International Journal of Hygiene and Environmental Health
International Journal of Hygiene and Environmental Health
International Journal of Hygiene and Environmental Health
Review
A R T I C L E I N F O A B S T R A C T
Keywords: Introduction: Airport apron workers are occupationally exposed to jet exhaust and major concern is related to the
Airport workers exposure to ultrafine particles (UFP) from aircrafts. To date, little attention has been given to occupational
Apron exposures to aircraft-related UFP, although aircraft engines have high emissions of ultrafine particles, which are
Air pollution
orders of magnitude higher than residential exposure. UFP could possibly contribute to the development of
Ultrafine particles
Health
cancer, heart disease, mental illness, and respiratory symptoms. In addition to particulate matter, apron workers
are exposed to other polluting substances associated with vehicles, aircraft exhaust or direct fuel emissions.
Methods: We performed a scoping review on occupational health hazards due to air pollution among apron
workers.
Results: Only three epidemiological studies were identified: two cross-sectional studies are of limited relevance
due to a small sample size and a lack of quantitative exposure data. One sizeable cohort study performed an
individual exposure measurement for UFP and considered relevant confounders. However, current studies are
not numerous enough to evaluate an association of occupational air pollution with potential health effects among
airport workers.
Conclusions: The results suggest that current scientific evidence on this topic is sparse. Further observational
studies in this occupational work force is highly recommended. For a better understanding of adverse health
effects due to air pollution and especially UFP, studies in different countries are essential, since working envi
ronments, medical monitoring of workers or safety standards might differ internationally.
1. Introduction nervous system ((HEI Review Panel on Ultrafine Particles, 2013; Hudda
and Fruin, 2016). Toxicological studies suggest that UFP exert a higher
Apron workers represent the ground personnel of airports and they toxicity per mass unit than larger particles and may possibly contribute
are asked to perform tasks such as aircraft fuel tanking, aircraft parking to the development and progression of various diseases ((HEI Review
or baggage handling. Due to their working environment, they are Panel on Ultrafine Particles, 2013; Ohlwein et al., 2019), such as cancer,
exposed to a mixture of air pollutants potentially harmful for human heart disease, mental disease, and respiratory symptoms, thereby
health (The Danish Ecocouncil, 2012). Among these potentially harmful increasing the risk of serious work-related illness and premature death
pollutants ultrafine particles (UFP, particles smaller than 100 nm in (Breysse et al., 2013). Despite possible adverse health effects, only few
aerodynamic diameter) are included (HEI Review Panel on Ultrafine airports monitor UFP (The Danish Ecocouncil et al., 2012).
Particles, 2013; Stacey, 2019). Due to their smaller size, UFP can be UFP in the air field can originate from aircrafts engines as well as
inhaled into the lungs deeper than other particles, until the from other combustion processes (e.g. motor vehicle emissions from
gas-exchanging region. From this region, UFP can enter the systemic cars, trucks and other diesel powered engines) (Touri et al., 2013).
circulation and diffuse into all organ systems including the brain and Aircraft-generated UFP are typically smaller (mean diameter of 10–20
* Corresponding author. Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Universitätsmedizin Mainz, 55101 Mainz, Germany .
E-mail address: hmerzeni@uni-mainz.de (H. Merzenich).
https://doi.org/10.1016/j.ijheh.2020.113649
Received 30 April 2020; Received in revised form 17 August 2020; Accepted 15 October 2020
Available online 25 October 2020
1438-4639/© 2020 Elsevier GmbH. All rights reserved.
H. Merzenich et al. International Journal of Hygiene and Environmental Health 231 (2021) 113649
Table 1
Description of epidemiological studies on health effects due to air pollution among apron workers at civil airports.
