Occupational Health Injuries and Illnesses Among Women Workers in the Chemical Industry: A Scoping Review

Abstract

Background:

The number of women in the chemical industry has recently increased due to more women pursuing science careers. It is necessary, therefore, to analyze the emerging health risks for female workers in the chemical industry. This study examines the relationship between occupational health and sex/gender in the chemical industry, with a gender perspective.

Methods:

We present a scoping review (n = 97). After removing duplicates and applying eligibility criteria, we selected 27 articles published in the last decade that explored the industry’s occupational risks.

Findings:

Most of the papers include predominantly male samples and describe adult populations, mainly from developed countries. The studies focus on various employment contexts of chemical industries. We identified health risks in oncology, dermatology, and the respiratory system, among others. We found that particular emphasis was given to the relationship between occupational exposure and cancer, especially breast cancer. Furthermore, we observed sex/gender differences in the prevalence of respiratory and dermatological disorders. These results highlight the need to consider specific sex/gender-based health risk factors in the chemical industry.

Conclusions/Application to Practice:

The chemical industry is considered a crucial health determinant, however, the studies focused on sex/gender-based differences without considering gender-specific physiology and work circumstances. Although some studies do mention sex/gender disparities, such as occupational rhinitis, which is more frequent in women, studies are scarce. The absence of a segregated analysis with a gender perspective could lead to the ignorance of emerging health risks for female workers, highlighting the urgent need to include a gender perspective in future research.

Keywords

chemical industry gender perspective interdisciplinary communication occupational risks sex

Background

Working in the chemical industry can pose a high risk to workers’ health. Growing evidence suggests that several occupational risk factors, such as chemical compounds, particles, or smoke, can be associated with an increased risk of disease (European Agency for Safety and Health at Work [EU-OSHA], 2022).

Some occupational illnesses associated with this sector are silicosis, chronic obstructive pulmonary disease (COPD), asthma, contact dermatitis, asbestosis, byssinosis, berylliosis, bronchiolitis obliterans, pulmonary fibrosis, and autoimmune diseases. Furthermore, several cancer types have been associated with exposure to chemical compounds, particles, or smoke (nose, lung, larynx, urinary tract, thyroid, kidney, and leukemia; Micallef et al., 2023; Valls-Llobet, 2018). Evidence suggests the association between certain occupations and cancer mortality, which could be attributed to exposure to risks including exposure to chemicals, in the workplace. However, workers from each employment category also have lifestyle differences (tobacco, alcohol, physical inactivity, diet, etc.) which are risk factors for cancer. Moreover, the employment category is related to other cancer-causing circumstances such as educational level, income level, or the residential environment (Instituto Nacional de Seguridad y Salud en el Trabajo, 2020).

Cancer represents approximately 53% of work-related deaths in the European Union (EU) and other developed countries (EU-OSHA, 2023). Several studies have shown that between 2% and 8% of all cancers worldwide are caused by occupational exposure to chemical substances that can be inhaled or absorbed through the skin. The estimations available are likely underestimation, partly because they do not include a large number of already-identified agents that could be carcinogens (National Occupational Research Agenda, 2017). The International Labour Organization (ILO) estimates 666,000 work-related cancer deaths per year, double the number of work-related accidents (EU-OSHA, 2022).

The chemical industry is traditionally male dominated although in recent decades more women have entered this job market (Vasconcelos et al., 2012). As a result, many studies on occupational health and the impact of chemical products on health lack data about women (Ngajilo & Jeebhay, 2019; Theobald, 2002). When studies do discuss women, they tend to exclusively address occupational health risks associated with reproductive health and fetal health (Balise et al., 2016; Miligi et al., 2013). Concerns about breastfeeding and protecting breastfeeding are also included. One study described that the best way to protect mothers and babies from the risks of chemical contamination is by avoiding, reducing, or eliminating the production and use of harmful chemical substances, especially during pregnancy and breastfeeding (Ortega-García et al., 2021).

Governmental agencies responsible for occupational health are aware of the need for strategies that help reduce the risk of work-related diseases in both men and women. However, few studies help said agencies establish prevention protocols that also consider sex/gender-based issues (Vasconcelos et al., 2012).

In differentiating sex and gender, sex is a term used to refer to the biological and physiological differences between men and women, while gender is used to refer to the societal roles and expectations of men and women (Habib et al., 2020; Wizemann & Pardue, 2001). This approach “improves the understanding that the sexual division of labour, biological differences, employment patterns, social roles and social structures all contribute to gender-specific patterns of occupational hazards and risks” (ILO, 2013).

