{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T07:20:45Z","timestamp":1772090445845,"version":"3.50.1"},"reference-count":74,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Firefighting is a hazardous occupation linked to elevated cancer risk. However, occupational exposures unique to this profession may also contribute to non-cancer morbidity and mortality. To better understand firefighters\u2019 health risks, it is essential to examine causes of death beyond cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Following PRISMA guidelines, we conducted a systematic review and meta-analysis of population-based studies published between 1978 and 2025. Studies reporting standardized mortality ratios (SMRs) for non-cancer causes of death were identified through database searches. We estimated pooled SMRs and 95% confidence intervals using random-effects models, tested for publication bias and study quality, and conducted moderator analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-five studies were included for final meta-analysis. Firefighters exhibited significantly lower mortality rate for heart disease (SMR\u202f=\u202f0.64; 95%CI: 0.51\u20130.80), cerebrovascular disease (SMR\u202f=\u202f0.67; 95%CI: 0.50\u20130.90), diabetes mellitus (SMR\u202f=\u202f0.48; 95%CI: 0.32\u20130.70), intentional self-harm\/suicide (SMR\u202f=\u202f0.52; 95%CI: 0.39\u20130.70), chronic lower respiratory disease (SMR\u202f=\u202f0.71; 95%CI: 0.55\u20130.91), and accidents\/injuries (SMR\u202f=\u202f0.77; 95%CI: 0.62\u20130.98) compared to the general population. In contrast, evidence for respiratory infections (\n                      <jats:italic>k<\/jats:italic>\n                      \u202f=\u202f3) and liver disease (\n                      <jats:italic>k<\/jats:italic>\n                      \u202f=\u202f6) was sparse and mortality estimates were comparable to those in the general population. Meta-regression analyses revealed no significant difference across studied moderators including study location, occupational data sources, incident types attended, gender, race, employment status, smoking status, or study quality score on the observed mortality patterns.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Firefighters experience lower mortality from multiple non-cancer causes, potentially due to occupational fitness requirements and the healthy worker effect. However, parity in mortality from liver disease and pneumonia\/influenza warrant further investigation into behavioral factors and occupational exposures. Our results refine the healthy worker effect by identifying cause-specific gaps and priorities for targeted prevention and surveillance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1714033","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T06:54:11Z","timestamp":1772088851000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Non-cancer mortality among firefighters: a meta-analytic review of heart disease, stroke, respiratory disease, liver disease, accidents, and suicide"],"prefix":"10.3389","volume":"14","author":[{"given":"Paulo S.","family":"Pinheiro","sequence":"first","affiliation":[{"name":"Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami","place":["Miami, FL, United States"]},{"name":"Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soyeon","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Education and Psychological Studies, University of Miami","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Negron","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Pinilla","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin N.","family":"Kobetz","sequence":"additional","affiliation":[{"name":"Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami","place":["Miami, FL, United States"]},{"name":"Department of Medicine, Leonard M. Miller School of Medicine, University of Miami","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto J.","family":"Caban-Martinez","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami","place":["Miami, FL, United States"]},{"name":"Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Leonard M. Miller School of Medicine, University of Miami","place":["Miami, FL, United States"]},{"name":"Sylvester Comprehensive Cancer Center, Leonard M. Miller School of Medicine, University of Miami","place":["Miami, FL, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"ref1","volume-title":"US fire department profile 2020","author":"Fahy","year":"2022"},{"key":"ref2","volume-title":"France: IARC monographs on the identification of carcinogenic hazards to humans, occupational exposure as a firefighter","year":"2023"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2639","DOI":"10.1002\/ijc.32199","article-title":"Cancer incidence and mortality among firefighters","volume":"145","author":"Jalilian","year":"2019","journal-title":"Int J Cancer"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1130754","DOI":"10.3389\/fonc.2023.1130754","article-title":"Cancer risk and mortality among firefighters: a meta-analytic review","volume":"13","author":"Lee","year":"2023","journal-title":"Front Oncol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1097\/01.jom.0000246229.68697.90","article-title":"Cancer risk among firefighters: a review and meta-analysis of 32 studies","volume":"48","author":"LeMasters","year":"2006","journal-title":"J Occup Environ Med"},{"key":"ref6","year":"2022"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1136\/oemed-2022-108703","article-title":"All-cause