The prevalences and levels of occupational exposure to dusts and/or fibres (silica, asbestos and coal): A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury
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The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large number of individual experts. Evidence from human, animal and mechanistic data suggests that occupational exposure to dusts and/or fibres (silica, asbestos and coal dust) causes pneumoconiosis. In this paper, we present a systematic review and meta-analysis of the prevalences and levels of occupational exposure to silica, asbestos and coal dust. These estimates of prevalences and levels will serve as input data for estimating (if feasible) the number of deaths and disability-adjusted life years that are attributable to occupational exposure to silica, asbestos and coal dust, for the development of the WHO/ILO Joint Estimates. We aimed to systematically review and meta-analyse estimates of the prevalences and levels of occupational exposure to silica, asbestos and coal dust among working-age (≥15 years) workers. Data sources We searched electronic academic databases for potentially relevant records from published and unpublished studies, including Ovid Medline, PubMed, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference lists of previous systematic reviews and included study records; and consulted additional experts. Study eligibility and criteria We included working-age (≥15 years) workers in the formal and informal economy in any WHO Member and/or ILO member State but excluded children (<15 years) and unpaid domestic workers. We included all study types with objective dust or fibre measurements, published between 1960 and 2018, that directly or indirectly reported an estimate of the prevalence and/or level of occupational exposure to silica, asbestos and/or coal dust. Study appraisal and synthesis methods At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, then data were extracted from qualifying studies. We combined prevalence estimates by industrial sector (ISIC-4 2-digit level with additional merging within Mining, Manufacturing and Construction) using random-effects meta-analysis. Two or more review authors assessed the risk of bias and all available authors assessed the quality of evidence, using the ROB-SPEO tool and QoE-SPEO approach developed specifically for the WHO/ILO Joint Estimates. Eighty-eight studies (82 cross-sectional studies and 6 longitudinal studies) met the inclusion criteria, comprising >2.4 million measurements covering 23 countries from all WHO regions (Africa, Americas, Eastern Mediterranean, South-East Asia, Europe, and Western Pacific). The target population in all 88 included studies was from major ISCO groups 3 (Technicians and Associate Professionals), 6 (Skilled Agricultural, Forestry and Fishery Workers), 7 (Craft and Related Trades Workers), 8 (Plant and Machine Operators and Assemblers), and 9 (Elementary Occupations), hereafter called manual workers. Most studies were performed in Construction, Manufacturing and Mining. For occupational exposure to silica, 65 studies (61 cross-sectional studies and 4 longitudinal studies) were included with >2.3 million measurements collected in 22 countries in all six WHO regions. For occupational exposure to asbestos, 18 studies (17 cross-sectional studies and 1 longitudinal) were included with >20,000 measurements collected in eight countries in five WHO regions (no data for Africa). For occupational exposure to coal dust, eight studies (all cross-sectional) were included comprising >100,000 samples in six countries in five WHO regions (no data for Eastern Mediterranean). Exposure to silica, asbestos and coal dust was assessed with personal or stationary active filter sampling; for silica and asbestos, gravimetric assessment was followed by technical analysis. Risk of bias profiles varied between the bodies of evidence looking at asbestos, silica and coal dust, as well as between industrial sectors. However, risk of bias was generally highest for the domain of selection of participants into the studies. The largest bodies of evidence for silica related to the industrial sectors of Construction (ISIC 41-43), Manufacturing (ISIC 20, 23-25, 27, 31-32) and Mining (ISIC 05, 07, 08). For Construction, the pooled prevalence estimate was 0.89 (95% CI 0.84 to 0.93, 17 studies, I2 91%, moderate quality of evidence) and the level estimate was rated as of very low quality of evidence. For Manufacturing, the pooled prevalence estimate was 0.85 (95% CI 0.78 to 0.91, 24 studies, I2 100%, moderate quality of evidence) and the pooled level estimate was rated as of very low quality of evidence. The pooled prevalence estimate for Mining was 0.75 (95% CI 0.68 to 0.82, 20 studies, I2 100%, moderate qualit
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Many countries have established strict legal regulations for occupational exposure to biodurable fibres longer than 5 μm and thinner than 3 μm (critical fibres) because they are considered harmful due to respirability, biodurability, and length.