Furthermore, in considering that lipid-soluble chemicals accumulate more easily in people with higher adiposity, we understand that female bodies are chemical bioaccumulators of the products in their environment and their workplace; women have almost 15% more body fat than their male counterparts (Jackson et al., 2017; Kapeleka et al., 2021; Valls-Llobet, 2018).

Some previous studies (Zhou et al., 2021) show the need for greater interdisciplinary communication between engineering and nursing to increase innovation in practice in occupational healthcare. Our study contributes to this. A scoping review of peer-reviewed literature was conducted as the first step in developing sex/gender-based occupational prevention programs in the chemical industry. For this reason, and given the scarce evidence, it would be more difficult to conduct a systematic review or meta-analysis. Our research question is: What are the sex/gender-based differences in occupational health risks in the chemical industry? Our objective was to examine what sex/gender-based occupational health differences exist.

Methods

We conducted a scoping review (Peters et al., 2020) following Arksey and O’Malley’s (2005) guidelines. We identified a research question, found relevant studies, selected studies, collected data, and summarized and reported the results. Furthermore, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist (Tricco et al., 2018).

We conducted systematic searches in four databases (CINAHL, PubMed, Scopus, Web of Science [WOS]) using the terms obtained from Medical Subject Headings (MeSH) and the search string: (occupational health OR occupational risks) AND (gender OR sex) AND (Chemical Industry). We performed the search between March and May 2022. We considered the following selection criteria (Figure 1):

(a) papers that analyze occupational risks in the chemical industry,

(b) papers that include sex/gender-specific data,

(d) year (from 2012),

(e) article type (original articles),

(f) access to the full text in each of the database’s search results.

Figure 1.

PRISMA-ScR flow diagram depicting the article selection process

The researchers determined which data to extract according to the studies’ titles and abstracts. We obtained the full texts from the publications that met the eligibility criteria. If there was a disagreement after reading an abstract, each researcher read the articles independently. Lastly, the researchers discussed the disagreements until they reached consensus.

We conducted the data analysis in two stages. During the first stage, we classified the studies with a reference number. To do so, we included the articles in a Microsoft Excel spreadsheet where we defined variables such as the study’s objective, design, and sample, to determine whether data were disaggregated by sex/gender, industry, and the area of health affected. During the second stage, we conducted an analysis classifying the information by common characteristics which led to four categories related to areas of health: oncology, dermatology, the respiratory system, and others. “Others” included the following areas of health: cardiology, hepatology, otorhinolaryngology, the urinary system, and rheumatology.

We performed a descriptive analysis of the results and described the sex/gender-related risks in the chemical industry.

Results

The search produced 97 articles. After removing the duplicates and articles that did not meet the eligibility criteria, we reviewed 58 full texts, resulting in 27 articles about occupational health in the chemical industry that were valid for our analysis. Table 1 shows the characteristics of the studies included.

Table 1.

Summary of Studies Included (Alphabetically Ordered)

