Exposure to physical hazards.

Construction workers are exposed to multiple physical hazards in their workplace that influence their occupational injury risk. They are exposed to chemical agents and hazardous building materials, climate change (eg, heat stress), falling objects, electrical shock, vibrational and mechanical forces from machinery and tools, sharp objects, unsafe or dangerous work environments, poor air quality, and noisy environments.^25,30,46-48 The most common causes of workplace injury for construction workers include slip and falls at ground level, falling from heights, and being struck by tools or building objects.^48-55 Construction activities are performed on ladders, scaffolds, stairs, roofs, and other building structures that produce risks of traumatic fall-related injuries.^12,50,56-58 When working on ladders or at heights, falls were demonstrated to be the most frequent cause of occupational injury.^55-57 The movement or height of ladders and scaffolders were found to be associated with fall-related injuries and fractures. Workers may also be exposed to electrical injury from the operation of tools or lack of safety equipment when working with electrical current.^32,57,58 Workers who frequently worked with electrical tools reported exposure to unprotected high voltage accidents, resulting in electrical burns and other types of electrical-related injuries (eg, traumatic shock, multiple injuries, and concussion with internal injuries).^32,58-61 Other causes of physical injury include or carrying objects, physical overexertion, repetitive postures and motion, assisting co-workers, and operation of construction machinery/devices.^7,9,62,63 Dutta³³ and Dutta et al³ stated that a lack of accommodation or facilities in the workplace for resting, quality food, and heat-related measures may also increase physical injury risk. Ekpenyong and Inyang¹⁰ found that body positions, including kneeling, vibration exposure, working in awkward postures, stooping or twisted posture, showed a strong association with musculoskeletal symptoms. Given the physical nature of the work and workload, ergonomic hazards can pose additional injury risks as they are prevalent and inherent within a construction work site.^64-66

Availability and use of PPE.

Many studies reported that lack of adequate personal protective equipment (PPE) and poor safety supervision contribute to workplace injury.^18,22,56,67 The most common reason for the lack of PPE was companies not providing PPE for their workers.^68,69 Hours worked (>8 hours per day or >45 hours/week), physically demanding jobs, lack of injury surveillance/ reporting procedures, and complex construction activities were also identified as mediating factors that contributed to lack of PPE usage, increased hazard exposure and occupational injury risk.^19,25,31,70 Other reasons include PPE usage interfering with the ability to perform their work, lack of safety training or supervision, concerns about employment insecurity when asking for PPE, and lack of awareness of hazards requiring PPE use.^11,22,71 PPE usage in studies of construction workers in African countries was variable and ranged from 3% to 70%.^{9,11,-16,18,49,72} PPE usage in North American and European countries were also variable at 50% to 70%.^51,53 PPE usage in construction reduced risk of injury by almost 2-5x in some studies.^13,15,49,72 Those without general safety training were also less likely to use PPE.⁷¹ Studies on women in the construction industry have reported inaccessibility to properly fitting PPE and inadequate sanitary facilities.⁶⁴ Construction workers in countries with hot and dry climates such as India developed heat-related symptoms during work, including heavy sweating, intense thirst, dehydration, and neurological symptoms such as headaches, blurred visions, and fainting due to an absence of accessible PPE.³

Safety training in the workplace and pre-employment preparation were rarely reported upon review of the included studies.⁷¹ Studies that did report access and availability to safety training noted that training and safety supervision were not regularly conducted.^{9,13,15,49,73} Those without injury prevention awareness, safety training, or knowledge of physical hazard mitigation generally had lower risk perceptions in the construction environment.^74,75 Perceptions of a safe work environment was also associated with lower physical injury prevalence.¹³ Workplace safety supervision was also found to be protective against workplace injury in most studies,^10,17,49 but not associated with injury reduction in one study.¹³ When compared to no safety supervision, injury rates were 2-3x lower.⁷² Effective safety training, adherence to safety procedures, supervision and safety personnel, and access to PPE were reported as critical to prevent occupational injury.^15,46,52,76

Company size and job type.

