Work-related respiratory health conditions among construction workers: a systematic narrative review

Our plain-English summary of Work-related respiratory health conditions among construction workers: a systematic narrative review, by E.F. Boadu, S.R. Okeke, C. Boadi, et al (BMJ Open Respiratory Research, 2023).

The study

• Authors: E.F. Boadu, S.R. Okeke, C. Boadi, E. Osei Bonsu, I.Y. Addo
• Journal: BMJ Open Respiratory Research
• Published: 2023;10(1)
• Type of article: Systematic review
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Emerging evidence in both developed and developing countries indicate that occupational health hazards and diseases among construction workers constitute a significant public health challenge. While occupational health hazards and conditions in the construction sector are diverse, a burgeoning body of knowledge is emerging about respiratory health hazards and diseases. Yet, there is a notable gap in the existing literature in terms of comprehensive syntheses of the available evidence on this topic. In light of this research gap, this study systematically reviewed the global evidence on occupational health hazards and related respiratory health conditions among construction workers.

Methods: Using meta-aggregation, guided by the Condition (respiratory health conditions), Context (construction industry) and Population (construction workers) (CoCoPop) framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, literature searches were conducted on Scopus, PubMed, Web of Science and Google Scholar for relevant studies on respiratory health conditions affecting construction workers. Four eligibility criteria were used in scrutinising studies for inclusion. The quality of the included studies was assessed based on Joanna Briggs Institute's Critical Appraisal tool, while the reporting of the results was guided by the Synthesis Without Meta-analysis guidelines.

Results: From an initial pool of 256 studies from the various databases, 25 studies published between 2012 and October 2022 were identified as meeting the inclusion criteria. In all, 16 respiratory health conditions were identified, with cough (ie, dry and with phlegm), dyspnoea/breathlessness and asthma emerging as the top three respiratory conditions among construction workers. The study identified six overarching themes of hazards that are associated with respiratory health conditions among construction workers. These hazards include exposure to dust, respirable crystalline silica, fumes, vapours, asbestos fibres and gases. Smoking and extended period of exposure to the respiratory hazard were found to increase the risk of contracting respiratory diseases.

Conclusions: Our systematic review indicates that construction workers are exposed to hazards and conditions that have adverse effects on their health and well-being. Given the considerable impact that work-related health hazards can have on the health and socioeconomic well-being of construction workers, we suggest that the implementation of a comprehensive occupational health programme is essential. Such a programme would extend beyond the mere provision of personal protective equipment and would incorporate a range of proactive measures aimed at controlling the hazards and mitigating the risk of exposure to the occupational health hazards.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

In plain English

This was a systematic narrative review of published research on work-related breathing problems among construction workers. The authors searched Scopus, Web of Science, PubMed and Google Scholar for English-language studies from 2012 to 2022. They included 25 studies covering at least 1 684 516 construction workers in 15 countries, and they summarised the findings in words rather than combining them statistically. Across the studies they found 16 respiratory conditions. Cough, breathlessness and asthma were reported most often; cancers were reported in 4 studies and silicosis in 3. Dust was the hazard named most often (15 studies), followed by respirable crystalline silica (8 studies). Asbestos fibres were named in 2 studies, and the review gave no separate findings for asbestos. Included studies reported that smoking and reluctance to use protective equipment increased the risk of respiratory disease, and that longer exposure was linked to more respiratory conditions. The authors concluded that these hazards are associated with problems ranging from mild symptoms to respiratory cancers and silicosis. Among the limitations they noted were the English-only search, small and cross-sectional included studies, and varied outcomes that prevented linking specific hazards to specific conditions.

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: Systematic narrative review (meta-aggregation, no statistical pooling) of studies published 2012 to 2022
• Who was studied: 25 included studies covering at least 1 684 516 construction workers in 15 countries, most often the USA (6 studies) and India (6 studies); searches covered studies from 2012 to 2022
• Exposure: Construction hazards grouped into six themes: dust, respirable crystalline silica, fumes (asphalt, exhaust, welding), vapours, asbestos fibres and gases
• Main results:
  • 16 specific respiratory conditions were identified across the included studies
  • The most frequently identified conditions were cough (13 studies in the text), dyspnoea/breathlessness (7 studies) and asthma (6 studies)
  • Severe or chronic diseases reported: cancers in 4 studies, silicosis in 3 studies, lung impairment and fibrosis in 3 studies
  • Dust was the hazard identified most often (15 studies), followed by respirable crystalline silica (8 studies)
  • Asbestos fibres were identified as a hazard in 2 of the included studies (Table 3)
  • Included studies reported that smoking and reluctance to use personal protective equipment increased the risk of respiratory disease among construction workers
  • In one included study (Mandal and Dutta), odds ratios for respiratory disorder among workers with more than 10 years of exposure to bitumen fumes ranged from 2 to 4.5
  • In the quality appraisal, 11 of the 25 included studies either did not identify confounding factors or identified them unclearly
• The authors' conclusion: The authors concluded that construction hazards are associated with health problems ranging from mild respiratory conditions to respiratory cancers and silicosis. They advocated an occupational health programme that goes beyond the tokenistic use of personal protective equipment.
• Limitations the authors state:
  • The search was limited to four databases, so the findings may be subject to indexing, publication and reporting bias
  • Only English-language studies were included, which may have caused selection bias
  • Only research articles published online were included
  • Some included studies had small samples and cross-sectional designs, so results cannot easily be generalised
  • Variety in outcomes and exposures prevented determining specific relationships between conditions and hazards

Topics

The National Library of Medicine indexes this study under subjects our site covers: Construction.

Medical terms in this study, explained in our Lexicon: Systematic Review, Meta-Analysis, Crystalline.

Related studies

• Occupation and work-related ill-health in UK construction workers — S.J. Stocks, S. Turner, et al. (2011)
• Work-related respiratory disease in the United Kingdom, 1989-1992: report on the SWORD project — S.K. Meredith, J.C. McDonald (1994)
• Occupational and work-related respiratory disease attributed to cleaning products — M. Carder, M.J. Seed, et al. (2019)
• SWORD '93. Surveillance of work-related and occupational respiratory disease in the UK — B.A. Sallie, D.J. Ross, et al. (1994)
• SWORD '97: surveillance of work-related and occupational respiratory disease in the UK — D.J. Ross, H.L. Keynes, et al. (1998)
• The incidence of medically reported work-related ill health in the UK construction industry — S.J. Stocks, R. McNamee, et al. (2010)

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