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In Queensland, Australia, an industry-wide screening program reported 270 cases( 25.6 %) among 1,054 stonemasons who had voluntarily undergone assessment as of June 2025. 20 In the United States, chest radiography and spirometry screening at one fabrication company identified silicosis in 12 % of current workers, 21 likely an underestimate given the low sensitivity of chest radiographs compared to computed tomography( CT). 22 In many countries, inadequate medical screening and public health surveillance programs further obscure the true burden; 5 in the United States alone, with an estimated 100,000 fabrication workers, tens of thousands of silicosis cases may emerge in the coming years.
21, 23
AS silicosis is often diagnosed in relatively young workers from minority, migrant, or immigrant communities after relatively short durations of exposure( approximately 5-20 years). In California, USA, most affected workers are Spanish-speaking immigrants from Mexico or Central America, with one case series reporting 51 of 52( 98 %) patients as Latino immigrant men. 4 Similar patterns have been described globally: in the United Kingdom, 6 of 8( 75 %) affected workers were foreign-born, 6 while in Australia, more than half( 50.7 %) of screened stone countertop workers were born outside the country, with a higher proportion among those with confirmed silicosis( 57.9 %) compared to unaffected workers( 43.5 %). 8 In the Chinese case series of 865 patients with AS silicosis seen at the Shanghai Pulmonary Hospital, 92.7 % were domestic migrant workers from rural to urban areas. 7 By comparison, the vulnerability of Spanish AS industry workers arose not from migrant status, but from the distinctive socio-economic conditions associated with the construction boom. From the late 1990s until the 2008 financial crisis, rapid economic expansion drove an exceptionally high consumer demand for AS. As a result, Spanish workers experienced substantial exposure to AS dust. They routinely undertook long, intensive workdays— often exceeding 10 hours and including unpaid overtime— within a poorly regulated sector, where informal, unrecorded labor practices had become normalized. 10
Immigrant workers, particularly those without legal residency status, face disproportionate occupational risks 24 and are often concentrated in insecure forms of employment, including work as self-employed contractors or within informal, cash-based labor markets. As a result of this insecure employment, workers shoulder disproportionate risks while having limited access to social protections and to effective occupational health, safety, and regulatory safeguards. 25 Precarious employment results in greater risk-taking among workers and a decreased willingness to report unsafe conditions; this may be further accentuated by education and language barriers, as well as a lack of awareness of their employers’ responsibilities to comply with occupational health and safety laws. Internal migrant workers in China have also been shown to receive lower wages, be routinely exposed to hazardous working conditions with insufficient protection, and be systematically excluded from government public benefit systems. 26
The vulnerabilities of immigrant and migrant workers are particularly concerning in an industry that fabricates AS countertops, with the high potential for generating toxic dust in workplaces. 27 In China, silica dust concentrations at unlicensed processing and installation sites substantially exceeded occupational exposure limits. 7 A similar lack of adequate dust control measures has been reported elsewhere: in California, only 25 % of affected workers reported consistent respirator use, and 45 % reported using water suppression, 4 while in Australia, 61.1 % of workers were very frequently or always exposed to dry cutting. 8
Qualitative studies in Spain and California further describe hazardous conditions, including dry cutting, inadequate ventilation, limited personal protective equipment, and visible dust accumulation, with installation work often carried out in poorly ventilated kitchens or within enclosed plastic sheeting, with the inability to use wet methods in homes. 9, 10 These studies also highlighted profound gaps in worker protection: only 1 in 20 California participants had formal safety training, while most instead relied on informal learning, and many perceived employer apathy toward safety or even threats of retaliation for raising concerns. 9 Access to health surveillance was limited despite regulatory requirements, a finding confirmed by multiple workplace investigations. 21, 28, 29 Workers frequently expressed a desire to leave the trade due to safety risks but felt constrained by immigration status, language barriers, and financial dependence on their specialized skills. 9, 10 Together, these findings illustrate the intersection of hazardous exposures and social vulnerability, underscoring the urgent need for targeted preventive interventions.
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