Environ Geochem Health (2023) 45:5961–5979
https://doi.org/10.1007/s10653-023-01611-x
ORIGINAL PAPER
Monte Carlo‑based probabilistic risk assessment for cement
workers exposed to heavy metals in cement dust
Abbas Jafari · Somayeh Asadyari ·
Zahra Moutab Sahihazar ·
Mohammad Hajaghazadeh
Received: 14 January 2023 / Accepted: 5 May 2023 / Published online: 17 May 2023
© The Author(s), under exclusive licence to Springer Nature B.V. 2023
Abstract This study assessed the carcinogenic and
non-carcinogenic health risks of cement plant work-
ers exposed to chromium (Cr), arsenic (As), cadmium
(Cd), and lead (Pb) in cement dust using a probabil-
istic approach. Air samples were collected according
to NIOSH 7900 and OSHA ID-121 methods and ana-
lyzed by an graphite furnace atomic absorption spec-
trometer. The EPA inhalation risk assessment model
and Monte Carlo simulation were utilized to assess
the health risks. Sensitivity analysis was used to
determine the influencing parameters on health risk.
The average concentrations of As and Pb exceeded
the occupational exposure limit (OEL), reaching a
maximum of 3.4 and 1.7 times the OEL, respectively,
Supplementary Information The online version
contains supplementary material available at https://​doi.​
org/​10.​1007/​s10653-​023-​01611-x.
A. Jafari
Cellular and Molecular Research Center, Cellular
and Molecular Medicine Research Institute, Urmia
University of Medical Sciences, Urmia, Iran
e-mail: abbasj63@gmail.com
S. Asadyari · Z. Moutab Sahihazar · M. Hajaghazadeh (*)
Department of Occupational Health, School of Public
Health, Urmia University of Medical Sciences, Urmia, Iran
e-mail: hajaghazadeh.m@umsu.ac.ir
S. Asadyari
e-mail: somaye.yari73@gmail.com
Z. Moutab Sahihazar
e-mail: moutab.z@gmail.com
in the cement mill. Individual metals’ cancer risk
exceeded the 1E–4 threshold in ascending order of
Cd < As < Cr. The mean cancer risk of Cr ranged
from 835E-4 (in raw mill) to 2870E-4 (in pre-heater
and kiln). Except for Cd, the non-cancer risk of met-
als exceeded the standard (hazard index, HQ = 1) in
the ascending order of Pb < As < Cr. The mean HQ
of Cr ranged from 162.13 (in raw mill) to 558.73 (in
pre-heater and kiln). After adjusting for control fac-
tors, the cancer and non-cancer risks remained over
the respective recommended levels. Sensitivity analy-
sis revealed that the concentration of Cr was the most
influential parameter on both carcinogenic (78.5%)
and non-carcinogenic (88.06%) risks. To protect
the health of cement factory employees, it is recom-
mended to minimize cement dust emissions, imple-
ment job rotation, and use raw materials with low lev-
els of heavy metals.
Keywords Cement industry · Heavy metals · Non-
cancer risk · Cancer risk · Monte Carlo simulation ·
Probabilistic risk assessment
Abbreviations
AT Average time
ADD Average daily dose
BW Body weight
CSF Cancer slope factor
ED Exposure duration
Ef Exposure frequency
t Exposure time
Vol.: (0123456789)
13
 5962
HI Hazard index
HQ Hazard quotient
IARC​ International agency for research on cancer
IR Inhalation rate
LADD Lifetime average daily dose
NIOSH National institute for occupational safety
and health
OSHA Occupational Safety and Health
Administration
QRA Quantitative risk assessment
R Cancer risk
RFC Reference concentration
Rt Total cancer risk
TWA​ Time-weighted average
USEPA United states environmental protection
agency
Introduction
Cement is an important adhesive in the construction
industry and mainly used to produce concrete. It is
produced worldwide in large quantities. Cement pro-
duction is projected to increase from 4.41 Gtonne.
yr−1 in 2020 to 5.00 Gtonne.yr−1 in 2030 (A blueprint
for a climate friendly cement industry [Internet].,
2008.Available from:https:, , wwf.panda.org, wwf_
news, 151621%2FA-blueprint-for-a-climate-friendly-
cement-industry. 2008). The cement industry is one
of the main industries of Iran, and its production has
increased significantly from 24 million tons in 2001
to 58 million tons in 2011. It accounts for 53 million
tons of domestic demand in addition to 6.9 million
tons of exports. Cement is mainly produced by dry
process in Iran, accounting for 97% of total produc-
tion. Three types of cement including ordinary Port-
land cement (OPC), Portland slag cement (PSC), and
Portland Pozzolana cement (PPC) are produced in
Iran (Ansari & Seifi, 2013).
Cement raw materials are obtained by blasting
rock quarries. The raw material is broken into small
particles at the plant and calcined in a pressured rota-
tory furnace at around 1400 degrees Celsius to pro-
duce clinker. The clinker is then ground with certain
minerals to form Portland cement (Etim et al., 2021).
Some trace elements such as chromium (Cr), cobalt
(Co), cadmium (Cd), nickel (Ni), zinc (Zn), lead (Pb),
arsenic (As), and copper (Cu) are present in the raw
Vol:. (1234567890)
13
Environ Geochem Health (2023) 45:5961–5979
materials used in the cement production (Achtern-
bosch et al., 2005).
Cement production is one of the most pollut-
ing industries due to the presence of stationary and
mobile sources in cement plants. During the produc-
tion and transport of cement, uncontrolled emissions
of gaseous and particulate matter are discharged into
the environment. Stock piles, quarrying, raw material
transportation, kiln operation, clinker cooling, and
milling are among the major sources of particulate
emissions. Exposure to cement plant emissions can
negatively impact the health of both workers and the
general public (Mishra et al., 2022). A cohort study
conducted in Korea included 1324 men who worked
at two Portland cement plants. This study revealed a
link between cement industry exposure and an ele-
vated risk of stomach and rectal cancer (Koh et al.,
2013). The research conducted by Smailyte et al.
confirmed that exposure to cement dust may increase
the chance of developing lung and bladder cancer
(Smailyte et al., 2004). A cohort study conducted on
employees from six Portland cement manufacturers
suggests a relationship between cement exposure and
stomach cancer (Koh et al., 2011). In a meta-analysis,
however, the meta-relative risks assessed across 26