Author/year	Aim	Research design	Participants/sample					Context		Concept
Author/year	Aim	Research design	Size	Men	Women	Age	Period	Industry	Research location	Health discipline
Ahmed et al. 2022	To assess the prevalence and risk factors of occupational asthma (OA) and its effect on quality of life	Cross-sectional	780	594	186	21–56 (36.43 ± 9.35)	May–October 2020	Detergent and cleaning product factories	El Asher men Ramadan city (Egypt)	Resp.
Airoldi et al. 2022	To evaluate the seroprevalence of immunoglobulin G and to identify high-risk job sectors during the first pandemic way	Cross-sectional	22,708	13,613	9,095	<20–>80 (median 45)	March 2010–August 2020	Chemical and petrochemical industry	North-West Italy	Resp.
Awadalla et al. 2012	To identify the occupational and environmental risk factors with the development of idiopathic pulmonary fibrosis (IPF)	Multicenter case-control study	201 cases (205 controls)	95 (114)	106 (91)	22–78 (51.0 ± 10.5)	January 2010–January 2011	Chemical industry	Cairo, Tanta, and Mansoura (Egypt)	Resp.
Bader et al. 2013	To compile and analyze data on urinary creatinine (UC) from a large workforce in the chemical industry	Epidemiological	6,438	6,148	290	Men 16–79 (median 43); women 17–58 (median 35)	1989–2009	Chemical industry	Germany	Uri.
Boudigaard et al. 2020	To investigate the association between occupational styrene exposure and systemic sclerosis (SS), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), small vessel vasculitis (SVV) or Sjögren’s syndrome	Longitudinal observational study	72,212	59,997	12,215	<39–>70	1979–2012	Plastic industry	Denmark	Rheu.
Farkas et al. 2016	To analyze the frequency of numerical and structural aberrations in peripheral blood lymphocytes of healthy individuals, considering biological and exposure conditions	Cohort study	2,145	1,097	1,048	Males 36.9 ± 11.4 Females39.9 ± 11.1	1989–2010	Chemical industry	Budapest (Hungary)	Onc.
Iwatsubo et al. 2014	To examine the relationship between occupational exposures to chloracetal C5 and renal cell carcinoma	Retrospective cohort mortality study and a nested case-control study	2,522 cohort (100 controls)	16 (76)	2 (6)	Median 26 (cohort study)/mean 56 years (case-control study)	1960–2003	Chemical industry workers (animal feed supplements)	Auvergne region (France)	Onc.
Jaakkola et al. 2021	To investigate potential relationships between occupation and three subtypes of asthma, namely atopic asthma (AA), non-atopic asthma (NAA), and asthma–COPD overlap syndrome (ACOS)	Epidemiological	368 cases (932 controls)	128 (438)	240 (494)	21–63	September 1997–March 2000	Chemical-products industry workers, fur and leather workers, metal workers, rubber and plastic workers, textile workers, wood, and paper workers	Pirkanmaa Hospital District (Southern Finland)	Resp.
Kaneko et al. 2020	To estimate inequalities in the risk of cancers related to occupational chemical exposure in various manufacturing categories	Case-control study	40,370 cases (26,746 controls)	32,238	8,132	65.3 ± 11.4	1984–2017	Manufacturing industry	Japan	Onc.
Marinaccio et al. 2018	To study the gender ratio among malignant mesothelioma (MM) cases, comparing the international gender ratio of mesothelioma among countries, and to assess the specific patterns of incidence and asbestos exposure in women	Analytical	21,398	15,311	6,087	<44–>85	1993–2012	Textile industry, asbestos-cement industry, food and beverages industry, manufacture of machinery and equipment, asbestos textile industry, manufacture of chemical and plastic products, rubber industry, glass, and ceramics production	Italy	Resp.
McElvenny et al. 2018	To study whether the risk of meningioma is associated with occupational exposures, including selected combustion products, dust, and other chemical agents	Seven-country population-based case-control study	1,906 cases (5,565 controls)	507	1,399	<40–<70+	2000–2004	Chemical industry related to the exposure to combustion products, dusts, and other chemical agents	Australia, Canada, France, Germany, Israel, New Zealand, UK	Onc.
Micallef et al. 2023	To estimate the population-attributable fraction and number of attributable cancer cases linked to occupational exposure	Population-level prevalence of lifetime exposure to 10 carcinogenic agents	94,849	62,292	32,557	15–84	1967–2007, 1997–2017	Painters, rubber industry workers	France	Onc.
Peremiquel-Trillas et al. 2019	To investigate whether occupational exposure to alkylphenolic compounds is associated with breast and prostate cancer	Population-based case-control study	1,513—breast cancer, 1,095—prostate cancer (3,055 controls)	1,095 (1,480)	1,513 (1,575)	<60–<70	2008–2013	Chemical industry	Spain	Onc.
Pereÿinský et al. 2014	To determine the most endangered professions and the most common causative factors of occupational rhinitis	A long-term retrospective study	66	21	45	Average 39 41 (men), 36 (women)	1990–2011	Textile industry, healthcare industry, raw mineral extraction, leather industry, chemical industry	Slovak Republic	Resp.
Prodi et al. 2015	To investigate the prevalence of epoxy resin sensitization among patients with suspected contact dermatitis and relate findings to patients’ occupation	Cross-sectional	19,088	6,268	12,820	<25–>58	1996–2010	Chemical industry	Northeastern Italy	Derm.
Riccó et al. 2016	To investigate whether exposure to phenolic resins is associated with quantitative olfactory disorders in workers in the abrasive industry	Cross-sectional	66	45	21	39.8 ± 10.15	2013	Chemical industry	Northern Italy	Resp.
Richardson et al. 2013	To report on cause-specific mortality in a national laboratory	Descriptive study	22,831	16,912	5,919	—	Before 1985 until 2008	Basic research in the chemical industry	US	Onc.
Robinson et al. 2015	To evaluate proportionate mortality ratios for leukemia and acute myocardial infarction by occupation and industry, race, gender, and ethnicity	Analytical	10,933,823	White 677,032; Black 4,817,910	White 4,817,910; Black 599,781	18–64	1985–1999, 2003–2004, 2007	Chemical industry	US	Card. Onc.
Santarossa et al. 2020	To investigate the epidemiology of occupational contact dermatitis (OCD)	Database and patch tests	18,859	6,778	12,081	15–>65	1996–2016	Paper industry, textile industry, metal workers	Northeastern Italy	Derm.
Scarselli et al. 2017	To evaluate occupational exposure levels to formaldehyde in the Italian workforce	Analytical	49,450 of estimated exposed	—	—	—	1996–2014	Manufacturing of chemicals and chemicals products, manufacturing of rubber and plastic products	Italy	Onc.
Schaal et al. 2017	To determine if combined exposure to heavy metals, solvents, and noise was associated with the development of hearing loss.	Epidemiological	1,546	1,360	186	18–77	2004–2015	Industrial shipyard	US	Oto.
Shakik et al. 2019	To characterize the risk of dermatitis among industry and occupation groups	Cohort study	23,843	14,783	9,060	15–77	2002–2016	Mines, quarries and oil wells, manufacturing industries	Ontario (Canada)	Derm.
Sritharan et al. 2019	To examine breast cancer risk by occupation and industry among both female and male workers	Cohort study	18,357	492	17,865	Mean 37.4	1983–2016	Mines, quarries and oil wells, manufacturing industries	Ontario (Canada)	Onc.
Troke et al. 2021	To characterize the risk of working-age acute myocardial infarction by industry and occupation group	Cohort study	24,514	20,837	1,677	Average 43.7	2006–2016	Mines, quarries and oil wells, manufacturing industries	Ontario (Canada)	Card. Onc.
Umicevid et al. 2022	To investigate the potential hepatotoxicity, nephrotoxic, and hematotoxic effects of simultaneous occupational low-level exposure of shoe workers to a mixture of organic solvents	Case-control study	131	16 (30 control)	55 (30 control)	28–46 (28–51, control)	2020	Shoe industry	Bosnia and Herzegovina	Tox.
White et al. 2014	To characterize work-related asthma by gender	Cohort study	8,239	3,296	4,943	16–<65	1993–2008	Mining, utilities, manufacturing	US	Resp.
Zorba et al. 2013	To explain the relationship between seven occupational dermatoses and several types of work	Epidemiological	4,000	2,550	1,450	—	2006–2012	Metal, plastic, detergent, food industry, footwear artisan, pharmaceutical, and paint manufacturing industry, industrial cleaning workers	Greece	Derm.

