Background
Occupational cancer represents a preventable yet persistently under-recognized component of the global cancer burden, particularly in Low- and Middle-Income Countries (LMICs), where regulatory capacity, surveillance systems, and exposure control remain uneven. In Brazil, deep regional inequalities, high labor informality, and gendered labor-market dynamics may produce heterogeneous mortality patterns that are obscured by national averages.
 
Objectives
To quantify long-term temporal trends in occupational cancer mortality in Brazil and its federative units from 1990 to 2023, identifying regional and sex-specific disparities and discussing implications for occupational health surveillance, cancer prevention, and evidence-informed public policy in an LMIC context.
 
Methods
We conducted an ecological time-series study using age-standardized mortality rates for cancers attributable to occupational exposures, derived from the Global Burden of Disease (GBD) database. Analyses included Brazil and all 27 states, stratified by sex. Temporal trends were assessed using segmented log-linear Joinpoint regression (version 5.4), estimating Annual Percent Change (APC) and Average Annual Percent Change (AAPC) with 95% confidence intervals (CI) and robust variance.
 
Results
At the national level, occupational cancer mortality declined modestly (AAPC −0.22%; 95% CI −0.29 to −0.15). This decline was driven by men (AAPC −0.46%; 95% CI −0.54 to −0.39), while mortality among women increased steadily (AAPC +0.65%; 95% CI +0.58 to +0.71), yielding a national sex gap of 1.11 percentage points. Marked subnational heterogeneity was observed. Among the 27 states, 15 (55.6%) showed declining overall mortality, concentrated mainly in the South and Southeast, whereas 12 states (44.4%) exhibited stable or increasing total trends, predominantly in the North, Northeast, and Midwest. Sex-specific analyses revealed sharper contrasts. Male mortality declined in 11 states (40.7%), remained stable in 7 (25.9%), and increased in 9 (33.3%), with the steepest declines observed in south or southeast states. In contrast, female mortality increased in 23 of the 27 states (85.2%), remained stable in 3, and declined in only 1 state. The highest female AAPCs were observed in north and northeast states.  In these states, female mortality growth exceeded male trends by more than 1.5 percentage points. Overall, in 22 states (81.5%), female AAPCs were equal to or higher than male AAPCs, reversing traditional occupational cancer patterns. Female time series displayed greater temporal fragmentation, with multiple joinpoints in 18 states, indicating alternating phases of acceleration and stabilization, whereas male trends—particularly in industrialized regions—were more linear and consistently declining. Part of the recent downturn (2019–2021) coincided with the COVID-19 period, suggesting potential underdiagnosis or underreporting rather than true risk reduction.
 
Conclusions / Implications
Although Brazil experienced an overall decline in occupational cancer mortality, this aggregate trend conceals profound regional and gender inequalities. The widespread increase in female mortality and unfavorable trends in nearly half of Brazilian states indicate persistent and emerging occupational hazards, particularly in informal and feminized sectors. Strengthening surveillance systems, expanding exposure registries, and adopting gender- and territory-sensitive prevention strategies are essential to translate epidemiological evidence into effective occupational cancer control policies in LMICs.