and cause-specific mortality in a cohort of WTC-exposed and non-WTC-exposed firefighters","volume":"80","author":"Singh","year":"2023","journal-title":"Occup Environ Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1093\/jbcr\/iry037","article-title":"Firefighter fatalities: crude mortality rates and risk factors for line of duty injury and death","volume":"40","author":"Kahn","year":"2019","journal-title":"J Burn Care Res"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"113594","DOI":"10.1016\/j.psychres.2020.113594","article-title":"An epidemiologic study of suicide among firefighters: findings from the National Violent Death Reporting System, 2003\u20132017","volume":"295","author":"Pennington","year":"2021","journal-title":"Psychiatry Res"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1296","DOI":"10.1161\/CIRCULATIONAHA.117.027018","article-title":"Firefighting and the heart: implications for prevention","volume":"135","author":"Kales","year":"2017","journal-title":"Circulation"},{"key":"ref11","first-page":"721","article-title":"Smoke inhalation among firefighters","volume":"10","author":"Bizovi","year":"1995","journal-title":"Occup Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.shaw.2023.01.005","article-title":"Occupational hazards in firefighting: systematic literature review","volume":"14","author":"Cuenca-Lozano","year":"2023","journal-title":"Saf Health Work"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.2307\/2533446","article-title":"Operating characteristics of a rank correlation test for publication bias","volume":"50","author":"Begg","year":"1994","journal-title":"Biometrics"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1136\/bmj.315.7109.629","article-title":"Bias in meta-analysis detected by a simple, graphical test","volume":"315","author":"Egger","year":"1997","journal-title":"BMJ"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v036.i03","article-title":"Conducting meta-analyses in R with the metafor package","volume":"36","author":"Viechtbauer","year":"2010","journal-title":"J Stat Softw"},{"key":"ref16","volume-title":"Statistical methods for meta-analysis","author":"Hedges","year":"1985"},{"key":"ref17","first-page":"295","article-title":"Analyzing effect sizes: random effects models","volume-title":"The handbook of research synthesis and meta-analysis","author":"Raudenbush","year":"2009"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1002\/ajim.22434","article-title":"French firefighter mortality: analysis over a 30-year period","volume":"58","author":"Amadeo","year":"2015","journal-title":"Am J Ind Med"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e0120305","DOI":"10.1371\/journal.pone.0120305","article-title":"Mortality due to malignant and non-malignant diseases in Korean professional emergency responders","volume":"10","author":"Ahn","year":"2015","journal-title":"PLoS One"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1002\/ajim.4700260108","article-title":"Mortality among fire fighters in metropolitan Toronto","volume":"26","author":"Aronson","year":"1994","journal-title":"Am J Ind Med"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1002\/ajim.1040","article-title":"Cohort mortality study of Philadelphia firefighters","volume":"39","author":"Baris","year":"2001","journal-title":"Am J Ind Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"6266","DOI":"10.3390\/ijerph17176266","article-title":"Mortality among fire Department of the City of New York rescue and recovery workers exposed to the world trade Center disaster, 2001\u20132017","volume":"17","author":"Colbeth","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1136\/oemed-2013-101662","article-title":"Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950-2009)","volume":"71","author":"Daniels","year":"2014","journal-title":"Occup Environ Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1136\/oem.49.9.664","article-title":"Mortality among firefighters from three northwestern United States cities","volume":"49","author":"Demers","year":"1992","journal-title":"Br J Ind Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1007\/bf01720297","article-title":"Mortality amongst Paris fire-fighters","volume":"11","author":"Deschamps","year":"1995","journal-title":"Eur J Epidemiol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1136\/oem.41.2.183","article-title":"Mortality of fire fighters in Western Australia","volume":"41","author":"Eliopulos","year":"1984","journal-title":"Br J Ind Med"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1136\/oemed-2016-104088","article-title":"Mortality and cancer incidence among male volunteer Australian firefighters","volume":"74","author":"Glass","year":"2017","journal-title":"Occup Environ Med"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1136\/oemed-2018-105336","article-title":"Mortality and cancer incidence among female Australian firefighters","volume":"76","author":"Glass","year":"2019","journal-title":"Occup Environ Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1136\/oemed-2015-103467","article-title":"Mortality and cancer incidence in a cohort of male paid Australian firefighters","volume":"73","author":"Glass","year":"2016","journal-title":"Occup Environ Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1002\/ajim.4700230608","article-title":"Mortality of urban firefighters in Alberta, 1927-1987","volume":"23","author":"Guidotti","year":"1993","journal-title":"Am