Job tasks, potential exposures, and health risks of laborers employed in the construction industry

Our plain-English summary of Job tasks, potential exposures, and health risks of laborers employed in the construction industry, by G. Burkhart, P.A. Schulte, C. Robinson, et al (American Journal of Industrial Medicine, 1993).

The study

• Authors: G. Burkhart, P.A. Schulte, C. Robinson, W.K. Sieber, P. Vossenas, K. Ringen
• Journal: American Journal of Industrial Medicine
• Published: 1993;24(4):413-25
• Type of article: Review
• Cited by: 56 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Construction laborers have some of the highest death rates of any occupation in the United States. There has been very little systematic research focused exclusively on "laborers" as opposed to other workers in the construction industry. We reviewed the English language literature and various data bases describing the occupational tasks, exposures, and work-related health risks of construction laborers. The sources of information included 1) occupational mortality surveillance data collected by the states of California and Washington and the National Institute for Occupational Safety and Health (NIOSH); 2) National Occupational Exposure Survey; 3) national fatality data; 4) cancer registry data; and 5) case reports of specific causes of morbidity. While the literature reported that construction laborers have increased risk for mesothelioma, on-the-job trauma, acute lead poisoning, musculoskeletal injury, and dermatitis, the work relatedness of excess risks for all-cause mortality, cirrhosis, cerebrovascular disease, chronic obstructive pulmonary disease, ischemic heart disease, and leukemia is less clear. Furthermore, while laborers are known to be potentially exposed to asbestos, noise, and lead, and the NIOSH Job Exposure Matrix describes other potential hazardous exposures, little research has characterized other possible exposures and no research has been found that describes the exposures associated with specific job tasks. More advanced study designs are needed that include a better understanding of the job tasks and exposures to construction laborers, in order to evaluate specific exposure-disease relationships and to develop intervention programs aimed at reducing the rate of work-related diseases.

In plain English

This article was a review of published literature and data on the job tasks, exposures and health risks of United States construction laborers. The authors searched four literature databases and also presented NIOSH death-certificate mortality ratios for 19 states, citing an analysis by Robinson and colleagues. A NIOSH job exposure matrix listed asbestos among many agents laborers may be exposed to, but gave no exposure levels. The authors wrote that asbestos exposure appears to occur during demolition and during construction or installation of insulation materials. In those data for 1984 to 1986, lung cancer proportionate mortality was significantly raised in white male laborers (PMR 1.13, 894 deaths), and four mesothelioma deaths occurred. Cancer registry studies they reviewed reported increased mesothelioma in construction laborers. In California data for a broader group, "other construction workers", lung cancer death ratios were significantly raised. After an exploratory adjustment for smoking, alcohol and socioeconomic status, they stayed above 1 but lost statistical significance. The authors concluded that mesothelioma, among other conditions, is clearly related to occupational factors, but noted that no analytical studies of construction laborers had appeared in English-language literature.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Review of published literature and compiled data sources, including NIOSH death-certificate proportionate mortality ratios cited to an analysis by Robinson et al.
• Who was studied: Construction laborers in the United States, as described in published literature, NIOSH death-certificate data for 876,731 decedents aged 20 and over from 19 states (1984 to 1986), California mortality data (1979 to 1981) and other sources
• Exposure: Potential exposure to asbestos (fiber type not stated), inorganic lead, solvents, carbon monoxide, noise and many other agents, according to the NIOSH Job Exposure Matrix. Asbestos exposure was described as occurring during demolition of existing structures and during construction or installation of insulation materials.
• Main results:
  • The proportionate mortality ratios shown came from NIOSH occupational mortality surveillance data for 1984 to 1986, cited to Robinson et al.
  • In the NIOSH 19-state data for 1984 to 1986, the proportionate mortality ratio for lung cancer was 1.13 (894 deaths) in white male construction laborers, marked as significant. It was 0.97 (328 deaths) in black male construction laborers, not marked as significant.
  • Four mesothelioma deaths occurred in the NIOSH data. They were not listed in the table.
  • Cancer registry studies the authors reviewed reported increased mesothelioma in the construction industry and specifically in construction laborers.
  • In California data for white male "other construction workers" (1979 to 1981), the SMR for cancer of trachea and lung was 1.63 (95% CI 1.39 to 1.91) unadjusted. After adjustment for smoking, alcohol consumption and socioeconomic status it was 1.09 (95% CI 0.93 to 1.28). The adjusted figure was still above 1, but its interval includes 1, so it was not statistically significant.
  • In the same California data for black male "other construction workers", the SMR for cancer of trachea and lung was 2.23 (95% CI 1.67 to 2.92) unadjusted. Adjusted, it was 1.26 (95% CI 0.94 to 1.65), which was above 1 but not statistically significant.
  • Little research had measured the extent of laborers' exposures to asbestos, lead, noise and other agents.
• The authors' conclusion: The authors concluded that mesothelioma, work-related injuries, acute lead poisoning, musculoskeletal injury, noise-induced hearing loss and dermatitis are clearly related to occupational factors. They stated that the limited literature and the absence of analytical studies prevent conclusions about which exposures cause the other increases in disease and death, and that more research is needed.
• Limitations the authors state:
  • Only descriptive reports, and no analytical studies, of construction laborers had been published in the English-language literature.
  • The NIOSH proportionate mortality ratios were not adjusted for smoking, alcohol or socioeconomic status.
  • The degree to which occupation was misclassified on death certificates is unknown.
  • The California group "other construction workers" also included other trades, such as insulation workers, and the proportion who were laborers was not stated.
  • The California mortality file stopped at age 64, so diseases with long latency could be missed.
  • The adjustment for smoking, alcohol and socioeconomic status was exploratory and had not been validated.
  • The job exposure matrix gives no quantitative exposure levels.

Topics

Medical terms in this study, explained in our Lexicon: NIOSH, Occupational Exposure, Cancer Registry, Mesothelioma.

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• Incident chronic obstructive pulmonary disease associated with occupation, industry, and workplace exposures in the Health and Retirement Study — S.R. Silver, W.A. Alarcon, et al. (2021)
• The incidence of medically reported work-related ill health in the UK construction industry — S.J. Stocks, R. McNamee, et al. (2010)
• The silence: the asbestos industry and early occupational cancer research--a case study — D.E. Lilienfeld (1991)
• Proportionate mortality among construction laborers — F. Stern, P. Schulte, et al. (1995)

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