Work- and hydration-related health outcomes prevalence among USA construction workers: evidence from the national...

Construction workers face elevated risks of heat-related illnesses, yet hydration and rest break policies remain inconsistent across regions and are not federally mandated.

To evaluate the association between occupational conditions and hydration-related health outcomes among national construction workers, focusing on regional disparities and policy relevance amid increasing ambient temperatures.

We analyzed 2023 National Health Interview Survey data, focusing on adults employed in the construction industry (n = 1,231) versus other industries (n = 16,241). We assessed participant self-reported back pain, diagnosed fatigue, cognitive difficulty, injury, and general health, while using regional indicators with higher temperatures, and the 2023-2024 national record-breaking heatwave, as hydration proxies. Weighted descriptive statistics, multivariate regression models, and sensitivity analyses were used to examine associations.

West region construction workers had the largest negative associations with back pain (β = -0.18), injury (β = -0.52), cognitive difficulty (β = -0.15), and better general health (β = -0.09), followed by the Midwest and Southern region workers for back pain and better general health. Workers' race, sex, educational attainment, Body Mass Index (BMI), and marital status play a crucial role in workers' reported health outcomes, with non-Hispanic Asians at higher odds of severe back pain, fatigue, and cognitive difficulty.

Hydration access is a critical, yet underregulated factor in preventing heat-related health outcomes in occupational settings across the USA. There is an urgent need for enforceable national standards mandating water and rest breaks for construction workers, particularly in high-heat regions given recent policies that have removed water breaks in the Southern region.