51. Respiratory Diseases in the Construction Industry
Occupational exposures encountered by construction workers (see page 35) can cause many kinds of lung diseases. For example, exposure to respirable crystalline silica and asbestos can lead to an interstitial lung disease that causes damage and fibrosis in lung tissue (called silicosis or asbestosis); chronic obstructive pulmonary disease (COPD), such as chronic bronchitis and emphysema; and lung cancer. Exposures in construction can also cause or exacerbate asthma. In 2015, the U.S. Bureau of Labor Statistics (BLS) reported about 500 nonfatal work-related “respiratory conditions” among the nation’s 6.5 million wage-and-salary construction workers in the private sector.1 This figure is believed to be a vast underestimation since work-relatedness of such illnesses is often difficult to establish due to long latency periods after exposure. Also, the connection between work exposures and the development of diseases like asthma is often overlooked.
Using chest x-rays to screen construction workers for interstitial lung disease, the Building Trades National Medical Screening Program (BTMed, see page 50) found that among former construction workers at U.S. Department of Energy (DOE) nuclear sites, 16.5% had an abnormal chest x-ray (chart 51a). For asbestos workers, the rate was more than double the overall average (33.7%).2
The BTMed pulmonary function test also found that nearly 40% of construction workers in the program had abnormal lung function (obstruction, restriction, or mixed conditions); the percentage was closer to 50% among truck drivers as well as brickmasons and concrete workers (chart 51b). For both chest x-rays and pulmonary function tests, workers in production (blue-collar; see Glossary) occupations had a higher prevalence of abnormalities than those employed in administrative or support positions, consistent with their exposure levels to workplace hazards (see page 35).
Construction workers who worked in former DOE nuclear facilities are also at risk of developing chronic beryllium disease (CBD), a disease that causes difficulty breathing and scarring of lung tissue. About 1.1% of construction workers included in the BTMed program had beryllium sensitivity (BeS),3 an indicator of CBD, and the percentage was nearly double for roofers (2.1%), boilermakers (1.9%), and sheet metal workers (1.9%; chart 51c). Construction workers may be exposed to beryllium from working in facilities where beryllium is manufactured or from using coal slag based abrasives as an alternative to sand in sandblasting.4
In addition to nuclear sites, respiratory hazards are common at construction worksites. Findings from the Health and Retirement Study, a large longitudinal survey on the U.S. population aged 50 years and older, showed that the proportion of respiratory cancer-related deaths for workers whose longest job was in construction trades was nearly double that for white-collar workers (14.6% versus 8.3%; chart 51d). Construction trade workers also had a higher percentage of deaths from diseases of the respiratory system than their white-collar counterparts (13.4% versus 8.9%). After adjusting for smoking and other major confounders, construction trade workers were about twice as likely to die of respiratory cancer or non-malignant respiratory diseases compared to their white-collar counterparts.5 The results suggest that the higher mortality rates among construction trade workers may be attributed to their long-term occupational exposure.5
Other studies on construction workers also confirm that exposure to vapors, gases, dusts, and fumes decreases workers’ lung function and increases prevalence of COPD and respiratory cancer.6-8 In a study of sheet metal workers, higher exposure to respiratory hazards such as dusts and fumes was associated with a higher prevalence of COPD.8 Prevalence of COPD was also higher among workers frequently exposed to asbestos, concrete dusts, mold, man-made fibers, and paints.8 Moreover, such work exposures can be exacerbated by smoking (see page 55). Therefore, workers’ respiratory health can be improved by both work exposure controls and smoking cessation interventions.
In addition to physical suffering, the annual costs of COPD to the nation from medical bills and absenteeism alone were $36 billion in 2010, and are expected to reach $49 billion by 2020.9 Reducing occupational exposures and respiratory diseases among construction workers would not only benefit the workers themselves, but also employers, society, and the nation (see page 35).
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Production workers – In this chart book, production workers are the same as blue-collar workers. From the Current Population Survey: all workers, except managerial, professional (architects, accountants, lawyers, etc.), and administrative support staff. Production workers can be either wage-and-salary or self-employed workers.
1. U.S. Bureau of Labor Statistics. Survey of Occupational Injuries and Illnesses. Table SNR10. Number of nonfatal occupational illnesses by industry and category of illness, 2015, https://www.bls.gov/iif/oshwc/osh/os/ostb4745.pdf (Accessed December 2017).
2. An abnormal chest x-ray was defined as parenchymal or pleural changes consistent with pneumoconiosis by criteria established by the International Labor Organization.
3. BeS is diagnosed by either two positive tests or a single positive test and a borderline test.
4. Occupational Safety and Health Administration. Final rule to protect workers from beryllium exposure, https://www.osha.gov/berylliumrule/index.html (Accessed November 2017).
5. Wang X, Dong X, Welch L, Largay J. 2016. Respiratory cancer and non-malignant respiratory disease-related mortality among older construction workers. Occupational Medicine and Health Affairs, 4: 235.
6. Borup H, Kirkeskov L, Hanskov D, Brauer C. 2017. Systematic review: Chronic obstructive pulmonary disease and construction workers. Occupational Medicine, 67(3): 199-204.
7. Dement J, Welch L, Ringen K, Cranford K, Quinn P. 2017. Longitudinal decline in lung function among older construction workers. Occupational and Environmental Medicine, 74(10):701-708.
8. Dement J, Welch L, West G. 2014. Airways obstruction among sheet metal workers participating in a respiratory screening program. CPWR Small Study Final Report, /publications/airways-obstruction-among-sheet-metal-workers-participating-respiratory-screening (Accessed August 2017).
9. Ford E, Murphy L, Khavjou O, Giles W, Holt J, Croft J. 2015. Total and state-specific medical and absenteeism costs of COPD among adults aged ≥ 18 years in the United States for 2010 and projections through 2020. Chest, 147(1): 31-45.
Chart 51d – Longest occupation refers to the respondent’s longest-held job reported to the Health and Retirement Study. Other blue-collar refers to production workers in non-construction trade occupations.
Charts 51a-51c – BTMed disease prevalence: Exams completed through March 2017. Contact: John Dement, Duke University Medical Center.
Chart 51d – Wang X, Dong X, Welch L, Largay J. 2016. Respiratory cancer and non-malignant respiratory disease-related mortality among older construction workers. Occupational Medicine and Health Affairs, 4: 235.