Reference Location Study Exposed group Control group(s) Exposure/Exposure assessment/ Selected results
design Health outcomes
Tunnicliffe Birmingham Cross- N = 53 baggage handlers, N = 86 terminal and office Aircraft fuel, jet exhaust Cough with phlegm:
et al. International sectional airport hands, marshallers, workers Job titles: categorisation according OR = 3.5 (95%CI
(1999) Airport (UK) operational engineers, to estimated time of exposure per 1.23–9.74)
fitters, engineering working day. High vs. medium
technicians (high exposure Respiratory and pulmonary exposure.
group) function. Irritative symptoms Runny nose:
N = 83 security staff, fire (questionnaire, medical OR = 2.9 (95%CI
fighters, airfield operations examination) 1.32–6.40)
managers (median exposure High vs. medium
group) exposure.
Yang et al. Taiwan Cross- N = 106 airport workers N = 305 security staff, Aviation fuel or jet stream exaust Cough:
(2003) Kaohsiung sectional (fuel handlers, baggage airfield operation Occupational groups according to OR = 3.41 (95%CI
International handlers, operational managers, clerks, proportion of time with direct 1.26–9.28)
Airport (TW) engineers, marshallers, accountants, maintenance exposure. Exposed vs. control
fitters, airport hands, personnel, terminal or Chronic respiratory symptoms and Dyspnoea:
engineering technicians) office workers acute irritative health effects OR = 2.34 (95%CI
(questionnaire) 1.05–5.18)
Exposed vs. control
Møller et al. Copenhagen Register- N = 6,629 baggage handlers N = 62,546 men in UFP Ischemic heart disease:
(2017) Airport (DK) based or other apron workers. unskilled positions Subgroup of 30 employees from five IRR = 1.0 (95%CI,
Møller cohort Employment period working indoors at largest occupational groups: 0.98–1.02)
et al. study 1990–2012 Copenhagen Airport or individual UFP-monitoring and (apron years,
(2020) men working in the greater (GPS-based) assessment of time continuous)
Copenhagen area. spent at the apron. For the entire Cerebrovascular
Employment period cohort: apron time as proxy for UFP disease:
1990–2012 exposure; IRR = 1.00 (95%CI
Incident cancer and cardiovascular 0.97–1.03)
disease, respiratory diseases, (apron years,
musculo-skeletal disorders, continuous)
mortality Additional published
results on musculo-
skeletal disorders are not
presented here.
CI Confidence Interval; GPS, Global Positioning System; IRR, Incidence Rate Ratio; OR, Odds Ratio; UFP, Ultrafine particles; VS. versus.
nm) than road traffic-related UFP (mean diameter of 30–40 nm). basis of official job titles into three exposure categories depending on
In addition to UFP, other polluting substances associated with ve their likely exposure to aircraft fuel or jet stream. A questionnaire on
hicles, aircraft exhaust or direct fuel emissions are volatile organic respiratory symptoms, smoking and demographic variables was sent out
compounds including polycyclic aromatic hydrocarbons, inorganic to 323 randomly selected airport employees. A total of 222 (69%)
gases like sulphur dioxide and nitrogen oxides. These substances are completed the study. Among them, 53 were classified as highly-exposed
related with respiratory health, irritative symptoms or cardiovascular group, 83 and 86 were in the medium- and low-exposure category,
disease (The Danish Ecocouncil et al., 2012; Touri et al., 2013). It is respectively. Although neither spirometry nor skin prick test demon
estimated that worldwide more than 2,000,000 civilian and military strated a difference between groups, it was shown that among male
personnel are occupationally exposed to jet propulsion fuel (Møller workers, high exposure was significantly associated with runny nose and
et al., 2017). Hence, it is important to elicit the number of observational cough with phlegm (Table 1). The results were adjusted for age and
studies, which investigate possible health outcomes due to exposure to smoking. The study yielded no evidence for an association between jet
air pollution in this occupational setting. pollutants and symptoms of occupational asthma.