published studies did not indicate an elevated risk of
cancer due to cement exposure (Cohen et al., 2014).
Eom et al. discovered that the incidence of lung and
bronchus cancer was considerably greater in sub-
jects residing near a cement plant than in the general
Korean population (Eom et al., 2017). The excess risk
of cancer incidence and mortality, mostly respiratory
tract cancers in both children and adults, was revealed
by a systematic review looking at the health effects
of the general population raised from emissions from
the cement plant. In this study, exposed subjects had
higher urine and blood concentrations of heavy met-
als and a marker of kidney damage than non-exposed
subjects (Raffetti et al., 2019). Therefore, it can be
concluded that air pollution from cement plants might
cause major health issues for the workers and the sur-
rounding population (Abimbola et al., 2007).
The cement dust could contain hazardous sub-
stances such as polyaromatic hydrocarbons, silica,
hexavalent chromium, arsenic, and some other
heavy metals (Kamaludin et al., 2020; Koh et al.,
2013). ­Cr+3 is a naturally occurring element that can
be found in rocks, soil, and in tiny quantities in the
human body. During the middle of the cement-baking
Environ Geochem Health (2023) 45:5961–5979
process in kilns, C­ r+3 is oxidized to C ­ r+6. However,
after this process, the amount of ­ Cr+6 gradually
declines over time. The International Agency for
Research on Cancer (IARC) classified hexavalent
chromium as a definite human carcinogen (Group I),
affecting the lung and sinonasal regions (Monographs
on the evaluation of carcinogenic risks to humans.,
1990). Inhalation of cement dust has been discovered
to cause serious respiratory health effects in cement
workers (Gizaw et al., 2016). Therefore, to provide
information about the risks posed to cement plant
workers, a quantitative health risk assessment may be
beneficial.
Many international authorities such as the World
Health Organization (WHO), the United States
Environmental Protection Agency (USEPA), and
the United States Food and Drug Administration
(USFDA) base regulatory decisions on quantita-
tive risk assessment (QRA). Typically, cancer risk
is evaluated using lifetime cancer risk (LCR), which
is the probability of developing cancer due to a cer-
tain exposure (Gupta & Gupta, 2022; Ramírez et al.,
2012). The non-cancer risk is shown as a hazard ratio
(HR), which is the ratio of the amount of a chemical
that a person could be exposed to the amount at which
no adverse health effects are expected (Zheng et al.,
2020). There are two methods for conducting a QRA:
deterministic and probabilistic approaches (Sahi-
hazar et al., 2022). In the deterministic approach,
each exposure parameter (input) in the risk equation
is given a single representative value, producing a
unique risk value (output). Individual attributes, such
as breathing rate and body weight, and environmen-
tal parameters, such as pollutant concentration, vary
greatly between work situations; hence, a single-point
value is typically not representative (Tong et al.,
2019a). This condition leads to an overestimation of
the calculated risk, which leads to conservative deci-
sions and a greater cost of remediation. Probabilistic
risk assessment (PRA) uses stochastic methods such
as Monte Carlo simulations to determine the degree
of variability and uncertainty associated with each
parameter in the risk equation (Rivera Velasquez
et al., 2013; Sakizadeh et al., 2019). Monte Carlo
simulation, which incorporates the variability of input
data, is a valuable tool for assessing health risks. In
this method, the health risk equation’s input distribu-
tion is established at first, and then, randomly selected
variables are used multiple times. The outcome is
5963
presented as a probability distribution (Cheng et al.,
2022; Sultana et al., 2022). As a result of using the
PRA method, the risk estimate is more realistic and
reasonable (Sahihazar et al., 2022).
Some previous studies have investigated the inha-
lation health risks of heavy metals using PRA in work
environments (Table 1). According to Table 1, heavy
metals pose notable risks of both carcinogenic and
non-carcinogenic effects on the health of individu-
als who are exposed to them. For instance, workers
employed in steelmaking plants (Dehghani et al.,
2021) and cement industry (Kamaludin et al., 2020)
are at risk of unacceptable cancer and non-cancer
health effects due to some heavy metals. Exposure
to heavy metals is known to have detrimental effects
on human health, and it is essential to evaluate the
associated health risks. The cement industry, being
a heavily polluted industry, is a common source of
heavy metal emissions, posing a risk to workers’
health in the work environment. Given the limited
research conducted on human health risk assessment
in the cement industry in Iran and worldwide, as well
as the significance of Quantitative Risk Assessment
(QRA) in identifying possible human risks and pro-
viding a scientific basis for management and deci-
sion-making, the current study aims to address this
research gap by conducting a study on employees at
a cement factory in West Azerbaijan, Iran, with the
following objectives in mind: (1) Determine the expo-
sure levels of cement workers to Cr, AS, Cd, and Pb;
(2) Evaluate the health risks imposed by Cr, AS, Cd,
and Pb by PRA method using Monte Carlo simula-
tion; (3) Perform a sensitivity analysis to identify the
influence of input parameters on health risks. It is
expected that the results of this study could aid in the
development of pollution control policies and proce-
dures for the cement industry by giving information
on exposure levels and health issues related to the
examined heavy metals.
Materials and methods
Study area and production process
This was a cross-sectional study conducted at a
cement plant in Urmia, West Azerbaijan Province,
Iran. Figure 1 depicts the location map of the fac-
tory. This cement plant is one of the major plants
Vol.: (0123456789)
13
 5964 Environ Geochem Health (2023) 45:5961–5979

