Cancer Risks among Emergency Medical Services Workers in Ontario, Canada

Abstract

Objectives

Emergency medical services workers, such as paramedics, provide important emergency care and may be exposed to potential carcinogens while working. Few studies have examined the risk of cancer among paramedics demonstrating an important knowledge gap in existing literature. This study aimed to investigate cancer risks among paramedics in a large cohort of Ontario workers.

Methods

Paramedics were identified in the Occupational Disease Surveillance System (ODSS) from 1996 to 2019. The ODSS was established by linking lost-time worker’s compensation claims to administrative health data, including the Ontario Cancer Registry to identify incident cases of cancer. Cox-proportional hazard models were used to calculate age and sex-adjusted hazard ratios and 95% confidence intervals to estimate the risk of cancer among paramedics compared to all other workers in the ODSS.

Results

A total of 7240 paramedics were identified, with just over half of the paramedics identifying as male similar to the overall ODSS cohort. Paramedics had a statistically significant elevated risk of any cancer (HR 1.19, 95% CI 1.06–1.34), and elevated risks for melanoma (HR 2.18, 95% CI 1.46–3.26) and prostate cancer (HR 1.73, 95% CI 1.34–2.22). Paramedics had a statistically significant reduced risk for lung cancer (HR 0.48, 95% CI 0.28–0.83). Findings were similar to cancer risks identified in firefighters and police in the same cohort.

Conclusions

This study contributes valuable findings to understanding cancer risks among paramedics and further supports the existing evidence on the increased risk of cancer among emergency medical services workers. We have observed some similar results for firefighters and police, which may be explained by similar exposures, including vehicle exhaust, shiftwork, and intermittent solar radiation. This can lead to a better understanding of carcinogens and other exposures among paramedics and inform cancer prevention strategies.

Acknowledgments

We would like to acknowledge Nelson Chong for his support with the ODSS data linkage.

Author Contributions

JS provided substantial contributions to the conception of the research, analysis of data, interpretation of the data, drafting of the manuscript and further revisions, gave final approval of the version to be published, and agreed to act as a guarantor of the work. PD contributed substantially to the design of the research, interpretation of the data, revised the manuscript critically, gave final approval of the version to be published, and agreed to act as a guarantor of the work. FE contributed to the acquisition of the data, analysis of the data, revised the manuscript critically, gave final approval of the version to be published, and agreed to act as a guarantor of the work. CB contributed to the acquisition and interpretation of the data, analysis of the data, revised the manuscript critically, gave final approval of the version to be published, and agreed to act as a guarantor of the work. MD contributed to the acquisition of the data, analysis of the data, revised the manuscript critically, gave final approval of the version to be published, and agreed to act as a guarantor of the work. TK contributed substantially to the design of the research, interpretation of the data, revised the manuscript critically, gave final approval of the version to be published and agreed to act as a guarantor of the work.

Ethical Approval

This study was approved by the University of Toronto Health Sciences Research Ethics Board (#39013).

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Data Availability Statement

Supporting data is available upon request and can be accessed if conditions are met that comply with organization guidelines.

Additional information

Funding

This work is supported by the Ontario Ministry of Labor, Immigration, Training, and Skills Development (14-R-029). The Occupational Cancer Research Center is supported by the Ontario Ministry of Labor, Immigration, Training, and Skills Development and the Ontario Health agency.