Note. Resp. = Respiratory; Uri. = Urinary; Rheu. = Rheumatology; Onc. = Oncology; Derm. = Dermatology; Card. = Cardiology; Oto. = Otorhinolaryngology; Tox. = Toxicology.

Most of the papers analyzed had a predominantly male sample (Ahmed et al., 2022; Bader et al., 2013; Boudigaard et al., 2020; Marinaccio et al., 2018; Micallef et al., 2023; Rana et al., 2021; Riccó et al., 2016; Schaal et al., 2017; Shakik et al., 2019; Troke et al., 2021; Zorba et al., 2013). All studies that specified age described an adult study population with an average age of 35 to 40 years mainly in developed countries on several continents. Most of the papers’ contexts were solely about the chemical industry (Airoldi et al., 2022; Awadalla et al., 2012; Bader et al., 2013; Boudigaard et al., 2020; Iwatsubo et al., 2014; Jaakkola et al., 2021; McElvenny et al., 2018; Peremiquel-Trillas et al., 2019; Prodi et al., 2015; Riccó et al., 2016; Richardson et al., 2013; Robinson et al., 2015;), while some focused on agriculture (Shakik et al., 2019; Sritharan et al., 2019; Troke et al., 2021; White et al., 2014). However, some papers described the field of metallurgy (Zorba et al., 2013), the footwear industry (Umicevic et al., 2022), printing (Santarossa et al., 2020), paint (Micallef et al., 2023), and the textile industry (Marinaccio et al., 2018; Perečinský et al., 2014).

We observed a wide range of areas of health among the studies analyzed (Figure 2): respiratory (Ahmed et al., 2022; Airoldi et al., 2022; Awadalla et al., 2012; Jaakkola et al., 2021; Kaneko et al., 2020; Perečinský et al., 2014; Riccó et al., 2016; White et al., 2014), otorhinolaryngology (Schaal et al., 2017); rheumatology (Boudigaard et al., 2020), urinary (Bader et al., 2013), hepatic disease (Umicevic et al., 2022), cardiology (Robinson et al., 2015; Troke et al., 2021), dermatology (Prodi et al., 2015; Santarossa et al., 2020; Shakik et al., 2019; Zorba et al., 2013), and oncology (Farkas et al., 2016; Iwatsubo et al., 2014; Kaneko et al., 2020; McElvenny et al., 2018; Micallef et al., 2023; Peremiquel-Trillas et al., 2019; Richardson et al., 2013; Robinson et al., 2015; Scarselli et al., 2017; Sritharan et al., 2019; Troke et al., 2021). Oncology and respiratory disorders were the most frequent. Table 2 summarizes the key findings by health discipline.

Figure 2.