Table 1  Probabilistic health risk assessment studies of heavy metals in various work environments
Pollutants Exposure Results References

PM2.5-bound heavy metals (V, Cr, Vehicle Inspection Unacceptable non-cancer risk due to (1)
Mn, Co, Ni, Cu, Zn, As, Cd and Pb) exposure to Cr and Mn
Unacceptable, but not high potential
cancer risk
PM2.5-bound heavy metals (V, Cr, highway toll station significant adverse non-carcinogenic (2)
Mn, Co, Ni, Cu, Zn, As, Cd and Pb) and carcinogenic risk
Pb, Fe, Mn, Cu, and Zn steelmaking plant Unacceptable non-cancer risk due to (3)
exposure to Pb and Mn
Unacceptable cancer risk due to expo-
sure to Pb
As, Cr Cement industry Unacceptable cancer and non-cancer (4)
risks due to exposure to As and Cr
PM2.5-bound heavy metals (Zn, Se, E-waste recycling zone, Unacceptable non-cancer risk for (5)
Pb, Sb, As, and Cd) adults and children due to all metals
Unacceptable cancer risk for adults
and children due to exposure to
Cr, Co, Ni, As, and Cd
As, Cd, Co, Cr, Pb, Mn, and Ni Taxi drivers Unacceptable non-cancer risk due to (6)
exposure to As, Cd, Mn, and Ni
Unacceptable cancer risk due to expo-
sure to As and Cd
Cr and Ni Welding of pipeline construction, Unacceptable cancer risk of Cr and (7)
pressure container manufacturing, Ni in the order of pipeline construc-
and shipyard building tion > pressure container manufac-
turing > shipyard building
PM2.5 and PM10-bound heavy metals traffic policemen in roadside locations Acceptable non-cancer and cancer (8)
(Cr, Mn, Ni, Zn, As, and Cd) risks for all metals
(1) Li P–H, Kong S-F, Geng C-M, Han B, Lu B, Sun R-F, et al. Assessing the hazardous risks of vehicle inspection workers’ expo-
sure to particulate heavy metals in their work places. Aerosol and Air Quality Research. 2013;13(1):255–65
(2) Li P–h, Yu J, Bi C-l, Yue J-j, Li Q-q, Wang L, et al. Health risk assessment for highway toll station workers exposed to PM2.
5-bound heavy metals. Atmospheric Pollution Research. 2019;10(4):1024–30
(3) Dehghani F, Omidi F, Fallahzadeh RA, Pourhassan B. Health risk assessment of occupational exposure to heavy metals in a steel
casting unit of a steelmaking plant using Monte–Carlo simulation technique. Toxicology and industrial health. 2021;37(7):431–40
(4) Kamaludin NH, Jalaludin J, Tamrin SBM, Akim AM, Martiana T, Widajati N. Exposure to Silica, Arsenic, and Chromium (VI)
in Cement Workers: A Probability Health Risk Assessment. Aerosol and Air Quality Research. 2020;20:2347–70
(5) Fang W, Yang Y, Xu Z. PM10 and PM2. 5 and health risk assessment for heavy metals in a typical factory for cathode ray tube
television recycling. Environmental science & technology. 2013;47(21):12,469–76
(6) Sepahi Zoeram F, Ebrahimi AA, Mehrparvar AH, Sarsangi Aliabad A, Fallah Zadeh H, Mehri H, et al. Health risk assessment of
inhalational exposure to heavy metals in drivers working in an urban desert city in the Middle East. Environmental monitoring and
assessment. 2022;194(8):1–9
(7) Yang SY, Lin JM, Lin WY, Chang CW. Cancer risk assessment for occupational exposure to chromium and nickel in weld-
ing fumes from pipeline construction, pressure container manufacturing, and shipyard building in Taiwan. Journal of occupational
health. 2018;60(6):515–24
(8) Fandi NFM, Jalaludin J, Latif MT, Abd Hamid HH, Awang MF. BTEX Exposure assessment and inhalation health risks to traffic
policemen in the klang valley region, Malaysia. Aerosol and Air Quality Research. 2020;20(9):1922–37

in the province and produces Portland cement. Near
the factory, there is adequate mountain rock soil for
use as a source of raw materials for cement produc-
tion. Similar to other factories, this one produces
cement in stages, from quarrying the raw materials
to cement packaging (Fig. 2). As depicted in Fig. 2,
quarrying is the initial stage in which raw materials
such as limestone is extracted from the mine close
to the factory and brought to the crushing unit by
trucks. The crusher reduces the raw materials to