“For occupational exposure to biodurable fibres longer than 5 μm and thinner than 3 μm—toxicologically ‘critical fibres’—many countries have established strict legal regulations, as such fibres are considered harmful due to their respirability, biodurability, and length [13].”
From Macrophages bend long fibres with flexural rigidity lower than 3 mN·nm2 to avoid frustrated phagocytosis (2026) · cites this paper as [13]
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- Authors
- Schlünssen, V., Mandrioli, D., Pega, F., Momen, N. C., Ádám, B., Chen, W., Cohen, R. A., Godderis, L., Göen, T., Hadkhale, K., Kunpuek, W., Lou, J., Mandic-Rajcevic, S., Masci, F., Nemery, B., Popa, M., Rajatanavin, N., Sgargi, D., Siriruttanapruk, S., Sun, X., Suphanchaimat, R., Thammawijaya, P., Ujita, Y., van der Mierden, S., Vangelova, K., Ye, M., Zungu, M., & Scheepers, P. T. J.
- Affiliations
- Aarhus University (DK)
- Istituto Ramazzini (IT)
- World Health Organization (CH)
- United Arab Emirates University (AE)
- Huazhong University of Science and Technology (CN)
- Northwestern University (US)
- KU Leuven (BE)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- Tampere University (FI)
- Ministry of Public Health (TH)
- Zhejiang Academy of Medical Sciences (CN)
- University of Milan (IT)
- Université Libre de Bruxelles (BE)
- Chinese Center For Disease Control and Prevention (CN)
- International Labour Organization (CH)
- National Center of Public Health and Analyses (BG)
- National Institute for Occupational Health (ZA)
- Radboud University Nijmegen (NL)
- Corresponding author
- Schlünssen, Vivi
- Pega, Frank
- ORCID
- Schlünssen, Vivi
- Mandrioli, Daniele
- Pega, Frank
- Momen, Natalie C.
- Ádám, Balázs
- Chen, Weihong
- Cohen, Robert A.
- Godderis, Lode
- Göen, Thomas
- Hadkhale, Kishor
- Kunpuek, Watinee
- Lou, Jianlin
- Mandic-Rajcevic, Stefan
- Masci, Federica
- Nemery, Ben
- Popa, Madalina
- Rajatanavin, Natthadanai
- Sgargi, Daria
- Sun, Xin
- Thammawijaya, Panithee
- Vangelova, Katya
- Ye, Meng
- Zungu, Muzimkhulu
- Scheepers, Paul T.J.
- Venue
- Environment International
- Publisher
- Elsevier BV
- Published
- 2023-08
- Volume
- 178
- Pages
- 107980
- ISSN
- 0160-4120 (ISSN-L)
- OpenAlex
- W4377194573
- Cited by
- 53
- References
- 161
- Citations by year
- 2026: 16 · 2025: 19 · 2024: 11 · 2023: 4 · 2022: 1 · 2021: 2
- FWCI
- 2.33
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Environment International (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Lirias (submittedVersion, cc-by)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Tampere University Institutional Repository (Tampere University) (submittedVersion, cc-by)
- Greater South Information System
- Funders
- World Health Organization
- National Research Centre
- TU Graz, Internationale Beziehungen und Mobilitätsprogramme
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Occupational and environmental lung diseases
- Social Sciences › Health › Occupational Health and Global Justice
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Safety in Workplaces
- Keywords
- occupational exposure, silica dust, asbestos fibers, coal dust, pneumoconiosis, prevalence, exposure levels, disability-adjusted life years, manufacturing industry, construction, informal economy, quality of evidence, risk of bias
- MeSH terms
- Adolescent, Asbestos, Coal, Cross-Sectional Studies, Dust, Humans, Occupational Diseases, Silicon Dioxide, Steam, World Health Organization, Prevalence, Occupational Exposure, Cost of Illness
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