Pie chart of the health disciplines related to occupational health injuries and illnesses among women workers in the chemical industry that have been reviewed in this literature search

Table 2.

Sex/Gender-Related Key Findings of Included Articles by Health Discipline

Health discipline	Author/year	Sex/gender-related key findings
Onc.	Farkas et al. 2016	No effect of gender on aneuploid frequency but increases with subjects’ age.
	Iwatsubo et al. 2014	From 1968 to 2006, no significant excess mortality was observed for all causes of death or all cancers. Excess mortality for kidney cancer was only found among women.
	Kaneko et al. 2020	There were four times as many males as females. About 30% of female cases were breast cancer cases, reflecting the low employment rate of women in Japan.
	McElvenny et al. 2018	Among women, there was some indication of exposure-response to asbestos and some indication of excess risks from formaldehyde in the highest exposure categories.
	Micallef et al. 2023	The lifetime occupational exposure prevalences were much higher in men than in women. In both sexes/genders, mesothelioma and lung cancer were the largest cancer sites impacted by the studied occupational agents and circumstances.
	Peremiquel-Trillas et al. 2019	Moderate positive association between occupational exposure to alkylphenolic compounds and breast cancer. No associations with prostate cancer. Stronger association among those who worked frequently exposed and with high intensity of exposure.
	Richardson et al. 2013	Evidence of excess mortality due to bladder cancer, leukemia, mesothelioma, and pleural cancer among males paid hourly. Excess bladder cancer and leukemia among females. Evidence of excess non-Hodgkin’s lymphoma among males in the most recent years of follow-up.
	Scarselli et al. 2017	For women, the profession suffering higher levels of exposure was chemical laboratory technicians working in healthcare. High-risk jobs for men included molding activity among plastic-products machine operators.
	Sritharan et al. 2019	Similar results for men in the same occupation groups as women, which suggests that there could be effects from common occupational factors for both genders.
Resp.	Ahmed et al. 2022	OA was prevalent among female workers with a statistically significant difference (p < .05). Cleaning agent exposure, both at home and at work, enhanced the risk.
	Airoldi et al. 2022	Significantly higher values of positivity were observed for the chemical industry workers (6.9%).No statistical difference was found among gender.Seroprevalence was associated with subjects’ age, geographical location, and occupational sector.
	Awadalla et al. 2012	Compared with the controls, the risk of IPF in male workers was observed to increase significantly in chemical and petrochemical industries, and carpentry and woodworking.
	Jaakkola et al. 2021	In women, a high risk of AA was found among chemical industry workers, waiters and those retired.The risk of NAA was increased in women in rubber and plastic workers, drivers, and dentists and dental workers.In women, a high risk of ACOS was identified among electrical and electronic workers and fur and leather workers.
	Marinaccio et al. 2018	The number of female pleural MM was proportionally higher in the oldest group of cases (>85 years old).By performing an international comparison, a significant correlation was found between the proportion of female MM deaths and the overall mortality rate.
	Pereÿinský et al. 2014	More cases of occupational rhinitis were found in women than in men.In women, a rising trend was recorded with increasing age, while in men, the disease occurred more often at a lower age.
	Riccó et al. 2016	In the univariate analysis and multivariate model, female sex/gender was associated with self-reported olfactory impairment and hyperosmia.
	White et al. 2014	Females with work-related asthma were more likely to be identified through workers’ compensation and less likely to be identified through hospital data.Females were more likely to have work-aggravated asthma and less likely to have new-onset asthma.Agent groups most frequently associated with work-related asthma were miscellaneous chemicals, cleaning materials and indoor air pollutants in females and miscellaneous chemicals, mineral and inorganic dust, and pyrolysis products in males.
Derm.	Prodi et al. 2015	In both sexes/genders, a significant correlation in chemical industry workers was found.There was also a correlation between female artisans and epoxy resin sensitization.
	Santarossa et al. 2020	Contact dermatitis predominantly affects women, even though men have a higher probability of having OCD.
	Shakik et al. 2019	Not reported.
	Zorba et al. 2013	There was no statistically significant correlation between gender and occupational dermatoses, except for dermatoses caused by mechanical injuries afflicting mainly men and for chronic contact dermatitis afflicting mainly women.
Uri.	Bader et al. 2013	The median concentration of UC (urea in urine) was 1.36 g/L, with male employees showing significantly higher values (1.37 g/L) compared to female employees (1.00 g/L).Due to the large number of male employees, their urine samples have a dominant effect on the calculations.The laboratory staff, with a higher proportion of female employees (78%), constitutes the largest subgroup within the female employees, while the most abundant job category among male employees is skilled chemical workers (55%).
Rheu.	Boudigaard et al. 2020	Non-significantly increased risk of SS among women and RA among men.An increased rate ratio of seropositive RA among highly exposed women and seronegative RA among highly exposed men.The risk of SS tended to increase with the duration of employment, mean exposure intensity, and mean exposure probability among women and less so among men.Increasing risk of SS, RA, and SVV following exposure received >10 years earlier among men.
Card.Onc.	Robinson et al. 2015	White male agricultural chemical workers show increased mortality.Need for further studies on potential cardiotoxins.Those in advertising, sales, management, public administration, and finance face elevated leukemia mortality risk.
Card.Onc.	Troke et al. 2021	Female-specific groups across the “metal fabricating industries”, like “metal stamping, pressing, and coating,” consistently had larger excess rates compared to males.Greater associations were detected for female workers in the major level group “rubber and plastics product industries,” compared to males employed in the same sector.
Oto.	Schaal et al. 2017	Gender characteristics among the exposure groups were nearly equal for the high metals/solvent, high noise/metals, and high noise/metals/solvents groups ranging from 88.3% to 89.9% male.
Tox.	Umicevid et al. 2022	All investigated liver function parameters were significant toxicant exposure determinants in male subjects.In the female group, significant exposure predictors were only aspartate aminotransferase and direct bilirubin.

