How much have adverse occupational health outcomes among construction workers improved over time? Evidence from 25 years of medical screening

Am J Ind Med. 2023 Jan;66(1):18-29. doi: 10.1002/ajim.23445. Epub 2022 Nov 17.


Background: Construction workers have always had a high risk of occupational illnesses. We used 25 years of data from a medical screening program serving older construction workers to determine how much health outcomes have improved over the past 60 years.

Methods: We investigated changes in relative risk for chest radiographs consistent with pneumoconiosis, COPD by spirometry, lung cancer mortality, and audiometry-assessed hearing impairment among workers participating in a medical screening program. Results were stratified by decade of first construction employment: before 1960, 1960-1969, 1970-1979, 1980-1989, and after 1990. Poisson and Cox regression analyses assessed relative risk by decade adjusted for age, sex, smoking, and years of construction trade work.

Results: Subjects were 94% male and, on average, 60 years old with 25 years of construction work. When compared to workers employed before 1960, those first employed after 1990 experienced the following reductions in model-adjusted relative risks: chronic obstructive pulmonary disease, 32%; all pneumoconiosis, 68%; parenchymal abnormalities, 35%; pleural abnormalities, 71%; hearing impairment, 20%; and lung cancer mortality, 48%. Risks started to decline in the 1960s with greatest reductions among workers first employed after 1970.

Conclusions: This study demonstrates the positive impact that adoption of occupational health protections have had over the past 60 years. The greatest risk reductions were observed for outcomes with strong regulatory and legal incentives to reduce exposures and associated risks, such as those associated with inhalation hazards (asbestos and silica), while lowest improvement was for hearing impairment, for which little regulatory enforcement and few prevention incentives have been adopted.

Keywords: BTMed; COPD; DOE; construction trades; hearing impairment; lung cancer; parenchymal changes; pneumoconiosis; surveillance.

MeSH terms

  • Construction Industry*
  • Female
  • Hearing Loss*
  • Humans
  • Lung Neoplasms*
  • Male
  • Middle Aged
  • Occupational Diseases* / epidemiology
  • Occupational Diseases* / etiology
  • Occupational Exposure* / adverse effects
  • Occupational Health*
  • Pneumoconiosis* / epidemiology
  • Pulmonary Disease, Chronic Obstructive*
  • Risk Factors