Vol:. (1234567890)
13
Environ Geochem Health (2023) 45:5961–5979
Fig. 1  A map depicting
the location of the cement
factory
Fig. 2  Operating procedures of the cement factory
approximately 6-inch particles. Afterward, second-
ary crushers or hammer mills reduce their size to 3
5965
inches. Then in a raw mill, the limestone is ground
with additional raw materials such as clay, with the
proportion of usually 80% limestone and 20% clay.
After that, the material is fed into a pre-heating
chamber consisting of a series of cyclones that use
hot gases from the kiln. Here, the basic ingredients
are transformed into oxides before being burned in
the kiln. The most important part of the cement pro-
duction process is the kiln phase. Through a series
of chemical processes involving calcium and sili-
con dioxide, clinker is manufactured from the raw
mixture. After leaving the kiln, the clinker is rap-
idly cooled, combined with gypsum and other addi-
tives, and then ground in the cement mill to create
the final product. The cement is transferred to silos
where it is bagged in 20 to 40 kg quantities. Air
samples were obtained from employees working in
the cement production units indicated in light yel-
low in Fig. 2.
Vol.: (0123456789)
13
 5966
Sample collection and analysis
Air samples were collected throughout the course of
four months, from March to June 2022. Sixty-two air
samples were collected utilizing the similar exposure
groups as a guide (Leidel et al., 1977). Air sampling
and analysis were carried out in accordance with
OSHA and NIOSH standard methods. Cr, Cd, and
Pb were sampled and analyzed using OSHA ID-121
(Method & ID-121, 2002). The NIOSH 7900 was
used for As sampling and analysis (NIOSH, 2003).
Dust samples were collected with a cassette filter
holder containing a 37-mm cellulose ester membrane
filter (0.8-micron pore size). The filter cassette was
placed within the workers’ breathing zone and con-
nected to a personal air sampling pump (SKC Ltd,
Deluxe 224-PCMTX8, UK). The pump’s flow rate
was adjusted to 2 L/min using an electronic calibra-
tor (BIOS DryCal DC-Lite, US). Each personal sam-
pling session lasted four hours. Each participant read
and signed an informed consent form prior to air
sampling.
During each sampling session, two field blank
samples were obtained by exposing the filter media
to the surrounding environment without drawing
any air through it. These blank samples were trans-
ported along with the main samples to the sampling
sites and stored in the laboratory during the storage
period. Before analysis, a media blank was also eval-
uated to determine the extent of background contami-
nation in the filter media. The values obtained from
the blank samples were subtracted from the sample
concentrations. Air filters were digested with the
appropriate acid solutions in order to extract metals.
A graphite furnace atomic absorption spectrometer
(Perkin Elmer 5100 AAS) was used to measure the
concentration of Cd, Cr, Pb, and As in air samples.
To determine the limit of detection (LOD), we added
the average concentration of each heavy metal in the
blank samples to three times the standard deviation.
The concentration LOD of heavy metals was obtained
0.10, 0.16, 0.008, and 0.20 µg.m−3 for Pb, Cr, Cd, and
As, respectively. The concentration of heavy metals
in the dust filters was above the LOD.
Human health risk assessment
There are various methods available for assess-
ing the risk associated with exposure to chemicals,
Vol:. (1234567890)
13
Environ Geochem Health (2023) 45:5961–5979
including the air pollution health risk assessment
(AP-HRA) (Hassan Bhat et al., 2021), the semi-
quantitative risk assessment method (SQRA)
(Zeverdegani et al., 2023), the chemical risk man-
agement self-assessment model (Chem-SAM)
(Karimi Zeverdegani et al., 2016), and the non-
cancer and cancer health risk assessment method
developed by the USEPA (Hosseinzadeh et al.,
2023; Tong et al., 2019b). The USEPA method is
the only tool that can separately evaluate the risk
of carcinogenic and non-carcinogenic effects. This
technique is comprehensive and focuses on quan-
titatively assessing the health effects caused by
chemical exposure. It has been frequently utilized
to evaluate cancer and non-cancer risks in differ-
ent workplaces (Fandi et al., 2020; Jiménez-López
& Hincapié-Llanos, 2022; Khoshakhlagh & Morais,
2022; Mazaheri Tehrani et al., 2020; Rostami et al.,
2021; Sahihazar et al., 2022; Tran et al., 2022).
A framework for assessing health risks was devel-
oped using the USEPA-recommended inhalation risk
model (USEPA 2009) and Monte Carlo simulation
(Fig. 3). Hazard identification, dose–response assess-
ment, exposure assessment, and risk characterization
are the four steps in risk assessment. The primary
goal of hazard identification is to detect compounds
that may be hazardous to human health (Shomar &
Rashkeev, 2021). In this study, the concentration of
heavy metals was quantified in five parts of a cement
factory, including crusher, raw mill, prep-heater and
kiln, cement mill, and packing plant.
There are three ways to be exposed to environ-
mental pollutants: inhalation, skin contact, and inges-
tion. Because heavy metals can be absorbed through
breathing, inhalation was chosen as the primary
exposure route in this investigation. Inhalation of
heavy metals such as Cr, Cd, As, and Pb could result
in adverse outcomes such as lung cancer and several
non-cancer health effects in the exposed popula-
tion (Ali et al., 2021; Proctor et al., 2021; Sah et al.,
2019). Therefore, the carcinogenic and non-carcino-
genic health effects of these heavy metals were evalu-
ated. Carcinogenic risk is defined as the possibility
of developing any type of cancer during one’s life-
time (70 years) if exposed to a certain concentration
of carcinogenic substance. Non-carcinogenic risk is
defined as the possibility of human exposure to non-
carcinogenic pollutants that may cause chronic dis-
eases or injuries (Tong et al., 2019c).
Environ Geochem Health (2023) 45:5961–5979
Fig. 3  The research framework used to assess the health risk of heavy metals
The non-cancer risk of As, Cd, Cr, and Pb, as well
as the cancer risk of As, Cd, Cr, and Pb, was calcu-
lated in this study. Equation (1) was used to define the
health risk model for cement workers.
C ⋅ IR ⋅ t ⋅ Ef ⋅ ED
( )
AAD∕LADD = (1)
BW ⋅ AT
where ADD = the average amount of heavy met-
als exposure through inhalation, in mg.Kg−1.
day−1, LADD = lifetime average daily dose of expo-
sure to heavy metals via inhalation in mg.Kg−1.
day−1, C = concentration of heavy metals (mg.m−3),
IR = inhalation rate ­(m3.h−1), t = exposure time
(h·day−1), Ef = exposure frequency (day·year−1),
ED = exposure duration (year), BW = body
weight of workers (kg), AT = averaging time
(day); AT = ED × 365 (for non-cancer risk), and
AT = 70 × 365 (for cancer risk).
The non-cancer risk was calculated using Eqs. (2)
and (3)
ADD
( )
HQ = (2)
RfD
∑
HI = HQ
The hazard quotient (HQ) represents the amount
of non-cancer risk associated with individual heavy
metals, whereas the hazard index (HI) shows the
5967
total non-cancer risk associated with all heavy metals
evaluated. HI ≤ 1, indicates no adverse health effects;
HI > 1, indicates the possibility of adverse health
effects. RfD is the reference dose in mg.Kg−1.day−1,
which is an estimate of the daily exposure to a sub-
stance that could pose a risk to human health over the
course of a lifetime (Schiavo et al., 2022).
The cancer risk (R) was calculated using Eqs. (4)
and (5)
R = LADD × CSF (4)
∑
Rt = R (5)
CSF represents the slope factor in mg·kg−1.day−1,
which is defined as a plausible upper-bound estimate
of the probability of a response per unit intake of a
chemical over a lifetime (USEPA, 1991). Rt is the
total cancer risk of all heavy metals that can be calcu-
lated by adding the individual risks (R).
R ≤ 1E-6 is an acceptable carcinogenic risk,
between 1E-6 and 1E-4 are considered potential for
carcinogenesis and R ≥ 1E-4 indicates an unaccepta-
ble carcinogenic risk (Kamal et al., 2015).
The reduction of prevention and control measures
(3)
(RPC) in reducing total cancer risk (­Rtc) and total
non-cancer risk (­HIc) was computed, respectively,
using Eqs. (6) and (7). We utilized the RPCs for a
ventilation system, two types of respiratory masks,
Vol.: (0123456789)
13
 5968 Environ Geochem Health (2023) 45:5961–5979

