|Year : 2021 | Volume
| Issue : 1 | Page : 22-26
An analytical cross-sectional study to compare pulmonary function and respiratory morbidity-related quality of life between construction workers with age-and gender-matched controls
Praveen K Chittaluru1, Raj K Korra2, Vinay K Asuri3, Pratyusha Annakula1, G M M Reddy1
1 Department of Pulmonary Medicine, Chalmeda Anandarao Institute of Medical Sciences, Karimnagar, Telangana, India
2 BDS Consultant Clinician
3 Chief Epidemiologist, Evidencian Research Associates
|Date of Submission||17-Apr-2020|
|Date of Decision||25-Jun-2020|
|Date of Acceptance||29-Jun-2020|
|Date of Web Publication||26-Apr-2021|
Dr. Raj K Korra
Department of Pulmonary Medicine, Chalmeda Ananadarao Institute of Medical Sciences (CAIMS), Karimnagar - 505 001, Telangana
Source of Support: None, Conflict of Interest: None
Context: Respiratory morbidity among construction workers is one of the most neglected occupational diseases, in spite of the high risk. Aims: The aim of this study is to compare the respiratory symptoms, pulmonary function, and respiratory morbidity-related quality of life between people working in construction sites and the age- and gender-matched controls. Settings and Design: It is an analytical cross-sectional study. Methods and Material: People working in the construction sites (mason/daily laborer) for at least 5 years and control group working in other occupations were included. People other than mason/daily laborer and people with a past history of COPD/bronchial asthma before joining the construction industry were excluded. Statistical Analysis Used: Pulmonary function test was done and St. George respiratory questionnaire was used to the quality of life. Unpaired t-test and Chi-square test/Fisher's exact test were used to compare numeric outcomes and categorical outcomes respectively. Results: We have included 120 construction workers and 120 age- and gender-matched controls. The Forced Vital Capacity (FVC) (mean difference [MD] 0.20, 95% CI 0.025–0.381, P value 0.025), FEV1 (MD 0.21, 95% CI 0.061–0.364, P value 0.006), and FEV1\FVC% predicted (MD 5.01, 95% CI 1.11–8.92, P value 0.012) were significantly lower among the construction workers. The overall SGRQ score was also significantly higher among the construction workers indicating poor overall respiratory morbidity-related quality of life (MD 12.69, 95% CI 10.59–14.80, P value <0.001). Conclusions: Pulmonary function and respiratory function-related quality of life are considerably poor among people working in the construction industry.
Keywords: Construction worker, pulmonary function test, quality of life, St. George respiratory questionnaire
|How to cite this article:|
Chittaluru PK, Korra RK, Asuri VK, Annakula P, Reddy G M. An analytical cross-sectional study to compare pulmonary function and respiratory morbidity-related quality of life between construction workers with age-and gender-matched controls. Indian J Occup Environ Med 2021;25:22-6
|How to cite this URL:|
Chittaluru PK, Korra RK, Asuri VK, Annakula P, Reddy G M. An analytical cross-sectional study to compare pulmonary function and respiratory morbidity-related quality of life between construction workers with age-and gender-matched controls. Indian J Occup Environ Med [serial online] 2021 [cited 2021 Jun 20];25:22-6. Available from: https://www.ijoem.com/text.asp?2021/25/1/22/314648
| Introduction|| |
Occupational exposure can lead to a wide range of lung diseases, affecting the airways, interstitial lung diseases, or even malignancies. Occupational lung diseases are one of the most neglected conditions across the globe. This is more so in cases of highly populated and resource-limited settings like India. This can be attributed to the major portion of the workforce still being in the unorganized sector, and lack of regular medical screening facilities coupled with poor awareness among both the patients and health-care providers. The construction industry is one such industry, with the possible high undiagnosed burden of occupational lung diseases.
The construction industry is witnessing phenomenal growth in developing economies like India. It is projected to grow at 5.6% during 2016–20, compared to 2.9% during 2011–15 and one of the largest contributors of employment. Construction workers are exposed to wide variety of physical and chemical environmental factors that can make them prone to respiratory morbidity., Exposure to cement dust, wide range of inorganic respiratory allergens, welding fumes, and so on in the construction site for a longer periods had been proved to reduce the lung function.,, Working in the construction industry has also been reported to be associated with marginally increased risk of lung cancer.
