Can mortality data help reveal hidden cancer risks across South Africa’s workplaces?

Cancer poses a significant public health challenge in South Africa, yet understanding how workplace exposures contribute to cancer risk remains limited. Traditional surveillance systems often lack detailed occupational information, making it difficult to identify high-risk industries or exposure patterns.

Mortality data provides a critical complementary perspective. Cause-of-death records, despite known limitations, consistently capture occupation details, allowing researchers to detect patterns that may not be visible through clinical systems alone. In settings with limited occupational surveillance, such as South Africa, mortality analyses offer one of the clearest windows into occupation-associated cancer risks, enabling early identification of concerns and guiding resource-efficient investigation.

The following series applies mortality data to occupational cancer surveillance for lung, bladder, and oesophageal cancers, highlighting high-risk occupations, key findings, and emerging strategies for workplace prevention and health policy in South Africa.

Materials and Methods

The series draws on Statistics South Africa (Stats SA) mortality data recorded between 2011 and 2015 for individuals aged 15–69 years. Occupations listed on death certificates were coded according to the South African Standard Classification of Occupations (SASCO).

Analytical methods included:

• Proportional mortality ratios (PMRs) to identify occupation groups with excess deaths for bladder and oesophageal cancer.
• Mortality odds ratios (MORs) to estimate elevated risks for lung cancer mortality after adjusting for available non-occupational factors.

Articles in this series

1. Cancer risk in the workplace: Using mortality data for occupational cancer surveillance

This article highlights the value of mortality data for occupational cancer surveillance. Using PMRs and MORs, it identifies patterns of cancer deaths across occupations and guides where further investigation and prevention efforts are needed.

2. Occupation groups associated with an increased risk of lung cancer mortality in South Africa

Analysis of 17 112 lung cancer deaths (2011–2015) shows elevated mortality among management, science and engineering, clerical, metal and machinery trades, machine operators, miners, construction, and other labour sectors. These results highlight occupations where exposure or lifestyle factors may contribute to lung cancer risk.

3. Bladder cancer mortality by major occupational category in South Africa, 2011–2015

Of 1 363 bladder cancer deaths, men in manufacturing, construction, transport, motor repair, retail, and accommodation sectors had higher mortality, while women in construction and education were most affected. The findings emphasise workplace exposure control and targeted prevention in high-risk industries.

4. Oesophageal cancer mortality by occupation in South Africa: A five-year review from 2011 to 2015

High oesophageal cancer mortality was observed among male skilled forestry, building, and machine operators, and female cleaners and helpers. The Eastern Cape had the highest burden, underscoring the need for workplace safety, public health education, and targeted interventions.

Together, this series provides a comprehensive view of how workplace exposures influence cancer mortality in South Africa. By identifying high-risk occupations and highlighting patterns across lung, bladder, and oesophageal cancers, the findings offer critical insights for prevention, workplace safety, and future research.

For a more in-depth look into this thought-provoking series download the full PDF below