and a ventilation system and respiratory mask combo. Input parameters

The exposure reduction efficiency of a typical ven-
tilation system, a dust-filtering mask, and a comfort
mask was established to be 70%, 80%, and 30%,
respectively, by Lahari et al. (Lahiri et al., 2005). In
the computation of R ­ tc owing to the application of a
ventilation system, for instance, the Rt was multiplied
by (1 − 0.7), while in the event of the combination of
a ventilation system and a dust-filtering mask, it was
multiplied by [(1 − 0.7) × (1 − 0.8)].
( )
Rtc = Rt × 1 − RPC1 × (1 − RPC2 ) × (1 − RPCn )
(6)
( )
HI c = HI × 1 − RPC1 × (1 − RPC2 ) × (1 − RPCn )
(7)
The input parameters for estimating the health risks
of cement plant employees were derived from prior
studies and the current investigation (Table 2). Indus-
trial workers’ time-activity patterns differ from those
of the general population. Consequently, some expo-
sure variables, such as exposure time (ET), expo-
sure duration (ED), and exposure frequency (EF),
must be gathered directly through on-site interviews
(Tong et al., 2019d). We interviewed 86 workers
from various parts of the cement plant to determine
their personal and exposure parameters such as job,
age weight, height, working experience, and work-
ing hours per day and per month. Using Crystal Ball
software (version 11.1.1.1, Oracle Inc., USA), the
probability distribution of parameters such as C, ET,
EF, ED, and BW was determined using the Ander-
son–Darling test. The type of distribution for input

Table 2  Input parameters in human health risk assessment

Symbol Parameters Unit Distribution type Distribution values References

C Concentration of heavy metals mg ­m−3 Log-normal As Table 2 This study

t Exposure time h ­d−1 Triangular Min = 8 This study
Likeliest = 10
Max = 12
Ef Exposure frequency d ­a−1 Triangular Min = 265 This study
Likeliest = 280
Max = 295
BW Body weight Kg Log-normal Mean = 78.6 This study
SD = 11.2
IR Inhalation rate m3 ­h−1 Fixed value 2.5 (1)
ED Exposure duration year Fixed value 30 (2)
AT Averaging time day Fixed value ED × 365 ( for non- (2)
cancer effects)
70 × 365 ( for cancer
effects)
CSF Cancer slope factor (mg/kg d)−1 Fixed value As = 1.5E + 01 (3)
Cd = 6.30E + 00
Cr = 4.20E + 01
RfD Reference dose mg ­Kg−1 ­day−1 Fixed value As = 3.00E-4 (3)
Cd = 1.00E-3
Cr = 2.86E-5
Pb = 3.50E-3

