Lung Cancer Risk in Female School Cooks: A Nationwide Retrospective
Cohort Study in the Republic of Korea

Lung Cancer Risk in Female School Cooks: A Nationwide Retrospective
Cohort Study in the Republic of Korea

Cohort studies
Incidence
Lung Neoplasms
Smoking
Ventilation

Exposure to cooking fumes exposure likely increases the lung cancer risk in school cooks,
but research on the incidence of lung cancer in school cooks is lacking. Therefore, this study aimed to
examine a nationwide cohort of school cooks for lung cancer by linking three Korean social insurance
databases to determine whether working as a school cook increases lung cancer risk.
Methods: A nationwide retrospective cohort of school cooks and clerks with lung cancer was established
by linking Employment Insurance, Industrial Accident Compensation Insurance, and National Health
Insurance Service databases. Covariates were matched using 1:1 propensity score matching (PSM) for
school cooks and clerks. Age-standardized incidence and hazard ratios (HRs) for lung cancer were
calculated using the Cox proportional hazards model. FineeGray subdistribution HRs were used for
sensitivity analysis. After further categorization into never- and ever-smoked subcohorts, the same analyses were performed.
Results: Post PSM, we identified 76 cases of lung cancer in school cooks during 259,819 person-years of
follow-up. The age-standardized incidence was 199.8 (95% confidence interval [CI]: 120.7e278.9) and
166.8 (95% CI: 95.8e237.7) for school cooks and clerks, respectively. The subdistribution HR for school
cooks post PSM was 1.72 (95% CI: 1.14e2.60). In the never-smoked subcohort, the subdistribution HR for
school cooks post PSM was 4.23 (95% CI: 2.36e7.58).
Conclusion: School cooks were at an elevated risk of developing lung cancer, likely due to exposure to
cooking fumes, highlighting the need for improved ventilation and preventive measures in school
kitchens to reduce lung cancer risk.

Jungwon Jang 1
, Eun Mi Kim 2
, Jaiyong Kim 2
, Jeehee Min 3
, Inah Kim 1,*

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1Department of Occupational and Environmental Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
2Department of Big Data Management, National Health Insurance Service, Wonju, Republic of Korea
3Department of Occupational and Environmental Medicine, Hanyang University Hospital, Seoul, Republic of Korea

9 January 2025

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