Employment status and occupation are associated with liver cirrhosis: A nationwide Swedish case–control study

Abstract Background Liver cirrhosis is often diagnosed in working‐age adults and carries a poor prognosis. A better understanding of variation by employment status and occupation may support earlier and more targeted diagnostic evaluation. Objectives To assess the odds of liver cirrhosis across labor‐market status and occupations in working‐age adults and whether these patterns differed by etiology. Methods In this nationwide case–control study, individuals aged 35–65 years with cirrhosis during 2002–2021 were identified from Swedish national registries and matched to up to four controls on age, sex, and municipality. Labor‐market status in the year before diagnosis was classified as employed, unemployed, disability/activity benefit, long‐term sick leave, or other. Employed individuals were classified into occupations. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals, with physical and engineering professionals as the reference group. Results We included 23,033 cases and 92,106 controls. Cases were less often employed than controls (25.7% vs. 66.2%) and more often belonged to labor‐market strata associated with a lower socioeconomic status. In analyses, including employed and unemployed individuals (7485 cases; 63,747 controls), unemployment was associated with the highest odds of cirrhosis. Among employed individuals, food preparation workers and refuse and recycling workers had the highest odds. Stratified by etiologies, associations were strongest for alcohol‐related cirrhosis. Patterns across sex strata were similar, with generally larger effect sizes in men. Conclusion Among working‐age adults, unemployment and selected occupations were strongly associated with incident cirrhosis. Routinely collected employment information may help identify groups who could benefit from earlier liver evaluation.