What Are the Non-Cancer Health Risks for Firefighters?

What you need to know

• Firefighters have lower mortality rates for many diseases compared to the general population, likely due to the “healthy worker effect”
• However, firefighters show increased risks for certain conditions like lower back pain, heart problems, and post-traumatic stress disorder compared to other occupational groups
• Disease risks can vary based on a firefighter’s specific job duties, years of service, and rank
• More research is needed on female firefighters, as most studies focus primarily on male firefighters

The unique health risks of firefighting

Firefighting is a physically and mentally demanding occupation that exposes workers to various hazards. While much research has focused on cancer risks in firefighters, less is known about other health impacts of this challenging profession. This systematic review examined 66 studies to better understand the non-cancer disease risks faced by firefighters compared to other occupations and the general population.

The healthy worker effect in firefighters

One of the key findings was that firefighters tend to have lower mortality rates for many diseases compared to the general population. This is likely due to what’s known as the “healthy worker effect.” Firefighters must meet certain physical fitness standards to be hired and maintain their jobs. As a result, they tend to be healthier on average than the general public.

For example, male firefighters had significantly lower death rates from infectious diseases, respiratory diseases, and liver diseases compared to the general population. They also had lower rates of diabetes.

However, this healthy worker effect can make it challenging to identify occupational health risks specific to firefighting. When firefighters are compared only to the general population, some job-related health impacts may be masked or underestimated. That’s why it’s important to also compare firefighters to other occupational groups with similar overall health status.

Increased risks for certain conditions

When compared to other occupations like police officers, military personnel, or office workers, firefighters showed higher rates of several health issues:

Musculoskeletal problems

Multiple studies found firefighters had increased risks of lower back pain, spinal issues, and disc herniation compared to other workers. This is likely related to the physical demands of the job, including heavy lifting and awkward positioning.

Heart issues

Firefighters had higher rates of angina (chest pain), heart attacks, and ischemic heart disease compared to other occupational groups. The intense cardiovascular strain of firefighting activities likely contributes to this increased risk.

Mental health

Post-traumatic stress disorder (PTSD) was more common in firefighters compared to other government workers. Rates of depression and anxiety also tended to be elevated, particularly among retired firefighters.

Sleep disorders

Firefighters reported higher rates of sleep issues like insomnia compared to office workers. Shift work and job stress may play a role in these sleep disturbances.

Risks vary by job type and experience

The review found that health risks often differed based on a firefighter’s specific job duties, years of service, and rank:

Job type

Fire suppression personnel (those actively fighting fires) tended to have the highest rates of sudden cardiac death and coronary heart disease. Emergency medical service (EMS) and rescue personnel had elevated risks of PTSD and back pain.

Years of service

More experienced firefighters (>20 years of service) had higher rates of hearing loss and hypertension. However, those with fewer years of service reported more sleep problems and mental health issues like suicidal thoughts.

Rank

Higher-ranking officers sometimes had increased risks of anxiety disorders compared to lower ranks. But results were inconsistent across studies.

Limitations and future research needs

While this review provides valuable insights, there are some important limitations to consider:

1. Most studies focused primarily on male firefighters. Very little data is available on health risks specific to female firefighters.

2. Study designs and methods varied widely, making it difficult to directly compare results across studies.

3. Job classifications and ranking systems for firefighters differ between countries, complicating international comparisons.

4. Some important health outcomes may be underreported due to stigma or fear of job consequences.

More research is clearly needed, particularly on female firefighters and long-term health impacts. Future studies should use consistent methods and definitions to allow for better comparisons.

Conclusions

• While firefighters tend to be healthier than average, they face increased risks of certain conditions like back problems, heart issues, PTSD, and sleep disorders compared to other workers.
• Health risks vary based on specific job duties, years of experience, and rank within the fire service.
• More high-quality research is needed, especially on female firefighters and long-term health effects.
• Targeted interventions addressing the most common health risks could help protect firefighters’ wellbeing throughout their careers and into retirement.

By better understanding the unique health challenges faced by firefighters, we can work to mitigate risks and provide appropriate support for these vital public servants. Ongoing research and evidence-based occupational health programs are essential for protecting those who dedicate their lives to protecting others.