The incidence of medically reported work-related ill health in the UK construction industry

Our plain-English summary of The incidence of medically reported work-related ill health in the UK construction industry, by S.J. Stocks, R. McNamee, M. Carder, et al (Occupational and Environmental Medicine, 2010).

The study

• Authors: S.J. Stocks, R. McNamee, M. Carder, R.M. Agius
• Journal: Occupational and Environmental Medicine
• Published: 2010;67(8):574-6
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Self-reported work-related ill health (SWI) data show a high incidence of occupational ill health and a high burden of cancer attributable to occupational factors in the UK construction industry. However, there is little information on the incidence of medically reported work-related ill health (WRI) within this industry. This study aims to examine the incidence of WRI within the UK construction industry.

Method: Standardised incidence rate ratios (SRRs) were used to compare incidence rates of reports of medically certified work-related ill health returned to The Health and Occupation Reporting network (THOR) within the UK construction industry with all other UK industries combined.

Results: Male UK construction industry workers aged under 65 years had significantly raised SRRs for respiratory (3.8, 95% CI 3.5 to 4.2), skin (1.6, 1.4 to 1.8) and musculoskeletal disorders (MSD; 1.9, 1.6 to 2.2). These SRRs were further raised for those working within a construction trade. The increased SRRs for skin disease within male construction industry workers were due to contact dermatitis (1.4, 1.2 to 1.6) and neoplasia (4.2, 3.3 to 5.3). For respiratory disease, the increased SRRs were due to non-malignant pleural disease (7.1, 6.3 to 8.1), mesothelioma (7.1, 6.0 to 8.3), lung cancer (5.4, 3.2 to 8.9) and pneumoconiosis (5.5, 3.7 to 8.0), but the SRRs for asthma (0.09, 0.06 to 0.11) and mental ill health (0.3, 0.1 to 0.4) were significantly reduced.

Conclusion: The significantly raised SRRs for medically reported MSD and significantly reduced SRRs for mental ill health in construction workers confirm self-reported UK data. These SRRs provide a baseline of the incidence of WRI in the UK construction industry from which to monitor the effects of changes in policy or exposures.

In plain English

This report analysed work-related ill health reported from 2002 to 2008 by specialist doctors to THOR, a voluntary UK surveillance scheme. Of 28 068 actual case reports, 3845 came from the construction industry. Men in construction were compared with all other employment sectors combined, as few reports involved women. For men aged 65 or under in the construction industry, the standardised incidence rate ratio was 7.1 (95% CI 6.3 to 8.1) for non-malignant pleural disease, 7.1 (6.0 to 8.3) for mesothelioma, 5.4 (3.2 to 8.9) for lung cancer and 5.5 (3.7 to 8.0) for pneumoconiosis. Ratios were higher for men in construction trades, for example 9.0 (7.6 to 10.6) for mesothelioma. Reporting doctors named asbestos as the suspected cause in 1661 of 1739 respiratory disease reports from the construction industry. Ratios for reported skin and musculoskeletal disorders were also raised. Those for reported work-related asthma and mental ill health were significantly lower. The authors concluded the figures give a baseline for monitoring changes in policy or exposures. They noted that variance in the denominator, and whether reporting doctors were representative, were not considered.

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: Short report analysing surveillance data. It calculated standardised incidence rate ratios (and, for men over 65, rate ratios) from reports to the voluntary THOR scheme, comparing construction with all other employment sectors combined.
• Who was studied: Cases of work-related ill health reported to THOR in the UK from 2002 to 2008 by respiratory physicians, dermatologists, rheumatologists and psychiatrists. Over 2000 physicians returned 28 068 actual case reports: 3845 (14%) were in the construction industry and 5538 (20%) in construction trades. Results were presented for males only. Labour Force Survey 2005 data were used as denominators.
• Exposure: Employment in the UK construction industry (Standard Industrial Classification code 45), or in construction trades. The trades were selected Standard Occupation Classification codes such as welders, pipe fitters, bricklayers, roofers, plumbers, carpenters, plasterers, scaffolders and labourers. Asbestos was the suspected cause named in most respiratory reports. No fiber types were specified.
• Main results:
  • For male construction industry workers aged 65 or under, the standardised incidence rate ratio for reported all respiratory illness was raised, at 3.8 (95% CI 3.5 to 4.2).
  • For non-malignant pleural disease, the ratio was 7.1 (6.3 to 8.1) for male construction industry workers aged 65 or under and 13.3 (11.8 to 15.0) for men in construction trades aged 65 or under.
  • For mesothelioma, male construction industry workers had a ratio of 7.1 (6.0 to 8.3) at 65 or under and a rate ratio of 5.0 (4.4 to 5.7) over 65. For men in construction trades, the figures were 9.0 (7.6 to 10.6) at 65 or under and 11.8 (10.4 to 13.3) over 65.
  • For lung cancer, the ratio was 5.4 (3.2 to 8.9) for male construction industry workers aged 65 or under and 9.1 (5.7 to 14.5) for men in construction trades aged 65 or under.
  • For pneumoconiosis, the ratio was 5.5 (3.7 to 8.0) for male construction industry workers aged 65 or under.
  • Within the construction industry, asbestos was specified as the suspected causal exposure in 1661 of 1739 (96%) actual reports of respiratory disease.
  • For male construction industry workers aged 65 or under, the ratios for reported work-related asthma, 0.09 (0.06 to 0.11), and mental ill health, 0.3 (0.1 to 0.4), were significantly reduced compared with all other sectors.
  • For male construction industry workers aged 65 or under, the ratios for reported skin disease, 1.6 (1.4 to 1.8), and musculoskeletal disorders, 1.9 (1.6 to 2.2), were raised. The ratio for skin neoplasia was 4.2 (3.3 to 5.3).
• The authors' conclusion: The authors concluded that the raised ratios for musculoskeletal disorders and the reduced ratios for mental ill health confirm UK self-reported data. They also concluded that the ratios provide a baseline from which to monitor the effects of changes in policy or exposures.
• Limitations the authors state:
  • Variance in the denominator could not be taken into account.
  • Possible bias was not considered, whether from differences in occupational group size estimates or from THOR reporters not being representative of all eligible physicians.
  • For those over 65, the denominators counted working people only, although many reports come from retired workers. Because the assumption behind this may be questionable, results were calculated separately for those under and over 65.
  • Reports with missing age or gender data were excluded. They were a small proportion of the data.
  • The low rate of mental ill health may partly reflect psychiatrists seeing only the more serious cases.

Topics

Medical terms in this study, explained in our Lexicon: Incidence, Mesothelioma, Lung Cancer, Pneumoconiosis.

Related studies

• Medically reported work-related ill-health in the UK agricultural sector — S.J. Stocks, S. Turner, et al. (2010)
• Occupation and work-related ill-health in UK construction workers — S.J. Stocks, S. Turner, et al. (2011)
• Chest physician-reported, work-related, long-latency respiratory disease in Great Britain — M. Carder, A. Darnton, et al. (2017)
• Job tasks, potential exposures, and health risks of laborers employed in the construction industry — G. Burkhart, P.A. Schulte, et al. (1993)
• Protest and survive, the U.K. Construction Safety Campaign: a case study of workers' and victims' family action and legal and regulatory inaction on construction health and safety — M. Holder, T. O'Brien (2007)
• Work-related respiratory health conditions among construction workers: a systematic narrative review — E.F. Boadu, S.R. Okeke, et al. (2023)

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