Note. Resp. = Respiratory; Uri. = Urinary; Rheu. = Rheumatology; Onc. = Oncology; Derm. = Dermatology; Card. = Cardiology; Oto. = Otorhinolaryngology; Tox. = Toxicology.

Oncology

We identified several findings concerning the studies on oncological diseases in the chemical industry. Studies like those by Sritharan et al. (2019), Peremiquel-Trillas et al. (2019), and Kaneko et al. (2020) highlighted the prevalence of breast cancer in both sexes/genders. Work-related exposure to alkylphenolic compounds in the chemical industry has been associated with this type of cancer, especially in female workers who are exposed to them frequently and at a high intensity (Peremiquel-Trillas et al., 2019). Kaneko et al. (2020) broadened the research spectrum to various types of cancer (pancreatic, liver, and lung cancer), observing risk differences in the Japanese manufacturing industry, which requires specific prevention strategies.

Marinaccio et al. (2018) identified a high proportion of female pleural mesothelioma in women over 85-year-old, yet with limited information available in comparison with data about men. Richardson et al. (2013) pointed to excess mortality from several cancer types, including mesothelioma and lung cancer, associated with specific chemical agents and occupational circumstances in the chemical industry. Iwatsubo et al. (2014) found excess mortality from kidney cancer among exposed women working in a French chemical plant. McElvenny et al. (2018) suggested that occupational exposure to mineral oil could be associated with an elevated risk of meningioma, and Robinson et al. (2015) identified increased risks of leukemia in agricultural chemical industry employees, especially white men.

Scarselli et al. (2017) drew particular attention to occupational exposure to formaldehyde—a recognized human carcinogen—with higher risks in the health sector and the wood-processing industry. Farkas et al. (2016) explored genetic alterations like aneuploidy and hypodiploidy related to the development of cancer without reaching sex/gender-specific conclusions or direct associations with exposure in standard working environments.

These findings emphasize the complex relationship between occupational exposure in the chemical industry and the risk of developing different types of cancer, highlighting the importance of specific prevention strategies and regulations in this sector.

Respiratory Illness

We discovered several findings in recent studies about respiratory disorders.

A study discussed three sub-types of asthma in adults finding sex/gender and occupation-based differences. A high risk of atopic and non-atopic asthma in different occupations was identified with variations between men and women (Jaakkola et al., 2021).

Another recent study compared socio-demographic and employment characteristics with an increased risk of developing occupational asthma in detergent and cleaning product factories. It highlighted a significant association with the female sex/gender (Ahmed et al., 2022). A previous study characterized work-related asthma by sex/gender stating that women were more likely to be identified through workers’ compensation, and they showed differences in clinical presentation compared to men (White et al., 2014).

Occupational rhinitis, the precursor of occupational asthma, showed a higher incidence in the food, textiles and agriculture industries, being more frequent among women. Its prevalence increased with age in women, while in men, it decreased in older age groups (Perečinský et al., 2014).

Sex/gender differences were observed concerning self-reported olfactory impairment in abrasive industry workers who had experienced occupational exposure. Women showed a higher frequency of hyperosmia, while self-reported anosmia was more common in both sexes/genders (Riccó et al., 2016).

The risk of Idiopathic Pulmonary Fibrosis (IPF) rose significantly in male workers in the chemical and petrochemical, carpentry, and woodwork industries, while agriculture was a risk factor among female workers. Occupational exposure to wood dust and wood preservatives was also associated with the risk of IPF in both sexes/genders (Awadalla et al., 2012).

