Sex Work and Related Health Outcomes: A Retrospective Cohort Study Using Primary and Secondary Care Data in England

Published Date: 16th March 2026

Publication Authors: Croxford. S

Online ahead of print - Preprints withe The Lancet
Abstract
Background: The health outcomes associated with sex work have not been extensively studied. The aim of this study was to evaluate the associations between sex workers and a wide range of health outcomes, including disease-specific hospital admissions.

Methods: Adults aged 18 years and older who were reported to have ever engaged in sex work (sex workers) were identified using a UK-based linked primary care database (Clinical Practice Research Datalink Aurum) and secondary care database (Hospital Episode Statistics Admitted Patient Care), including records between 1st January 2001 and 1st January 2022. The primary outcomes were a range of 70 different health conditions identified in primary and secondary care. Cox regression models were used to assess the association between sex workers and developing each health outcome individually. The study was part of a larger, multi-method investigation into the health needs of sex workers in the UK.

Results: The study included 12,580 patients in primary care comprising 1,377 sex workers and 11,203 non-sex workers. Similarly, 10,413 patients were identified in secondary care comprising 894 sex workers and 9,519 non-sex workers. Most sex workers were white females from the most deprived quintile and were more likely to smoke, consume alcohol, and use drugs. Sex work was associated with mental health disorders, sexually transmitted diseases, substance misuse, self-harm, and death, in addition to other health outcomes such as asthma, hepatitis B, pancreatitis, cirrhosis, chronic kidney disease, back pain, and falls. Similarly, an association was observed between sex workers and hospital admissions for digestive disorders, mental health disorders, substance use disorders, musculoskeletal disorders, and epilepsy.

Conclusions: Sex work is significantly associated with a wide range of poor physical and mental health outcomes. This highlights the large breadth of unmet needs for sex workers in terms of clinical support. The targeted interventions are needed to break down the barriers between sex workers and access to healthcare services and increase the chances of their health needs being sufficiently met to reduce the risk of developing these conditions.

Simms-Williams, N.; Croxford, S.; Et al. (2024). Sex Work and Related Health Outcomes: A Retrospective Cohort Study Using Primary and Secondary Care Data in England. SSRN. [Online]. Available at: https://dx.doi.org/10.2139/ssrn.6406637 [Accessed 10 April 2026].