The studies reviewed generally found that companies with fewer employees are exposed to greater risks for physical injury in the workplace. Fall-related injuries and fatal and non-fatal accidents were reported more often in smaller companies with less than 25 employees.^{56,57,68,77,78} Workers in smaller companies have greater risk for physical injury for multiple reasons including less resources to invest in occupational health and safety reporting and rehabilitation,^31,69,77 less knowledge of workplace hazards, and poorer management of safety training and resource implementation as compared to larger companies.^{18,69,70,73,78} Smaller companies are also more likely to recruit ethnic and unskilled laborers that have low-risk perception, language and or cultural communication barriers, and a lack of safety knowledge that may increase risk for physical injury.^31,77

The characteristics of the job performed within a construction company is also an important risk factor for physical injury. Commercial construction workers are at a higher risk of injury and more likely to report musculoskeletal pain in their hands, neck, lower back, and knees compared to residential workers.^69,74 Temporary or seasonal workers and unskilled laborers are at higher risk for workplace accidents and physical injury in construction settings.^{8,10,13,18,51,76,79} A study of Ethiopian construction workers found a higher prevalence rate of lower back pain in daily laborers than other building construction workers.⁴⁹ Electricians, carpenters, painters, roofs, substructure workers, and plumbers also have higher work-related musculoskeletal disorders, and fatal and non-fatal accident rates.^{10,32,51,56,80} Electricians, bricklayers, and building laborers were found to be exposed to more electrical accidents than other trades workers.³² Bricklayers also have a high rate of musculoskeletal symptoms in the neck, as well as back and upper limb disorders.^10,23 Crane operators, insulators, and painters had higher odds of neck disorders, while roofers and floorers had higher odds of lower back and lower extremity injuries.⁶⁶ No studies reported consistent data on construction jobs that have lower risk for physical injury, however 2 studies found that plumbers, welders, and ironworkers reported less injuries than their construction counterparts.^14,79

Psychosocial stressors.

Several psychosocial stressors exist in the construction workplace. Workers experience work pressures that result in long and demanding working schedules, high work demands, disruptions of work-life balance, limited work task variability, and low work autonomy.^10,14,25 They interact with diverse groups of people in changing environments, which may expose them to unique stressors as they enter the job site.⁸¹ Physical injury, poor physical health, and musculoskeletal symptoms have been associated with high work demands, time pressure, overtime and long working hours, and skill underutilization.^{13,17,50,53,70,78,81-83} Lack of supervisory and co-worker support for safety and wellbeing was associated with decreased work ability, absenteeism, higher job strain, and musculoskeletal symptoms.^69,70,81-84 Similarly, Kiconco et al¹³ reported that competent supervision did not reduce or prevent physical injury. Job dissatisfaction was associated with an increased risk for occupational injury globally due to multiple factors, including negative attitudes toward the work environment, job uncertainty, financial stress, repetitive work, and/or low worker morale in the workplace.^{7,13,16,25,30,72} Conversely, job satisfaction and co-worker support has been reported to reduce the risk for lower back pain and work-related injury.⁸⁵ Also, studies reported experiences of workplace violence, physical and sexual harassment, age and gender-based discrimination, and bullying for construction workers with a more prominent impact on a female workers’ wellbeing and physical health.^30,61,86

Gender-related barriers.

Construction work has traditionally been viewed as a physically challenging male-dominated career.^30,87 Hegemonic masculinity with strong personal identification with the worker role, stigmatization of injury disclosure, physical overcompensation, and displays of competitiveness and aggressiveness may often be seen in the construction workplace.^59,87 Occupational research has focused primarily on male workers on the job site since they represent more than 80% to 90% of the global construction workforce.^65,86 Accordingly, gendered exposures to hazard in the construction workplace result in different risk profiles for men and women.^3,83 Curtis et al³⁰ found that differences in physical capabilities resulted in gender-specific task exposures with women more likely to be exposed to tasks involving chemicals, while men were predominantly engaged in tasks related to dust and welding fumes. Due to gendered distributions of work tasks, studies have reported that males experience more traumatic injuries through exposure to dangerous, physically challenging, and risky work environments.^30,59 Studies suggest that the development of brotherhood cultures, which enforces masculine behavioral norms may lead to gender segregation, discrimination, social isolation, workplace bullying, and pressures to perform in the workplace resulting in increased perceived stress and physical injury, more so in women compared to their male counterparts.^3,28,30,59 Women may experience withholding of training or job information due to the competitive masculine environment which may lead to a higher rate of injuries, reduced willingness to report injuries, and poor safety knowledge.^28,65 When faced with this institutionalized belief, women were found to need to prove themselves, leading to the fear of reporting injuries and a greater disregard for work-life balance.^30,61 Women also experience reduced protection from physical hazards and higher risk of musculoskeletal symptoms due to differences in body anthropometry resulting in challenges to procure properly fitting PPE and inadequate sanitary facilities.^28,55,61,64 These gender differences in hazard exposures require women to develop personal resilience and reframe negative experiences to withstand the challenges of working in a male-dominated career.¹