In another cross-sectional study, self-reported respiratory and irri
2. Methods tative symptoms in workers of the Taiwan Kaohsiung International
Airport (KIA) were investigated (Yang et al., 2003). The study base (n =
We performed a scoping review on occupational health hazards due 880) comprised all current airport staff except contract workers and
to air pollution among apron workers at civil airports. We searched airline employees. A questionnaire on chronic respiratory symptoms and
PubMed until March 2020 and selected observational studies on airport acute irritative health effects was applied (response rate: 78%). After
personnel and UFP. Furthermore, we searched also the reference lists of exclusion of uneligible persons, the final analysis included 106 workers,
the identified original articles and reviews. In concordance with the who were directly exposed to jet stream or fuel (high-exposed group),
conclusion of Møller et al. (2017), only few studies investigated the and 305 terminal or office workers (low-exposed group). Chronic res
relation between UFP exposure among airport employees and adverse piratory symptoms like cough and dyspnoea were significantly more
health effects. prevalent among the exposed group after adjustment for age, smoking,
education and previous occupational dust or fume exposures (Table 1).
3. Results These results were well in line with the findings of the British study
(Tunnicliffe et al., 1999). The prevalence rates for acute irritative
Table 1 reports the results of the scoping review. Three studies were symptoms were not significantly different between exposure groups.
identified. Both studies were limited by a small number of participants and a
The effect of occupational exposure to aircraft fuel and jet exhaust on lack of quantitative exposure data (Tunnicliffe et al., 1999; Yang et al.,
respiratory and pulmonary function was first investigated in workers of 2003). Categorisation of workers into a high and low exposure group
the Birmingham International Airport (UK) (Tunnicliffe et al., 1999). In was based on job titles, but not on measurements or a standardised
this cross-sectional survey, 680 fulltime workers were classified on the job-exposure-matrix. Hence, specific health effects due to combustion
2
H. Merzenich et al. International Journal of Hygiene and Environmental Health 231 (2021) 113649
Table 2
Description of exposure studies related to emissions associated with airports’ activities.
Reference Location of the study Collected data and primary site Control site (if Selected results
present)
Hudda et al. (2014) Los Angeles Particle number concentrations downwind from Freeways adjacent Airport particle number emissions exceeded 75,000
International the Los Angeles International Airport. to the airport. particles/cm3, more than the average freeways.
Airport, LAX, USA.
(Hudda and Fruin, Los Angeles Particle size distributions and spatial pattern of Local background The smaller the size of particles, increased lung
2016) International particle number/particle surface area vs. increasing deposition fractions were observed: increase in
Airport, LAX, USA. concentrations distance alveolar-lung deposited surface area concentrations
2–3 km downwind from LAX, decreasing to a twofold
increase 18 km downwind.
Keuken et al. (2015) Schiphol Airport, Total and size-resolved particle number A regional Air traffic contributes to elevated particle number
AMS, the concentration and black carbon at a monitoring background site. concentration downwind of the airport (3x), but not to
Netherlands. site near Schiphol. the mass concentrations of black carbon.
Stafoggia et al. Ciampino Airport, Particle number concentration at together with NP Particle number concentration was estimated to
(2016) CIA Italy. meteorological data, at a sampling site located increase of 5400 particles/cm3/min 15′ before and
southwest of the airport. after take-offs, with a peak of 19,000 particles/cm3/
min 5′ after take-offs. During landings, same figures
were 1300 and 1000 particles, respectively.
Shirmohammadi Los Angeles Particle number, mean particle size, CO2, black Freeways adjacent Particle number, black carbon, and PM2.5 were 11, 2.5,
et al. (2017) International carbon and PM2.5 at a sampling site 150 m to the airport. and 1.4 times greater than those from the freeways.
Airport, LAX, USA. downwind of the south runways of the airport.
Masiol et al. (2017) Heathrow, Ultrafine particle counts and size, black carbon General road Heathrow airport accounts for 30–35% of total
LHR, England. and PM2.5 over two sampling campaigns (warm traffic in London. particles in both seasons. Fresh (24–36%) and aged
and cold season) together with air pollutants and (16–21%) road traffic emissions and urban
weather data. accumulation from London (around 10%) represent
other main contributors.
