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Chart Book (6th edition): Health Indicators and Services - Health Risk Factors and Chronic Illnesses among Construction Workers

55. Health Risk Factors and Chronic Illnesses among Construction Workers

Cigarette smoking, obesity, diabetes, and hypertension (high blood pressure) pose major risks to health.1 Each of these factors may lead to serious health consequences and contribute separately or jointly to premature death.1-3

Although the prevalence of smoking in the U.S. has declined steadily over the past four decades, cigarette and tobacco use is still widespread in the construction industry. In 2015, nearly 24% of workers in the construction industry were current smokers, compared to about 15% of workers in all industries (chart 55a). Smoking is more common in some construction occupations. About 42% of workers in heating and air conditioning mechanic occupations reported that they were current smokers in 2015, higher than any other occupation in construction (chart 55b). However, the prevalence may not represent the entire construction workforce in the nation since just 25 states were included in the estimates. The risk of chronic lung disease and cancer among construction workers who smoke is magnified by exposure to occupational hazards, such as welding dust, silica, and asbestos3-5 (see pages 34 and 51). Overall, cigarette smoking causes about one of every five deaths in the United States, and is responsible for 90% of all lung cancer deaths and 80% of deaths due to chronic obstructive pulmonary disease (COPD).3

Obesity has been linked to stroke, diabetes, and several other chronic conditions that are common causes of preventable death.1,2,6-7 The prevalence of obesity among U.S. workers, measured by body mass index (BMI, see Glossary), jumped nearly 50%, from 21% in 2000 to 30% in 2015 (chart 55c). The percentage among construction workers fluctuated, but increased generally during this period, reaching 34% in 2015. Among construction workers aged 35-54 years, 79% were either overweight or obese, compared to 69% of workers in all industries in the same age group (chart 55d). A healthy weight can be reached through a nutritious diet and healthy lifestyle. Even modest weight loss is likely to produce health benefits, such as improvements in insulin sensitivity and reduced inflammation .7

Diabetes is a growing epidemic with a devastating physical, emotional, and financial burden to the nation.8 In 2015, 30.3 million American adults had diabetes, accounting for over 9% of the population. Of these, 7.2 million were undiagnosed.9 Following this trend, nearly 10% of construction workers had been diagnosed with diabetes in 2015, and the percentage was double (19%) among those aged 55 years and older (chart 55e). When left untreated, diabetes can lead to heart disease, as well as other complications such as kidney disease, nerve damage, and death. However, diabetes is preventable or treatable through lifestyle changes such as healthy eating and exercise.8

Hypertension is a heart disease risk factor. In 2015, 32% of construction workers had been diagnosed with hypertension, and 9% had a heart condition (see Glossary; chart 55f). Among construction workers aged 55 years and over, 53% had hypertension and 16% had a heart condition. Compared to the average of all industries, the higher prevalence of heart conditions in construction (9% versus 8%) is notable, considering that the high physical demands of construction work (see pages 32 and 33) may have already driven workers with such conditions to leave the industry (known as the healthy worker effect). These numbers may be underestimated since such conditions do not always exhibit obvious symptoms, and workers may be unaware that they have this risk.8 Uncontrolled hypertension can damage blood vessels and lead to a heart attack, stroke, or other health complications over time.8

Controlling these risk factors is essential to improving the overall health of construction workers given that these workers are greatly exposed to occupational hazards (see pages 32-36) in special working environments (see pages 2, 20-22, and 26-28). To promote the overall health of workers, the National Institute for Occupational Safety and Health (NIOSH) has encouraged integrating safety and health interventions and other well-being activities in the workplace through the Total Worker Health™ program.10


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Body Mass Index (BMI) – From the National Health Interview Survey: a measure of body weight relative to height. It is calculated as weight in kilograms divided by height in meters squared. Healthy weight for adults is defined as a BMI of 18.5 to less than 25; overweight as greater than or equal to a BMI of 25; obesity as greater than or equal to a BMI of 30.

Heart condition – From the National Health Interview Survey: The respondents were asked, “Have you EVER been told by a doctor or other health professional that you had...any kind of heart condition or heart disease


1. Centers for Disease Control and Prevention. Heart disease risk factors, (Accessed January 2018).

2. Saltiel A, Olefsky J. 2017. Inflammatory mechanisms linking obesity and metabolic disease. Journal of Clinical Investigation, 127(1): 1-4.

3. Centers for Disease Control and Prevention. Health effects of cigarette smoking, (Accessed July 2017).

4. Tan E, Fishwick D, Pronk A, Drossard C, Ludeke A, Bochmann F, Schlunssen V, Hansen J, Sigsgaard T, Ostrem R, Eduard W, Bugge M, Warren N. 2016. The avoidable future burden of COPD due to occupational respirable crystalline silica exposure in the EU. Occupational and Environmental Medicine, 73(1), 74-75.

5. Graber J, Delnevo C, Manderski M, Wackowski O, Rose C, Ahluwalia J, Cohen R. 2016. Cigarettes, smokeless tobacco, and poly-tobacco among workers in three dusty industries. Journal of Occupational & Environmental Medicine, 58(5): 477-484.

6. Centers for Disease Control and Prevention. Adult obesity facts, (Accessed July 2017).

7. Magkos F, Fraterrigo G, Yoshino J, Luecking C, Kirbach K, Kelly S, Fuentes L, He S, Okunade A, Patterson B, Klein S. 2016. Effects of moderate and subsequent progressive weight loss on metabolic function and adipose tissue biology in humans with obesity. Cell Metabolism, 23(4): 591-601.

8. American Heart Association, Conditions, (Accessed January 2018).

9. American Diabetes Association, Statistics about diabetes, (Accessed November 2017).

10. The National Institute for Occupational Safety and Health. Total Worker Health, (Accessed November 2017).



All charts – Data cover all employment.

Chart 55b – The following states are included in the tabulation: Colorado, Connecticut, Florida, Georgia, Idaho, Illinois, Iowa, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Tennessee, Utah, Washington, West Virginia, and Wisconsin.

An asterisk (*) indicates that estimates should be used with caution as the sample sizes are small and they do not meet standards of reliability/precision.

Charts 55c and 55d – A body mass index (BMI) between 25 and 29.9 is considered overweight, and a BMI of 30 or higher is considered obese. See Glossary for a full description of BMI or go to for more information (Accessed July 2017).



Charts 55a and 55c – National Center for Health Statistics. 2000-2015 National Health Interview Survey. Calculations by the CPWR Data Center.

Chart 55b – 2015 Behavioral Risk Factor Surveillance System (25 states), National Institute for Occupational Safety and Health, unpublished data (November 2017). Contact: Winifred Boal,

Charts 55d, 55e, and 55f – National Center for Health Statistics. 2015 National Health Interview Survey. Calculations by the CPWR Data Center.


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