There is a gendered experience of physical injuries while working in construction with different hazard exposure, injury risk profiles, and rehabilitation patterns.⁵³ Men experience more fall-related fatal and non-fatal injuries while women experience more injury due to inanimate objects.⁵⁹ Males are more likely to experience traumatic work-related injuries and electrical accidents compared to female workers.^22,54,59,60 Studies have shown that males have a lower risk perception and are vulnerable to injury due to undereducation, higher risk-taking behaviors, and neglect of safety procedures.⁷⁵ Studies estimate that males experience between 2 and 6 times greater risk of injury in the workplace.^{7,8,11,12,14,16,17} This increased risk estimate is to be interpreted with caution, as women have been underrepresented in occupational research.⁸⁷ Women are at greater risk for physical injury when they experience high job strain, increased body anthropometry or age-related declines in physical performance and muscle mass due to differences in aerobic capacity.^54,75,87 Both genders report high rates of carpel tunnel syndrome while working in the construction trades.⁸⁸ Liu et al⁷⁵ found that women had higher levels of occupational health risk perception, more help-seeking behavior, and faster recovery times from work-related injuries than male workers.

Migrant and ethnic disparities.

Ethnic visible minorities and migrant workers experience high rates of physical injuries in the global construction industry.^68,89 Hispanic American and non-American workers in the US faced disproportionately higher fatality rates than their non-Hispanic American counterparts.^{22,31,73,89,90} Similar findings were reported among foreign workers in China and Switzerland.^55,91 Other studies have reported that native and White Caucasian workers report a higher rate of work-related musculoskeletal disorders than Hispanic workers, however they acknowledge this may be due to underreporting in construction settings.^22,58,66,90 Hispanic workers are also more likely to occupy construction jobs with higher risks of injury including laborers, painters, drywall installers, and electricians.⁹⁰ Studies have suggested that ethnic and migrant workers are more vulnerable to work-related injuries as they tend to work with smaller construction companies that may not have injury reporting procedures or reliable occupational health and safety programming, making the risk of physical injury higher.^22,31,68 Job insecurity, financial stress, education level, and inability to utilize health and safety compensation systems may also prevent injury reporting rates among this vulnerable group of workers.^10,28,63 Ethnic and migrant low-income workers may also experience difficulties in accessibility of PPE and vocational training to prepare them for the hazards of construction work.¹³

Language and cultural factors may predispose migrant workers to experience physical injury or accept dangerous construction work.^55,68 Dutta³³ found that migrant workers often do not understand English-based instructions and therefore experience job stress and hardship due to reprimands from their supervisors. Dutta³³ stated that due to the mistreatment workers experience because of communication and language barriers, they develop different beliefs, values, and perceptions of risks and anxieties. This lack of effective communication also impacted their ability to concentrate and identify hazards in the workplace leading to increased injuries and errors made during work.^73,89 The difficulties understanding health and safety regulations may also prevent adequate safety risk assessment resulting in accepting high risk, transient work in dangerous conditions.⁸⁹ Gabriel Ibarra-Meja et al⁶³ reported that risk perception for Hispanic-Latino construction workers was associated years of residence in the working country. This acknowledges the impact of cultural influences on injury reporting as a sign of weakness and fears of job loss and retaliation among these workers. These linguistic barriers may reduce adaptability and resiliency to stress in the hazardous construction work environment.⁶⁸