(1) Kamaludin NH, Jalaludin J, Tamrin SBM, Akim AM, Martiana T, Widajati N. Exposure to Silica, Arsenic, and Chromium (VI)
in Cement Workers: A Probability Health Risk Assessment. Aerosol and Air Quality Research. 2020;20:2347–70
(2) Wang F, Wang J, Han M, Jia C, Zhou Y. Heavy metal characteristics and health risk assessment of PM2. 5 in students’ dormito-
ries in a university in Nanjing, China. Building and Environment. 2019;160:106,206
(3) Wang F, Wang J, Han M, Jia C, Zhou Y. Heavy metal characteristics and health risk assessment of PM2.5 in students’ dormito-
ries in a university in Nanjing, China. Building and Environment. 2019;160:106,206

Vol:. (1234567890)
13
Environ Geochem Health (2023) 45:5961–5979 5969

parameters is listed in Table 2. The arithmetic mean impact of the parameter on the model’s output (Tong
of the parameters was entered into the equation for et al., 2019c).
calculating potential health risks.

Results and discussion

Monte Carlo simulation and sensitivity analysis
On the basis of the established health risk assessment
methodology, the Monte Carlo simulation method
was utilized to evaluate cancer and non-cancer risks
of heavy metal-exposed workers. Crystal Ball soft-
ware was used to run a Monte Carlo simulation with
10,000 trials set to keep the simulation stable (Jack-
man et al., 2011). The results are provided in the form
of statistical values, a summary of percentiles, and
the outcome probability distribution. As a key func-
tion of Monte Carlo simulation, sensitivity analysis
was utilized to determine the crucial input parameters
in the predicted risk. The sensitivity analysis is used
to figure out how much certain parameters affect the
output of a model. If the sensitivity is more than zero,
it correlates positively with the risk outcome; if it is
less than zero, it correlates negatively with the risk
outcome. The greater the sensitivity, the larger the
Concentration of heavy metals in cement dust
The descriptive statistics for the concentration of
heavy metals in cement dust are given in Table 3.
As indicated in Table 3, in different parts of the
cement factory the mean concentration of As (0.018
to 0.034 mg.m−3) and Pb (0.054 to 0.085 mg.m−3)
exceeded the occupational exposure limit (OEL)
of As (TLV-TWA = 0.01 mg.m−3) and Pb (TLV-
TWA = 0.05 mg.m−3). In other words, the exposure
of cement workers to As and Pb in the most polluted
area of the factory (cement mill) were 3.4 and 1.7
times the OELs. In contrast, the mean concentration
of Cd (0.00011 to 0.00036 mg.m−3) and Cr (0.018
to 0.064 mg.m−3) were substantially lower than the
OELs of Cd (TLV-TWA = 0.01 mg.m−3) and Cr (TLV-
TWA = 0.5 mg.m−3). The packing plant and cement
mill were identified as the factory parts which had the

Table 3  Concentration of Station C (mg ­m−3)

heavy metals in cement dust
collected from different AM a SD b GM c GSD d Min Max
parts of the factory
Crusher As 0.027 0.012 0.025 1.524 0.015 0.047
Cd 0.00017 0.000053 0.00016 1.3615 0.00011 0.00026
Cr 0.021 0.020 0.015 2.571 0.0028 0.070
Pb 0.072 0.114 0.040 2.697 0.009 0.394
Cement mill As 0.034 0.0158 0.030 1.738 0.01 0.059
Cd 0.00036 0.00014 0.00034 1.3809 0.00025 0.00075
Cr 0.043 0.028 0.035 1.961 0.015 0.101
Pb 0.085 0.073 0.065 2.055 0.030 0.241
Pre-heater & Kiln As 0.0195 0.013 0.016 1.758 0.008 0.049
Cd 0.00015 0.000086 0.00010 3.2261 0.00008 0.00029
Cr 0.064 0.014 0.062 1.255 0.045 0.086
Pb 0.071 0.014 0.069 1.249 0.045 0.089
Raw mill As 0.024 0.012 0.021 1.802 0.008 0.047
Cd 0.00016 0.000047 0.00015 1.3839 0.00008 0.00021
Cr 0.018 0.009 0.015 1.920 0.004 0.033
Pb 0.068 0.021 0.065 1.446 0.028 0.089
Packing plant As 0.018 0.009 0.016 1.798 0.005 0.034
a b
arithmetic mean, standard Cd 0.00011 0.00012 0.00006 3.2874 0.00001 0.00038
deviation, cgeometric Cr 0.025 0.017 0.020 2.067 0.007 0.052
mean, dgeometric standard Pb 0.054 0.028 0.045 2.006 0.008 0.099
deviation