An association between age, geographical location, and occupation sector was found without statistically significant sex/gender differences for the seroprevalence of Immunoglobulin G (IgC) in the chemical industry (Airoldi et al., 2022).

These studies highlight the importance of considering specific occupational and gender-based risk factors in respiratory diseases contributing to a more comprehensive understanding of the risks associated with different work-related contexts.

Dermatology

Studies about dermatology mainly discussed issues related to occupational dermatitis.

A significant correlation was found between sensitivity to epoxy resins and suspected contact dermatitis in mechanics, carpenters, and chemical industry workers of both sexes/genders. This relationship was also observed among farmers, fishermen, construction workers, and unemployed people, but only in men (Prodi et al., 2015).

In Greece, occupational dermatitis (OD) showed a high prevalence, and although no significant correlation with sex/gender was found, the dermatoses caused by mechanical injuries mainly affected men, while chronic contact dermatitis mainly affected women (Zorba et al., 2013). Other studies also suggest that men are more likely to develop occupational dermatitis (Santarossa et al., 2020).

A study about Ontario’s Occupational Disease Surveillance System identified expected associations between occupation, industry, and dermatitis risk. The study’s cohort—made up mainly of men with an average age of 39.5 years—showed a statistically significant increased risk in specific occupations, such as social sciences, crafts, and equipment operations, as well as manufacturing industries, with an elevated risk (10% or more) of contact dermatitis (Shakik et al., 2019).

These studies highlight the importance of considering occupational and gender-based factors when addressing occupational dermatitis, providing valuable information about correlations and risks associated with different worker groups.

Other Health Disorders

We also identified significant results in the areas of health classified as “Others,” indicating the following sex/gender differences. In a study (Bader et al., 2013) whose sample included and analyzed sex/gender differences, although a high percentage of men were recognized to mainly be skilled chemical workers, compared to a small percentage of women with a greater laboratory presence and a lower body mass index (BMI), they detected low levels of creatinine in both sexes/genders (1.4 g/L), with a lower median concentration of urinary creatinine in women, and with a closer range compared to male employees. However, they would be within the ranges outlined by the World Health Organization (1996; 0.3–3.0 g/L).

An increased risk of systemic sclerosis was found with employment duration, mean exposure intensity, and mean exposure probability, particularly among women. Among men, an increased risk of systemic sclerosis, rheumatoid arthritis, and small-vessel vasculitis related to accumulative styrene exposure was observed (Boudigaard et al., 2020).

One study highlighted a significantly elevated risk of acute myocardial infarction (AMI) among men employed in the coal mining industry. Another study identified the elevated AMI risks in select groups of women, such as those who transport, manufacture and process metals, textiles, and rubber and plastic products. The authors suggested a need for follow-up studies to identify possible cardiotoxic elements in the agricultural chemical product and supplies industry (Robinson et al., 2015; Troke et al., 2021).

One study highlighted the sex/gender differences in groups exposed to metals, solvents, and noise. The proportion of men was higher in groups with high exposure to metals/solvents and high exposure to noise/metals/solvents (88.3%–89.9%). The group with the lowest proportion of men was high noise exposure (73%; Schaal et al., 2017).

Results were reported by sex/gender in the field of hepatotoxicology. The study identified that liver function parameters—gamma-glutamyl transpeptidase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin direct—were significant toxic exposure factors in men. In women, the most important exposure predictors were AST and bilirubin direct. Multivariate logistic regression analysis showed that bilirubin direct was the most important predictor of exposure in shoe factory workers, regardless of sex/gender (Umicevic et al., 2022).

These results underline the importance of considering sex/gender differences when assessing health in “Other” areas of health fields, providing valuable information to understand the risks and specific associations in different occupational populations.

Discussion

The literature we reviewed showed that working in the chemical industry is a health determinant, for example, in developing occupational asthma, dermatitis, or cancer, as Micallef et al. (2023) and Valls-Llobet (2018) reported.

On analyzing the publications in this scoping review, we found that they do not include a gender perspective. Instead, they report and analyze results only considering the sex/gender variable, associating differences to employment type and not the physiological differences between men and women. They also do not mention the need for sex/gender-based risk prevention programs. Consequently, the studies do not analyze or discuss if the sex/gender differences are due to the physiological characteristics of men and women or the way symptoms are disclosed due to sociocultural beliefs regarding masculinity/femininity. Furthermore, they do not follow any of the criteria included in the “Guide to including a gender perspective in health research” (Escuela Andaluza de Salud Pública, 2010) which is a useful tool for quickly detecting poor gender perspective practice, as is often the case in scientific writing.