Education

Globally, studies have found that educational attainment in construction workers are relatively low with less than 10% to 20% of workers having completed post-secondary education.^12,74,75 Fewer years of educational attainment was associated with increased risk for work-related musculoskeletal disorders and dangerous exposures in the workplace.^10,22,74 Workers who completed a high school education or less had a 3-4x greater risk of work-related injury and musculoskeletal disorders than those who completed post-secondary education (eg, college or university).^12,18 Lette et al⁴⁹ suggested that workers who did not participate in vocational training have a 3x higher risk of physical injury than those who did. Greater years of educational attainment were associated with injury reduction. Del Puerto and Gilkey⁷⁴ reported that with each additional year of formal education, there was a reduction in the risk of physical injury. Education level was also found to effect risk perception and coping behavior in construction workers with those having more education being more apt to mitigate hazard exposure and reduce injury risk.⁷⁵

Physical health.

Construction workers experience poor long-term health outcomes and one of the highest occupational injury rates among industrial, health, and office workers.^{3,46,85,92,93} Hanson et al⁹³ found that construction workers reported being pain-free significantly less than the general US population. The experience of chronic pain contributed to reduced participation in normal social activities, medical co-morbidities (eg, coronary heart disease, high cholesterol, obesity, hypertension), and sleep disorders. Jenkins et al⁸⁸ reported that construction trades workers experience higher rates of carpal tunnel syndrome compared to the general US population. Work stress and access to occupational health and safety services may contribute to poor health outcomes in construction workers.¹⁴ Studies suggest poor health and injury surveillance post-injury that may influence the development of chronic pain, absenteeism, leaving occupation due to health-related reasons, and disability.^7,66,76,84 Dale et al⁶⁹ found that residential carpenters frequently reported missing days of work due to work-related pain or injury or missing days due to any pain or injury. Regular access to clinical pain management and injury treatment was important for symptom management, presenteeism, and prevention of diminished physical health.^25,84,94 Good health status was associated with less risk for lower back pain.⁸⁵ Welch et al⁸⁴ reported that factors for disability retirement include older age, presence of a musculoskeletal disorder, severity of injury, pain and functional disability, low work ability, lack of accommodation, lack of work support, and low expectations of recovery.

Physical injuries commonly reported in the construction industry were fractures, lacerations, contusions, abrasions, burns, sprains and strains, carpal tunnel syndrome, fall-related injuries, electrical trauma, head and eye injuries, and musculoskeletal disorders.^{8,13-17,19,47,49,50,53,63,67,71,72} Body parts that were often injured include the hands, upper and lower limbs, knees, lower back, and bilateral shoulders.^{12,23,47,51,57,79,95} Traumatic or severe injuries were often sustained in the upper half of the body (eg, head, thorax, abdomen) and pelvic regions.^{32,48,52,58,62} Construction workers who worked in carpentry and floor laying often reported lower back pain or musculoskeletal pain in the hands, knees, back, and wrists.^69,85 Construction workers also experience skin irritations and disorders.^18,49,61 Workers are exposed to various building and construction chemicals (eg, cement and concrete, etc.) that may cause skin irritations and chronic skin disorders. These chemical exposures may also put workers at-risk of respiratory conditions including asthma, rhinitis, and pneumonia.⁶¹ Eye injuries were the least commonly reported injury in this scoping review and were largely due to irritation or foreign objects in the eyes.^18,49,62

Obesity.

Obesity was evaluated in 7 (~9%) of the studies in this review. The overall findings suggest that construction workers may have higher BMI scores in the range of overweight or obese, implicating postural-related risk for injury, work ability, and increased mechanical strain on muscles and joints.^10,81,93 Obesity has also been linked to poor health outcomes (eg, high blood pressure, sleep disorder, osteoarthritis), absenteeism, short-term absence of disability, and illness.⁷⁶ Ekpenyong and Inyang¹⁰ identified that high BMI scores were associated with a 2x increased prevalence of work-related musculoskeletal disorders, especially when performing heavy construction tasks. Dong et al³¹ reported that obesity was associated with a workplace injury, Gu et al⁹² found no association between BMI scores and work-related injuries for workers in the construction industry. Gilkey et al⁸⁵ reported that body anthropometry was a risk factor for work-related injury in female construction workers only. Gilkey et al⁸⁵ found a positive correlation between BMI and low back pain.

