Keywords

1 Introduction

The construction industry is related to the mining industry, i.e., in extracting sand and stones as aggregates and subjecting workers to exposure to mixed dust (Agioutanti et al. 2020; Sauvé 2015). Several authors mention pneumoconiosis originated from occupational exposure to dust and fibres as one of the work-related diseases in the construction industry (Stocks et al. 2011; Sauvé 2015; Cummings et al. 2019; Bell and Mazurek 2020). These dusts, derived from different minerals such as silica and asbestos, are suspended in the air, resulting in diseases such as silicosis and asbestosis (Stocks et al. 2011; Nelson et al. 2011; Sauvé 2015; Nicol et al. 2015; Walters et al. 2018). Also the mineral nanoparticles are very toxic. They enter the body and can affect several vital mechanisms through blood circulation (Ophir et al. 2019; Bajpayee et al. 2004). In a comparative study on pneumoconiosis between China, Australia, and the United States, it was observed that China lags in studying health concerning safety. This lag is due to companies’ emphasis on eliminating work accidents with visible consequences rather than invisible causes such as pneumoconiosis diseases (Han et al. 2018). Between 2001 and 2016 in the United Kingdom, in the Birmingham region, Occupational Lung Disease Services (OLDS) conducted a study to assess the prevalence of pneumoconiosis from asbestos in various industries. There were 160 cases found, of which 71 (44%) were from the construction industry (Walters et al. 2018). Due to the long incubation period, patients with asbestosis were detected only after working in construction for 25, 30 or 40 years (Philteos et al. 2004). However, exposure to silica, asbestos, and mixed dust, forces companies to have greater attention to mitigating health effects considered incurable and characteristics suggestive of asbestosis disease that can impair worker performance, such as oxidative stress, fibrotic degeneration of lung tissue, complexation iron, apoptosis, and inflammation (Chong et al. 2006; Perret et al. 2017; Schmajuk et al. 2019). Likewise, asbestos, silica, and mixed dust were considered risk factors for pneumoconiosis in a study about Global Burden diseases (GBD 2016) and Risk Factors Collaborators (RFC 2016). The WHO/ILO (World Health Organization/International Labour Organization) in 2018 presented a systematical review protocol that designed quantitative studies on the prevalence of pneumoconiosis attributed to risk factors. This study was about the chemical agents (asbestos, silica, and mixed dust) from 1960 to 2018 among the working-age population and disaggregated by country, sex, age, and industrial sector occupation, including the construction industry (Mandrioli et al. 2018; Hall et al. 2020; Kurth et al. 2020; Dhatrak and Nandi 2020).

To investigate pneumoconiosis, it is necessary to consider confounding factors in the manifestation of the disease, such as age, sex, biomass, smoking, tuberculosis, socioeconomic status, pathological conditions and type of work (Han et al. 2017). In addition, the permissible exposure limit (PEL) for free silica was established to prevent the development of the disease. Several studies noted significant differences (Liu et al. 2017). Some of them were set by OSHA and ACGIH (Linch 2002; Dhatrak and Nandi 2020). For identifying pneumoconiosis, an exposure questionnaire (Ben Saad et al. 2013), spirometry tests (Prasad et al. 2020; Quanjer et al. 2012) and chest X-rays were also suggested to check rounded or irregular opacities, especially in the upper and lower lung fields (Han et al. 2018; Baur 2020; Dhatrak and Nandi 2020). Other authors suggest post-mortem pathophysiological diagnoses of lung tissue (Naidoo et al. 2005; Ndlovu et al. 2016).

This review focuses on pneumoconiosis resulting from exposure to workplace chemical agents such as silica, asbestos, and mixed dust. Some studies which have been visited recognise that silica, asbestos, and mixed dust are risk factors for pneumoconiosis in the construction industry. So, the present systematic literature review (SLR) intends to answer the following questions:

To what extent does the prevalence of pneumoconiosis contribute to illness in civil construction between 2001 and 2021?

Which chemical agent has the greatest weight in the prevalence of pneumoconiosis?

2 Materials and Methods

The research used the PRISMA Statement (Page et al. 2021). The information to compose the research was extracted from six electronic academic databases: Scopus; Ovid Medline with Daily Update; OSH update; Web of Science; EMBASE; and PubMed. Cited references were extracted using keywords related to the topic. A checklist was created to facilitate the analysis of the results, considering the following items: the authors’ surnames and publication year, prevalence of pneumoconiosis, exposure to chemical agents, i.e., exposure to silica, asbestos and/or mixed dust, and the disease(s) derived from chemical agents. After selecting the articles related to the construction industry, the authors included pneumoconiosis papers related to other sectors, such as mining, to compare data and results.