A recent review highlighted the possibility of severe disability due to respiratory dysfunction, the need for continuous monitoring of respiratory function, and interventions to minimize the damage to the lungs. Appropriate workplace interventions to reduce occupational exposure to dust in the construction site had been reported to lower COPD and improved lung function. Despite the millions of workforce and the possibility of the high burden of respiratory diseases, the number of studies on occupational lung diseases among construction workers is very limited. Studies documenting the impact of respiratory morbidity on the quality of life are even more scarce. Hence, the current study was conducted with the objective of comparing the respiratory symptoms, pulmonary function, and respiratory morbidity-related quality of life between people working in construction sites and the age- and gender-matched controls working in other occupations.
| Materials and Methods|| |
The study was an analytical cross-sectional study, with the study group being people working in the construction sites and the comparator group involved people working in occupations, with no occupational exposure to inhalable substances potential to cause respiratory morbidity. The study was conducted by the department of pulmonary medicine of a tertiary care teaching hospital located in Telangana.
The study included both men and women working in the construction site as a mason or daily laborer for at least 5 years duration. The study excluded people other than mason or daily laborer, people with a past history suggestive of COPD or bronchial asthma.
Sample size was calculated assuming the expected mean and standard deviation of the FEV1/FVC% in the construction workers as 109 ± 6.94 as per previous study by Sumana et al. Considering minimal clinically significant difference in outcome parameter to detect as 3% between the study groups, with 90% power and 5% two-sided alpha error, the required sample size was 112 subjects in each group. We have included 120 subjects in each group in the final analysis.
Construction workers were recruited from three construction sites in the field practice area of the institution, selected by convenient sampling. The comparator group was selected from the staff working in the hospital setting. Matching was done at the group level dividing the participants into 5 years age intervals. Gender matching was also done at the group level.
Pulmonary function was assessed by spirometry (using SproTech Model CMSP 01) by trained paramedical staff, using a standardized protocol. Respiratory morbidity-related quality of life was assessed by St. George respiratory questionnaire after necessary written permission from original authors. The questionnaire is a disease-specific quality-of-life instrument measuring the impact on overall health, daily life, and perceived well-being. Symptoms, activity, and impact of symptoms are assessed. The higher overall score indicated more limitation or poor quality of life.,, Validated local language (Telugu/Hindi) versions of the tool were procured from the original authors.
Quantitative variables were checked for normal distribution within each category of explanatory variable. Normally distributed quantitative parameters, the mean values were compared between study groups using independent sample t-test (two groups). Categorical outcomes were compared between study groups using Chi-square test/Fisher's exact test. P value <0.05 was considered statistically significant. IBM SPSS version 22 was used for statistical analysis.
This study was obtained from Institute ethics committee (IEC), CAIMS (Ref: IEC/CAIMS/09/2019, Dated: 03.10.2019).
| Results|| |
The final analysis included 120 construction workers and same number of controls. No statistically significant differences were observed age and gender composition. The proportion of current smokers was slightly higher (15.83% vs. 12.5%) among cases. The proportion of past smokers was 1.67% among both the groups (P-value 0.760). Among construction workers, 79 (65.83%) were masons and the remaining 41 (34.17%) were daily laborers [Table 1].
|Table 1: Comparison of baseline demographic and lifestyle-related parameters between the study groups (n=240)|
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Cough was the most common symptom reported by 35% of the construction workers and 24.17% of the controls (P-value 0.066). The proportion of people with other symptoms was also higher among construction workers, though the differences were statistically not significant. The proportion of subjects reporting upper respiratory symptoms (sneezing, running nose, stuffy nose, etc.) was significantly higher among the construction workers (45% vs. 15.83%, P value < 0.001) [Figure 1].
|Figure 1: Comparison of respiratory symptoms (in the last 30 days) between the study groups (N = 240)|
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The mean FVC (MD 0.20, 95% CI 0.025–0.381, P value 0.025), mean FEV1 (MD 0.21, 95% CI 0.061–0.364, P value 0.006), and mean FVC% predicted (MD 5.01, 95% CI 1.11–8.92, P value 0.012) were statistically significantly lower among the construction workers, as compared to controls. Even though the FEV1% predicted and FEV1/FVC values were slightly lower among the construction workers, the difference was statistically not significant [Table 2].
