Is exposure to cement dust and heavy metals associated with reduced pulmonary function? A cross-sectional study among cement factory workers in Türkiye.

Abstract

To assess the relation of exposure to cement dust and heavy metal (aluminium, cadmium and lead) exposures to pulmonary function among male cement plant workers. The study also aimed to evaluate dose-response relationships and prevalence and severity of respiratory symptoms among exposure categories compared with a control group. Cross-sectional study. Secondary-level occupational health clinic in Ankara, Türkiye. 461 male non-smoking cement plant employees were included in total. Participants were categorised into packaging (n=101), milling (n=162) and office unexposed workers (n=198). Inclusion criteria were more than 70% work history in the cement industry and exclusion of pre-existing respiratory disease and missing data from the participants. Not applicable. Pulmonary function tests (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC and peak expiratory flow (PEF)) and urinary, cadmium and blood lead concentrations were measured. Lung function impairment was the primary outcome measure; secondary outcomes included metal exposure-pulmonary measure correlations. Significant negative correlations existed between FEV1 and urine aluminium (r=-0.622, p<0.001), blood cadmium (r=-0.430, p<0.001) and lead (r=-0.473, p<0.001). Adjusted generalised linear models showed much lower FVC, FEV1 and PEF in the high-exposure milling group compared with controls (p<0.001). Workers with blood aluminium levels≥35 µg/L had lower FVC (4.26 L), FEV1 (3.61 L) and PEF (7.07 L/min) than those with lowered levels (p<0.001). Dose-dependent pulmonary function loss with increased metal levels was observed. Occupational cement dust and heavy metal exposure is closely linked to impaired pulmonary function in cement plant employees, particularly those who work in higher exposure jobs. The implications are robust endorsement of targeted monitoring and preventive interventions. Long-term longitudinal research is necessary to identify long-term outcome and efficacy of exposure reduction approaches.