2.1 Search Strategy

The strategy used in data extraction was based on a 20-year time horizon (2001–2021). “Data were extracted from works published between January 2001 and December 2021,” taking into account title contents, abstracts, and keywords of all articles retrieved from the six databases. The following keywords have been considered, using the booleans “OR” and “AND”: [(construction AND asbestos); OR (construction AND silica) OR (asbestos AND mixed dust)]; [(concrete AND asbestos) OR (silica AND mixed dust)]; [(occupational lung disease AND construction)]; [(permissible exposure limit AND silica) OR (construction industry AND mixed dust)]; [(pneumoconiosis AND construction)]; [(abrasive blasting AND silicosis) OR (pneumoconiosis AND asbestosis)]; [(pneumoconiosis AND spirometry)]; [(chest r-x AND pneumoconiosis) OR (asbestos AND mixed dust)]; (construction AND accidents); (pneumoconiosis AND accidents). The asterisk symbol was used to ensure that all possible variations of the terms were considered.

Data were extracted using a standard form developed in Excel to organise and compare information from the articles.

To be included/excluded in this review, studies had to meet the following criteria: experimental random or observational analytical studies focused on pneumoconiosis prevalence caused by silica, asbestos, and mixed dust in the construction industry or related activities with measurements (similar tasks of mining has been included). In addition, the articles need to have available full text and be written in English.

2.2 Data Analyses

The absolute frequencies of diseases in the included studies associated with exposure to at least one of the chemical agents (silica, asbestos and mixed dust) as well as the associated risk factor were sought.

The determination of the absolute and relative frequencies and the verification of the level of prevalence, in percentage, was through the following equation:

$$ {\text{fr}} = {\text{fi}}/{\text{N}} \times 100\% $$

where:

  • fi—(absolute frequency) shows how many times the disease appeared for each article reviewed according to its risk factor;

  • N—refers to the total number of diseases associated with a risk factor;

  • fr—(relative frequency) shows the impact number converted into a percentage.

3 Results

3.1 Study Selection and Characteristics

A comprehensive selection of studies was carried out in this systematic review, using the six databases and observing the inclusion/exclusion criteria referred to in the methodology. A total of 1823 records were screened, 1357 of which were removed because they were duplicates, incomplete, not peer-reviewed, not published in scientific journals, or off-topic. Were screened 466 articles having these been removed 440 because they did not correspond to the period under study (2001–2021), had contradictory objectives, or were not written in English. There were found 26 articles considered eligible (Fig. 1). The extracted information is summarised in Table 1.

Fig. 1
figure 1

Study screening diagram (Page et al. 2021)

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Table 1 Characteristics related to pneumoconiosis occurrence from exposure to silica, asbestos, and mixed dust
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3.2 Distribution of Diseases According to Exposure Agent

The construction industry involves a wide range of activities, such as stone-breaking, concrete or brick cutting, pipe cutting, abrasive blasting, and tunnelling (Wang and Meng 2018). Exposure to crystalline silica, asbestos and mixed dust (risk factor) develops silicosis and asbestosis. Mixed dust is a blend of minerals, and it has the potential to cause pneumoconiosis (Nelson et al. 2010). A statistical analysis has been performed with the compiled data from items and characteristics described in Table 2. Moreover, diseases associated with different risk factors can be identified. Note that a disease may be associated with more than one risk factor.

Table 2 Absolute and relative frequencies of risk factors and diseases
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The comparison of prevalence was represented by the absolute and relative frequencies of each type of disease caused by the three chemical agents: silica, asbestos and mixed dust.

Regarding the global analysis of the disease distribution in relation to pneumoconiosis, is noted: silica (37.5%), asbestos (21.4%), and mixed dust (41.1%). Obtained through the relative frequencies of the diseases of each agent divided by the total occurrence of the diseases (56%).

Analysing the occurrence of individualised diseases in relation to their risk agent, the following higher frequencies are noted: silica for (Silicosis 38.1%); asbestos for (asbestosis and lung cancer 33.3%), and mix dust for (lung cancer 21.7%) Table 2.

3.3 Permissible Exposure Limit

The literature review shows the need to establish an exposure limit value, given the risk factors for pneumoconiosis in the mining and construction industries (Hall et al. 2020). Despite the effort involving several organisations that deal with workers’ health, there has been no consensus on standardising exposure values.

Whether due to the continuous exposure to risk factors or too high values of the Permissible Exposure Limit (PEL) (Liu et al. 2017), there are differences in standard levels of silica compared to those recommended by Occupational Safety and Health (OSH) and international organisations in several countries, (Linch 2002; Dhatrak and Nandi 2020) (Fig. 3). The two values corresponding to the United States belong to NIOSH (0.05 mg/m3) and MSHA (0.10 mg/m3). China values vary according to the type of ore, from 0.07 to 0.35 mg/m3. There is currently a difference in exposure values in countries such as India, France, and Portugal, contributing to the prevalence of diseases related to pneumoconiosis, Fig. 2.

