics. We searched the Cochrane Library, Embase, PubMed, and KoreaMed databases using relevant keywords from their inception to April 30, 2021. The Risk of Bias Assessment Tool for Non-randomized Studies version 2.0 was used to assess the quality of evidence. Because of study heterogeneity, a narrative synthesis was presented. The systematic literature search yielded 2491 studies, of which 66 met the selection and quality criteria. We confirmed that the healthy worker effect is strong in firefighters as compared to the general population. We also displayed a significant increase in the incidence of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and post-traumatic stress disorder in firefighters compared to other occupational groups. Contradicting results around PTSD and anxiety disorders risks related to rank were reported. Sufficient evidence for increased risk of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and post-traumatic stress disorder was available. There was a difference in the risk of non-cancer disease depending on job type, years of service, and rank. However, caution should be exercised when interpreting the results because the classification criteria for firefighters' jobs and ranks differ by country.
Keywords: Occupational health; Firefighters; Musculoskeletal diseases; Post-traumatic stress disorder; Chest pain; Myocardial infarction


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