While there are very few studies that highlight sex/gender differences in the chemical industry, several make it a point of discussion. There is a higher frequency of occupational rhinitis among women—although the study does not explore the reasons—and more reports of olfactory disorders in women (Perečinský et al., 2014). This could be because women pay more attention to their health (Li et al., 2023; Varì et al., 2016).

In the case of meningioma, there are anthropometric differences between men and women, such as muscle mass or hormone replacement therapy (McElvenny et al., 2018).

An increased risk of acute myocardial infarction (Robinson et al., 2015) and cancer was observed in women (Peremiquel-Trillas et al., 2019) after they began entering traditionally male-dominated professions.

Iwatsubo et al. (2014) describe the need for studies on kidney cancer in women, given that the researchers suggest that the women in the study did not share work areas or undertake similar tasks. To this end, they did not extract a hypothesis of occupational etiology. One study on the urinary system expects a larger sample of males, the predominant sex/gender in an industrial production plant, and highlights significant differences in BMI and urinary creatinine concentrations in both sexes/genders (Bader et al., 2013).

Studies discuss the importance of long-term monitoring of former nuclear workers to understand the range of possible occupational health problems associated with effects related to production activities in the nuclear weapons industry, particularly to identify long-latency diseases and occupational exposure with lasting effects (Richardson et al., 2013). However, they do not refer to the need for a segregated analysis with a gender perspective.

Only one article affirms the need to include a gender perspective in studies on occupational risks in the chemical industry (Marinaccio et al., 2018). The lack of a gender perspective when analyzing occupational health in the chemical industry could give rise to emerging risks and new challenges for female workers’ health and safety. To this end, information on health security, education, and occupational health awareness in workers and employers must be adapted to this new context, striving to ensure safe and healthy workplaces for both sexes/genders in the future.

Implications for Occupational Health Nursing Practice

The implications of this scoping review on the chemical industry for occupational health nursing practice highlight the need for a more comprehensive approach that includes both a gender perspective and the consideration of sex differences.

Although health determinants, like the development of asthma, dermatitis, and cancer, were identified, a lack of gender analysis in the studies we reviewed was apparent. Nursing professionals are therefore encouraged to advocate for a gender perspective, considering physiological, socio-cultural, and gender role differences.

Specific findings for women in the chemical industry, such as a higher prevalence of occupational rhinitis and olfactory disorders, require more targeted attention in occupational risk prevention and management. The differences attributed to anthropometric characteristics and hormone replacement therapy highlight the importance of adapting occupational health checks. The change in gender roles is also associated with risks like increased risk of acute myocardial infarction and cancer in women. Nursing care must focus on awareness and supporting these occupational transitions. In the nuclear industry, the importance of long-term monitoring is recognized but the lack of segregated sex/gender analysis is highlighted. Including a gender perspective is therefore vital to fully understand the health effects. Studies must also consider whether differences are due to women’s double burden or men doing more physical work, both of which are underlying sex/gender disparities. In short, occupational health nursing practice needs to take on a more inclusive approach, considering the particularities of men’s and women’s health in the chemical industry.

Finally, interdisciplinary collaboration between nursing and other scientific fields emerges as a promising approach to promote innovation and best practices in occupational health care.

In Summary

The scoping review emphasizes the need for an integrated approach in occupational health nursing within the chemical industry, urging the inclusion of a gender perspective.

Despite identifying health determinants, such as asthma and cancer, a lack of gender analysis in the reviewed studies highlights the necessity for nursing professionals to advocate for a comprehensive consideration of physiological, socio-cultural, and gender role differences.

Specific health findings for women in the chemical industry, such as a higher prevalence of occupational rhinitis and olfactory disorders, require focused attention in occupational risk prevention. Differences in anthropometric characteristics and hormone replacement therapy emphasize the need for adapted occupational health checks.

Changes in gender roles, linked to increased risks of acute myocardial infarction and cancer in women, underscore the importance of nursing care in supporting individuals through occupational transitions.

Footnotes

Acknowledgements

The assistance of Ana María Pedraza during the development of this work is highly appreciated.

Author Contributions

All authors have made a substantial contribution to this manuscript: Conceptualization, Methodology, Formal Analysis, Investigation, Writing-Original Draft, Writing-Review & Editing. CA: Conceived the original idea, Supervision. AAR: Funding Acquisition. ILT, DTE: Data Curation. RRS: Visualization. All authors read and approved the manuscript.

Conflict of Interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors kindly acknowledge the financial support from the Andalusian Regional Government (Department of University, Research and Innovation) 2022 Research Incentive Program (2022/CTS-979).

ORCID iDs

Rocío Romero-Serrano

Carmen Arnaiz

Dolores Torres-Enamorado

Inmaculada Lancharro-Tavero

Almudena Arroyo-Rodríguez

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