Fig. 2
figure 2

Permissible exposure limit depending on the country (Linch 2002)

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4 Discussion

The prevalence of pneumoconiosis in the construction industry has been studied since the last century (Linch 2002; Higgins et al. 2011; Sauvé 2015; Mandrioli et al. 2018; FCL 2021). In addition, there were studies on asbestos, silica, and mixed dust considered the risk factor for occupational pneumoconiosis, responsible for 100% of this disease (GBD 2016; RFC 2016). Review shows that exposure to chemical agents (silica, asbestos, and mixed dust) are responsible for diseases such as; Silicosis, asbestosis, lung cancer, chronic pulmonary obstructive diseases, moderate to marked emphysema, mixed dust pneumoconiosis, unknown pneumoconiosis, pulmonary tuberculosis, and progressive massive fibrosis (PMF) Tables 1 and 2. These diseases are associated with causes of pneumoconiosis morbidity and mortality in the construction industry due to dust and fibres (Stocks et al. 2011; Agioutanti et al. 2020).

Based on the global review analyse, Table 2, it is noted that mixed dust has a higher frequency of diseases with 41.1%. This can be justified by the presence of two elements together, namely silica and asbestos, forming a compound, joining the diseases of each element (Baur 2020). Then, silica with 37.5% and asbestos with 21.7% caused a long latency fibrotic lung diseases/pneumoconiosis (Stocks et al. 2011; Walters et al. 2018), referenced in Table 2. There is a long latency period for these diseases and a lack of health care for workers in the construction industry. These two factors make employers decline their responsibility (Ndlovu et al. 2016). In pneumoconiosis, workers may have signs of pulmonary dysfunction (pneumoconiosis) 20, 30, 40 or more years after leaving the company. Few studies have shown shorter times (Philteos et al. 2004; Nicol et al. 2015). The individual analysis of the maximum frequencies of diseases related to exposure to the three chemical agents supports the prevalence of pneumoconiosis in the construction industry with the following values: silica (Silicosis 38.1%), asbestos (asbestosis and lung cancer 33.3% both); and mixed dust (lung cancer 21.7%). Although the research shows evidence of pneumoconiosis from silicosis in the mines (Bajpayee et al. 2004; Stocks et al. 2011; Dhatrak and Nandi 2020; Baur 2020), the higher values of silicosis concerning asbestos and mixed dust referred to in Table 2, can support its impact on the construction industry. Knowledge of the risk factors with the most significant impact on the work environment helps identify the causes and, consequently, implement preventive and corrective actions (Bell and Mazurek 2020).

More evidence was seen at the South African Conference on silicosis analysis over 75 years. It was found that silica still affects 19% of construction industry workers (Sauvé 2015). The presence of different levels of exposure in many countries may influence the pneumoconiosis prevalence value (Fig. 2). Exposure Limit Values are not the same in all countries, although there are international organisations that seek to establish a common value for all countries. The existence of different limits influences the value of the prevalence of pneumoconiosis (Linch 2002; Dhatrak and Nandi 2020).

Construction industry workers are subject to the use and handling of products and machines such as explosive pressure vessels, explosives and breakers, machines and loaders, mixed dust, silica and asbestos (Baur 2020; Agioutanti et al. 2020). Proposals to combat pneumoconiosis were suggested, from preventive (work education) and corrective actions, which can be added using diagnosis like exposure questionnaires, spirometry (Prasad et al. 2020), chest X-ray (Dhatrak and Nandi 2020), Computer Tomographic (CT), and Magnetic Tomography Imaging (Ben Saad et al. 2013).

5 Conclusion

After the present literature review, 26 articles were considered eligible. The research shows that the prevalence of pneumoconiosis in the construction industry is due to the raw materials containing chemical elements considered risk factors, namely silica, asbestos and mixed dust. In the global analysis of the risk factors for pneumoconiosis, it was found that mixed dust is responsible for the higher frequency of pneumoconiosis (41.1%), followed by silicosis and asbestosis with 37.5% and 21.7%, respectively. In the individual analysis of the diseases, silicosis is observed more frequently, with 38.1% associated with silica, followed by asbestosis and lung cancer with 33.3% both related to asbestos and mixed dust with lung cancer (21.7%). In conclusion, the three risk factors contribute to diseases that cause pneumoconiosis; mixed dust has the highest number of diseases, while silicosis is the most frequently associated with silica.