Sleep quality.

Sleep quality was assessed in 7 (~9%) of the studies reviewed. Sleeping problems and poor sleep quality was associated with risk for myalgias and musculoskeletal disorders.^12,53,72,93 Wendimu et al⁹⁶ reported an association between poor sleep quality and a history of physical injury. Dutta³³ found that lack of sleep results in greater levels of fatigue and, consequently, a higher risk of workplace injury. Similarly, Hussen et al¹² stated that workers in Ethiopia doing night shifts were more injured than those during the day shifts, possibly due to circadian rhythm alterations resulting in more fatigue, sleepiness, and less vigilance. This is further evidenced by Kiconco et al,¹³ who found more than a quarter (30.2%) of workers had a sleeping disorder in the building construction industry in Uganda, with 70% of the occupational injuries occurring among night shift workers. In contrast, Abbas et al⁴⁷ did not find an association between sleep quality and occupational risk of non-fatal physical injury. From the literature, it appears there is a reciprocal relationship between sleep quality and physical injury, such that poor sleep quality may predispose to injury and previous injury may implicate poor sleep quality.

Age.

Age was identified as an influential factor for identifying physical injury risk and developing mitigation strategies. The reviewed studies identified 2 distinct age groups that were at increased risk for physical injury in the construction workplace. Younger workers (⩽25 years of age) were identified as an at-risk group for non-fatal and fatal physical injury and occupational accidents.^{8,13,22,32,47,50,58,60,69,74,76,79} Studies suggested that younger workers may have an increased risk for physical injury due to lack of apprenticeship or job training, poor occupational safety compliance, inability to identify hazards and request for support to manage hazards, and lower job skill.^9,18,63 Younger workers may engage in longer work schedules, shift work, and overtime that can increase their exposure to workplace hazards and subsequent injury.⁷⁶ Other studies found no association of increased injury trends for younger workers, but rather higher injury prevalence in workers aged 30 to 44.^{12,49,51,55,88}

Older workers (aged 45-55) were also identified as vulnerable to physical injury in the construction workplace.^60,66,74,92 Studies reported that older workers are more likely to sustain severe and consequential injuries that would put them at risk for prolonged disability, early retirement, or job change due to concerns with work ability.^{55,56,66,78,81} Generally, musculoskeletal symptoms and disorders increased with age.^10,25 Older workers are more likely to be self-employed and have less access to occupational safety and health programs.⁶⁶ Work-related fatality rates have also been found to increase with age.^55,76,91 Few studies reported that older workers have a poorer general health status and accumulation of chronic stressors that may influence injury risk.^10,93 Welch et al⁸⁴ reported that for each yearly increase in age was associated with a 15% increase in the likelihood of leaving roofing. Self-perceived ability to undertake physically intensive tasks, changes in physical functioning, and ability to manage work demands also declines with aging conferring risk to workplace injury.^{10,62,66,69,97} Anantharam et al⁴⁸ and Lombardi et al⁵⁷ identified an association between increasing age, pre-existing conditions, and the risk of fractures when working on ladders that could predispose older workers to increased fall risk. After injury, older workers were reported to have more days at work than their younger counterparts.⁷⁴ Interestingly, few studies reported no association between aging and increased injury or accident risk.^13,14,32,92

Marital status.

There were mixed findings on the influence of marital status on physical injury risk in the construction workplace. Generally, married workers reported more work-related physical injuries than single workers.^9,16 This increased rate of work-related injuries may be due to higher life responsibilities, financial stress, fatigue accumulation, and work-family conflict.^9,16,30 However, other studies reported that married workers had less risk for physical injury in the workplace.^12,18 Liu et al⁷⁵ found that there was no difference in occupational risk perception between married and single workers. Overall, there is no conclusive data on the impact of marital status on risk of physical injury for construction workers.