|Table 2: Comparison of the mean measured by spirometer between the study groups (n=240)|
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Respiratory morbidity-related quality of life was poor in all the domains, including the symptom (MD 18.79, 95% CI 15.97–21.61, P value < 0.001), activity (MD 15.50, 95% CI 12.07–18.94, P value < 0.001), and impact (MD 9.17, 95% CI 7.64–10.74, P value < 0.001). The overall SGRQ score was also significantly higher among the construction workers indicating poor overall respiratory morbidity-related quality of life (MD 12.69, 95% CI 10.59–14.80, P value < 0.001) [Table 3].
|Table 3: Comparison of mean of SGQR score between the study groups (n=240)|
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The proportion of participants with abnormal pattern of pulmonary function test (PFT) was higher in construction workers as compared to controls. Restricted pattern was the most common pathology observed in 48.78% of masons and 36.71% of construction labor. Obstructed pattern was observed in 18.99% of construction labor and 9.76% of masons. Mixed pattern was observed in 3.8% of construction labor [Table 4].
|Table 4: Comparison of nature of work across pattern of lung disease modified (n=240)|
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| Discussion|| |
Despite a multitude of studies documenting the adverse impact of multiple exposure factors in the construction sites on respiratory morbidity, it is the relatedly unexplored aspect. Though the lower respiratory symptoms were no significantly higher among construction workers, upper respiratory symptoms were statistically significantly higher. A study by Deshmukh et al. among construction workers has documented respiratory symptoms (cough) to be the most common symptom, reported by about two-thirds of construction workers. Chronic exposure to silica has been prevented to result in higher prevalence of various respiratory symptoms as compared to other occupations. Chronic exposure to cement dust was associated with high prevalence of cough, sputum, wheezing, and dyspnea by Kakooei et al. These differences may be attributed to differences in the operational definitions used, duration of work in the construction industry, use of personal protective equipment, and so on undermining the need for standard evaluation methods.
We have found significantly lower FEC, FEV1, and FVC% predicted values among construction workers. Majority of them had restricted pathology, followed obstructed, and mixed pathology. The available literature has reported contrasting findings in this regard. Some studies documented a statistically significant reduction in all PFT parameters, whereas others reported reduction in selected parameters and few studies reported a reduction in none. In a study exposure to high amounts of silica, significant reduction in pulmonary function was reported with >50% showing moderate restriction similar to current study. Another study reported pulmonary function parameters to be better among controls, as compared to construction workers, but the differences were very minimal and statistically insignificant. Studies also have documented higher levels of respirable crystalline silica (quartz and cristobalite) in the ambient air of construction sites. Meijer et al. have found a strong association between chronic exposure to low levels of concrete dust and lung function independent of smoking. Rafeemanesh et al. have reported a strong correlation between length of exposure to cement dust and pulmonary function decline. As per a recent meta-analysis by Moghadam et al., all the mean pooled PFT parameters have to be lower among the construction workers.
Construction workers have reported poor respiratory morbidity-related quality of life due to comparatively higher symptoms, higher levels of restriction of activity, and a higher level of perceived negative impact. This aspect had not been explored by many studies in the past. Studies conducted on other similar population groups like people working in stone quarries; mining workers were reported to have poor respiratory morbidity related to the quality of life.
Hence, it can be concluded that the pulmonary function and the respiratory function-related quality of life are considerably poor among people working in the construction industry. The study could not explore the role of potential confounding factors. Also, the selection of controls was done based on convenience; hence, the control group may not be a true representative of the overall community, leading to poor generalizability.
Prospective cohort studies with periodic assessment of respiratory function may provide us a better understanding of the cumulative effect of the long duration of occupational exposure cement and other pollutants in the construction industry. Appropriate workplace interventions are needed to reduce the exposure levels and resulting adverse impact on respiratory function among people working in the construction field.
We acknowledge the technical support in data entry, analysis, and manuscript editing by “Evidencian Research Associates.”
Chalmeda Anand Rao Institute of Medical Sciences, Approved. CAIMS (Ref: IEC/CAIMS/09/2019, Dated: 03.10.2019)
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]