Vol.: (0123456789)
13
 5970
lowest and highest concentrations of As, Cd, and Pb,
respectively. The lowest and greatest concentrations
of Cr were measured in raw mill and pre-heater and
kiln stations, respectively. The air monitoring results
suggested that As and Pb may be major heavy metal
pollution in cement production and that air pollution
management measures should be actively performed
to lower dust levels. In a comparable study conducted
in a cement industry in Iran, the mean concentra-
tion of Cd, Pb, and Cr in the respirable dust sam-
ples was 2.41, 10.39, and 1.36 µg.m−3 (Pouransari,
2020). These concentrations are not comparable to
ours because they collected the respirable fraction of
the suspended dust. However, similar to our findings,
the mean concentration of Pb was much greater than
the concentrations of Cd and Cr in the air samples.
It is revealed that the metal content concentrations in
cement dust are factory dependent (Ogunbileje et al.,
2013). The mean concentrations of As and Cr in the
breathing zone of workers in a Malaysian cement
industry (Kamaludin et al., 2020) were 0.1 ± 0.02 and
1.53 ± 2.47 mg.m−3 which were much higher than the
concentrations obtained in this investigation. A recent
investigation in Indonesia showed that the mean con-
centration of fine particulate matter (23.68 µg.m−3) in
the cement factory exceeded the air quality guidelines
of the World Health Organization (Mallongi et al.,
2023). The findings of the current study and similar
ones demonstrated that the inhalation exposure of
cement workers to heavy metals could be above the
environmental and occupational standard levels, mak-
ing air pollution control in the cement factories a
global concern.
The working units of the cement factory are not
completely separated from one another. Therefore,
the wind might transport the suspended dust from one
area of production to another. In the present research,
the concentration of metals in the cement mill, which
crushes clinker into a fine powder, was higher than
in other areas of the factory. Gizaw et al. found that
cement mill employees were more likely than raw
mill employees to develop chronic respiratory prob-
lems (OR = 3.72, 95% CI = 1.92, 7.21) (Gizaw et al.,
2016). Meo et al. discovered that cement mill workers
had significantly higher levels of fractional exhaled
nitric oxide (FENO) than their non-exposed coun-
terparts (31.71 ± 2.963 ppb vs. 25.39 ± 2.46 ppb)
(Meo et al., 2014). These studies and our findings
indicate the higher probability of exposure to air
Vol:. (1234567890)
13
Environ Geochem Health (2023) 45:5961–5979
pollutants and, thus, the higher incidence of adverse
health effects among cement workers, particularly in
the cement mill. Cement workers, particularly those
who operate in a cement mill, are therefore advised to
take engineering and personal protection measures to
reduce suspended dust and protect themselves.
Health risk assessment for workers
Carcinogenic risk assessment
Arsenic, cadmium, and chromium have carcinogenic
effects. Therefore, the USEPA method was utilized
to evaluate the cancer risk associated with inhaling
these heavy metals. To estimate the cancer risk for
arsenic, cadmium, and chromium, the Monte Carlo
simulation method was run by the Oracle Crystal
ball software with 10,000 iterations. The findings of
the simulations of cancer risk are shown in Table 4
and Supplementary materials (Fig. S1). According
to Table 4, the mean cancer risk of individual met-
als in all sections of the cement factory exceeded the
acceptable level of 1E-4. The cancer risk of metals
was in the ascending order of Cd < As < Cr. The mean
cancer risk of Cr ranged from 835E-4 (in raw mill)
to 2870E-4 (in pre-heater and kiln), indicating that
all workers face a definite cancer risk. A comparable
investigation in Malaysia (Kamaludin et al., 2020)
revealed a lifetime cancer risk of 4707E-4 in cement
industry workers owing to Cr exposure, which is more
than the risk assessed by the current study. In addi-
tion, the cancer risk of Cr for manufacturing workers
in an e-waste factory in Shanghai, China, was 3.45
times the acceptable limit of 1E-4 (Fang et al., 2013).
During pipeline construction, manufacturing of pres-
sure containers, and shipyard constructing, the aver-
age incremental lifetime cancer risk due to Cr expo-
sure was 4.2, 1.1E-1, and 3.4E-3, respectively (Yang
et al., 2018). In Nigerian auto-panel workshops, the
ILCR for adults owing to inhalation of chromium in
scrap car paint dust ranged from 1.09 E-3 to 1.37 E-3,
which was 10.9 to 13.7 times the EPA-recommended
threshold (Widziewicz et al., 2016).
The mean cancer risk of As ranged from 297E-4
(in the packing plant) to 556E-4 (in the cement mill),
which was 297 and 556 times the acceptable health
risk (1E-4), showing that cement workers are at a
high risk of developing cancer. Similarly, Kamalu-
din et al. observed that the As cancer risk for cement
Environ Geochem Health (2023) 45:5961–5979 5971

Table 4  Summary of the cancer risk estimate statistics

Station Min Max Mean SD Percentile
5th 50th 95th

Crusher R As 66E-4 2044E-4 429E-4 194E-4 188E-4 393E-4 795E-4

R Cd 0.131E-4 4.28E-4 1.12E-4 0.391E-4 0.6E-4 1.07E-4 1.85E-4
R Cr 31E-4 12069E-4 990E-4 929E-4 194E-4 727E-4 2611E-4
Rt 157E-4 12406E-4 1420E-4 961E-4 520E-4 1177E-4 3063E-4
Cement mill R As 74E-4 2519E-4 555E-4 265E-4 236E-4 501E-4 1057E-4
R Cd 0.4E-4 12E-4 2.43E-4 1.01E-4 1.15E-4 2.26E-4 4.27E-4
R Cr 122E-4 17714E-4 1921E-4 1275E-4 587E-4 1588E-4 4348E-4
Rt 418E-4 18546E-4 2480E-4 1315E-4 1031E-4 2169E-4 4970E-4
Pre-heater & Kiln R As 22E-4 3096E-4 313E-4 223E-4 90E-4 256E-4 726E-4
R Cd 87427E-4 8.00E-4 1.04E-4 0.5E-4 0.3E-4 0.8E-4 2.19E-4
R Cr 828E-4 7957E-4 2871E-4 778E-4 1755E-4 2788E-4 4281E-4
Rt 959E-4 8425E-4 3186E-4 832E-4 1984E-4 3099E-4 4677E-4
Raw mill R As 52E-4 2529E-4 401E-4 210E-4 155E-4 356E-4 804E-4
R Cd 0.2E-4 3.07E-4 1.08E-4 0.3E-4 0.5E-4 1.03E-4 1.73E-4
R Cr 122E-4 4862E-4 835E-4 450E-4 323E-4 734E-4 1686E-4
Rt 201E-4 5449E-4 1237E-4 509E-4 605E-4 1143E-4 2160E-4
Packing plant R As 28E-4 1514E-4 297E-4 156E-4 115E-4 262E-4 589E-4
R Cd 12042E-4 19E-4 0.7E-4 0.8E-4 0.1E-4 0.4E-4 2.26E-4
R Cr 89E-4 16609E-4 1165E-4 833E-4 336E-4 954E-4 2700E-4
Rt 196E-4 16997E-4 1463E-4 859E-4 571E-4 1256E-4 3035E-4
R: Cancer risk of individual heavy metal; Rt: Total cancer risk