Reference Location of the study Collected data and primary site Control site (if Selected results
present)
(Hudda et al., Logan International Ultrafine particle number concentrations from 16 NP Evidence of aviation-related particle infiltration. Median
2018) Airport, BOS, USA residences located in two study areas in the greater outdoor particle number concentration were 19,000 and
Boston metropolitan area (MA, USA) 10,000 particles/cm3 and median indoor particle number
concentration were 7000 and 4000 particles/cm3.
Rose and Frankfurt Airport, Ultrafine particle pollution in two sites in the NP At one site, the total concentration during the day averages
Jacobi FRA, Germany vicinity of Frankfurt Airport. between 4300/cm3 and 5200/cm3. At night the total
(2018) concentration is about 10–30% lower than during the day.
At the other site, when the wind blows from the direction of the
airport, the total concentration averages about 18,000/cm3,
whereby the particles with sizes from 10 nm to 30 nm alone
account for about 75% of the total concentration. During the
night, the major decrease in small particles concentration was
observed when the wind blows from the direction of the
airport, thus leading to a decrease in the total concentration of
about 75%.
Lopes et al. Lisbon Airport, LA Ultrafine particle counts concentrations in several Sites under the Results show high positive correlations between particle
(2019) (Portugal) sampling sites in the vicinity of LA landing or take- number concentration values and the number of flights (r =
off path. 0.90). Furthermore, air traffic enhances particle number
concentration values downwind to the airport, especially for
take-offs.
NP Not Present.
exhaust or jet fuel, to particulate matter, volatile organic compound The cohort was linked with national registries to identify potential
(VOCs) or other components of jet-related pollutants could not be dis health effects for each individual: incident cancer and cardiovascular
entangled. Furthermore, health outcomes were assessed with disease, respiratory diseases, musculoskeletal disorders and mortality
self-administered questionnaires. Thus, reporting bias could not be data. In addition, information on potential confounders was collected.
excluded. Finally, cross-sectional studies can only be used to describe Lifestyle data were assessed with a questionnaire survey or telephone
the prevalence in differently exposed groups. Other study designs are interview. Furthermore, traffic-related air pollution exposure at the
more suitable for investigating causal relationships. residence of each cohort member was assessed (Møller et al., 2017). The
The large Danish register-based cohort study with Copenhagen investigators found no associations between cumulative apron-years and
Airport workers (Denmark) overcame mostly all these disadvantages incidence of ischemic heart disease or cerebrovascular disease during a
(Møller et al., 2017). The cohort considered men in unskilled jobs mean follow-up of 14.4 years (Møller et al., 2020). However, at baseline,
employed at Copenhagen airport between 1990 and 2012. The exposed the median age for the reference group and the exposed group was 31
group (n = 6629) included baggage handlers or other outdoor workers and 28 years, respectively and therefore the study population might
on the apron. A reference cohort (n = 62,546) considered men in un have been too young to observe enough events (n = 221 among the
skilled positions working indoors at Copenhagen Airport and men exposed). An extended follow up might yield further knowledge
working in the greater Copenhagen area. Compared to the previous regarding the relationship between occupational UFP exposure and CVD
ones, this study includes an individual exposure estimation for a specific among apron workers.
component of air pollution: for a subgroup of workers from the five
largest occupational groups, personal monitoring of UFP was performed 4. Discussion and conclusions
and combined with an assessment of “time spent on the apron”, which
was projected to the entire cohort (Møller et al., 2017). Environmental air pollution and traffic related pollution have
3
H. Merzenich et al. International Journal of Hygiene and Environmental Health 231 (2021) 113649
obtained considerable attention as a risk factor for respiratory and car Acknowledgments
diovascular disease in the general population. In the EU, yearly
300–500,000 premature deaths are caused by pollution with fine par The authors declare consent for publication.
ticles. For UFP, however, evidence is still scarce and the available evi
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