J Ind Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1136\/oem.47.12.805","article-title":"A cohort study on the mortality of firefighters","volume":"47","author":"Hansen","year":"1990","journal-title":"Br J Ind Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1002\/ajim.4700170407","article-title":"Cohort mortality study of Seattle fire fighters: 1945-1983","volume":"17","author":"Heyer","year":"1990","journal-title":"Am J Ind Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1093\/occmed\/kqu080","article-title":"Failing firefighters: a survey of causes of death and ill-health retirement in serving firefighters in Strathclyde, Scotland from 1985-94","volume":"48","author":"Ide","year":"1998","journal-title":"Occup Med (Lond)"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1002\/ajim.20160","article-title":"Mortality in Florida professional firefighters, 1972 to 1999","volume":"47","author":"Ma","year":"2005","journal-title":"Am J Ind Med"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1136\/oem.35.2.104","article-title":"Mortality among Boston firefighters, 1915\u20131975","volume":"35","author":"Musk","year":"1978","journal-title":"Br J Ind Med"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1007\/s00420-025-02150-x","article-title":"Mortality in firefighters: extended follow-up of a Danish cohort, 1970\u20132021","volume":"98","author":"Pedersen","year":"2025","journal-title":"Int Arch Occup Environ Health"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1007\/s00420-018-1323-6","article-title":"Mortality in a cohort of Danish firefighters; 1970\u20132014","volume":"91","author":"Petersen","year":"2018","journal-title":"Int Arch Occup Environ Health"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1136\/oemed-2019-105962","article-title":"Mortality in a cohort of US firefighters from San Francisco, Chicago and Philadelphia: an update","volume":"77","author":"Pinkerton","year":"2020","journal-title":"Occup Environ Med"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1136\/oem.47.7.462","article-title":"Respiratory mortality among firefighters","volume":"47","author":"Rosenstock","year":"1990","journal-title":"Br J Ind Med"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1002\/ajim.4700250208","article-title":"Mortality and cancer incidence in Stockholm fire fighters","volume":"25","author":"Tornling","year":"1994","journal-title":"Am J Ind Med"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1002\/ajim.4700110608","article-title":"Mortality of a municipal-worker cohort: IV. Fire fighters","volume":"11","author":"Vena","year":"1987","journal-title":"Am J Ind Med"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1093\/annweh\/wxaa036","article-title":"Mortality among firefighters in Spain: 10 years of follow-up","volume":"64","author":"Zhao","year":"2020","journal-title":"Ann Work Expo Health"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1218","DOI":"10.1093\/aje\/kws373","article-title":"The healthy worker effect in cancer incidence studies","volume":"177","author":"Kirkeleit","year":"2013","journal-title":"Am J Epidemiol"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1093\/occmed\/kqx033","article-title":"Cardiac health and fitness of Colorado male\/female firefighters","volume":"67","author":"Li","year":"2017","journal-title":"Occup Med (Lond)"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"101492","DOI":"10.1016\/j.pmedr.2021.101492","article-title":"Cardiometabolic health among United States firefighters by age","volume":"23","author":"Moffatt","year":"2021","journal-title":"Prev Med Rep"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1097\/JOM.0b013e31820af362","article-title":"The prevalence of overweight, obesity, and substandard fitness in a population-based firefighter cohort","volume":"53","author":"Poston","year":"2011","journal-title":"J Occup Environ Med"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1002\/ajim.22572","article-title":"24-hour work shifts, sedentary work, and obesity in male firefighters","volume":"59","author":"Choi","year":"2016","journal-title":"Am J Ind Med"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"908267","DOI":"10.1155\/2012\/908267","article-title":"The prevalence of cardiovascular disease risk factors and obesity in firefighters","volume":"2012","author":"Smith","year":"2012","journal-title":"J Obes"},{"key":"ref49","volume-title":"NFPA 1583: standard on health-related fitness programs for firefighters","year":"2022"},{"key":"ref50","volume-title":"NFPA 1582: standard on comprehensive occupational medical program for fire departments","year":"2022"},{"key":"ref51","year":""},{"key":"ref52","doi-asserted-by":"publisher","first-page":"5432","DOI":"10.3390\/ijerph18105432","article-title":"Hypertension in the United States fire service","volume":"18","author":"Khaja","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"145","DOI":"10.2174\/1573402118666220103094201","article-title":"Blood pressure responses in firefighters: a review","volume":"18","author":"McMorrow","year":"2022","journal-title":"Curr Hypertens Rev"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1097\/JOM.0000000000001846","article-title":"Cardiovascular disease risk factor changes over 5 years among male and female US firefighters","volume":"62","author":"Smith","year":"2020","journal-title":"J Occup Environ Med"},{"key":"ref55","volume-title":"NFPA 1451: Standard for a fire service vehicle operations training program","year":"2018"},{"key":"ref56","volume-title":"NFPA 1500: Standard on fire department occupational safety and health program","year":"2021"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1002\/ajim.20972","article-title":"Tobacco use among firefighters in the Central United States","volume":"54","author":"Haddock","year":"2011","journal-title":"Am J Ind Med"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1002\/ajim.20459","article-title":"Floodwater exposure and the related health symptoms among firefighters in New Orleans, Louisiana 2005","volume":"50","author":"Tak","year":"2007","journal-title":"Am J Ind Med"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.annepidem.2020.08.058","article-title":"Influenza vaccination coverage and (SARS-CoV-2) seroprevalance in a fire department","volume":"52","author":"Caban-Martinez","year":"2020","journal-title":"Ann Epidemiol"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"360","DOI":"10.15288\/jsad.2015.76.360","article-title":"Alcohol use and caloric intake from alcohol in a national cohort of U.S. career firefighters","volume":"76","author":"Haddock","year":"2015","journal-title":"J Stud Alcohol Drugs"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1093\/occmed\/kqs162","article-title":"Alcohol use among firefighters in the Central United States","volume":"62","author":"Haddock","year":"2012","journal-title":"Occup Med (Lond)"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"928","DOI":"10.1097\/JOM.0b013e318225898f","article-title":"Sleep problems, depression, substance use, social bonding, and quality of life in professional firefighters","volume":"53","author":"Carey","year":"2011","journal-title":"J Occup Environ Med"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"1013","DOI":"10.47739\/2373-9363\/1012","article-title":"Perceptions of alcohol use among US firefighters","volume":"2","author":"Jahnke","year":"2014","journal-title":"J Subst Abus Alcohol"},{"key":"ref64","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1093\/occmed\/kqu124","article-title":"Covariates of alcohol consumption among career firefighters","volume":"64","author":"Piazza-Gardner","year":"2014","journal-title":"Occup Med (Lond)"},{"key":"ref65","volume-title":"Hepatitis B vaccine and titer requirements for firefighters, police, and EMTs","year":"2001"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"106704","DOI":"10.1016\/j.envint.2021.106704","article-title":"Firefighters\u2019 occupational exposure: contribution from biomarkers of effect to assess health risks","volume":"156","author":"Barros","year":"2021","journal-title":"Environ Int"},{"key":"ref67","doi-asserted-by":"publisher","first-page":"114370","DOI":"10.1016\/j.envres.2022.114370","article-title":"Associations between serum perfluoroalkyl acid (PFAA) concentrations and health related biomarkers in firefighters","volume":"215","author":"Nilsson","year":"2022","journal-title":"Environ Res"},{"key":"ref68","doi-asserted-by":"publisher","first-page":"191","DOI":"10.5993\/AJHB.39.2.5","article-title":"Social support, stress, and suicidal ideation in professional firefighters","volume":"39","author":"Carpenter","year":"2015","journal-title":"Am J Health Behav"},{"key":"ref69","doi-asserted-by":"publisher","first-page":"980","DOI":"10.1111\/sltb.12500","article-title":"The capability for suicide in firefighters","volume":"49","author":"Streeb","year":"2019","journal-title":"Suicide Life Threat Behav"},{"key":"ref70","doi-asserted-by":"publisher","first-page":"1686","DOI":"10.3389\/fpsyg.2020.01686","article-title":"Utilization and impact of peer-support programs on police officers\u2019 mental health","volume":"11","author":"Milliard","year":"2020","journal-title":"Front Psychol"},{"key":"ref71","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.jad.2015.08.007","article-title":"Career prevalence and correlates of suicidal thoughts and behaviors among firefighters","volume":"187","author":"Stanley","year":"2015","journal-title":"J Affect Disord"},{"key":"ref72","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.jad.2017.06.016","article-title":"Suicidal thoughts and behaviors among women firefighters: an examination of associated features and comparison of pre-career and career prevalence rates","volume":"221","author":"Stanley","year":"2017","journal-title":"J Affect Disord"},{"key":"ref73","doi-asserted-by":"publisher","first-page":"3394","DOI":"10.18203\/2320-6012.ijrms20203702","article-title":"A comprehensive review of the healthy worker effect in occupational epidemiological studies","volume":"8","author":"Algarni","year":"2020","journal-title":"Int J Res Med Sci"},{"key":"ref74","doi-asserted-by":"publisher","first-page":"571","DOI":"10.1186\/1471-2458-11-571","article-title":"Quantification of the healthy worker effect: a nationwide cohort study among electricians in Denmark","volume":"11","author":"Thygesen","year":"2011","journal-title":"BMC Public Health"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1714033\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T06:54:13Z","timestamp":1772088853000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1714033\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,26]]},"references-count":74,"alternative-id":["10.3389\/fpubh.2026.1714033"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1714033","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,26]]},"article-number":"1714033"}}