plant workers was 734.87E-4, which is approxi-
mately 735 times the acceptable recommended level
(Kamaludin et al., 2020). The mean risk of As-related
cancer among taxi drivers in Yazd, Iran, was 5.7E-
4, or 5.7 times the acceptable level (Sepahi Zoeram
et al., 2022). It reveals that the cancer risk of As may
exceed the EPA standard even in occupational catego-
ries that are not exposed to high dust pollution levels.
In Poland, urban individuals’ lifetime carcinogenic
risk from exposure to total As (from ­PM2.5 particles)
varied from 0.51E-6 (in summer) to 2.0E-6 (in win-
ter) (Widziewicz et al., 2016). Wang et al. examined
the exposure of traffic officers in Tianjin, China, to
roadside trace elements and found that the cancer risk
of arsenic bound to ­PM2.5 and ­PM10 was greater than
1E-6 (Wang et al., 2020).
The mean cancer risk of Cd was smaller than
both Cr and As and ranged from 0.755E-4 (in pack-
ing plant) to 2.43E-4 (cement mill), demonstrating a
definite cancer risk for cement workers. Taxi drivers
in Yazd, Iran, had an average excess cancer risk of
Cd of 1.1E-4, which is slightly above the acceptable
level of 1E-4 (Sepahi Zoeram et al., 2022). In their
study of the health effects of ­PM2.5-bound heavy met-
als in Karaj, Iran, Kermani et al. reported that Cd has
the highest risk of cancer among heavy metals, at
4.81E-4 (Kermani et al., 2021). Because of the sig-
nificant quantities of this heavy metal in the air, it
appears that Cd poses a cancer risk in occupational
and outdoor contexts.
According to Table 4, the total cancer risk of
As, Cr, and Cd ranged from 1240E-4 (in the raw
mill) to 3190E-4 (in the preheater and kiln), which
is much more than the recommended limit of 1E-4.
In other words, between 1,420 and 3,190 out of
every 10,000 workers in a cement production fac-
tory who are exposed to As, Cr, and Cd without
engineering or personal protection are anticipated
to develop cancer. The potential effect of employ-
ing the ventilation system, two types of mask, and
the combination of the ventilation system and the
masks on reducing the total cancer risk (­ Rtc) is pre-
sented in Table 5. According to Table 5, total can-
cer risks were not lowered below the recommended

Vol.: (0123456789)
13
 5972 Environ Geochem Health (2023) 45:5961–5979

Table 5  Cancer and non-cancer risks after adjusting for control factors
Type of risk Job tasks Rt Rtc
Ventilation system Mask Comfort mask Ventilation sys- Ventilation
with filter tem + Mask with system + Comfort
dust filter dust mask

Crusher 1420E-4 430E-4 280E-4 990E-4 90 E-4 300 E-4

Cancer risk Cement mill 2480E-4 740E-4 500E-4 1740 E-4 150 E-4 520 E-4
Pre-heater & Kiln 3190E-4 960E-4 640E-4 2230 E-4 190 E-4 670 E-4
Raw mill 1240E-4 370E-4 250E-4 870 E-4 70 E-4 260 E-4
Packing plant 1460E-4 440E-4 290E-4 1020 E-4 90 E-4 310 E-4
HI HIc

Crusher 219.53 65.86 43.91 153.67 13.17 46.10

Cement mill 408.03 122.41 81.61 285.62 24.48 85.69
Non-cancer Pre-heater & Kiln 579.06 173.72 115.81 405.34 34.74 121.60
risk
Raw mill 187.75 56.32 37.55 131.42 11.26 39.43
Packing plant 245.63 73.69 49.13 171.94 14.74 51.58
Rt: Total cancer risk; Rtc: Total cancer risk achieved by prevention and control measures; HI: Hazard Index; HIc: Hazard Index
achieved by prevention and control measures

level of 1E-4 when ventilation systems or their Non‑carcinogenic risk assessment

combination with masks were utilized. The TCR
in a raw mill, for instance, was lowered from
1240E-4 to 70E-4 when the ventilation system was
combined with mask with filter dust. In a similar
study conducted in a cement factory (Kamaludin
et al., 2020), the cancer risk of As and Cr did not
fall below the recommended level of 1E-4 despite
the use of protective and preventative measures.
Yeheyis, Aguilar (Yeheyis et al., 2012) found that
engineering controls resulted in a 78% reduction
and masks resulted in a 65% reduction in the 95%
upper-bound values of health risks of silica in con-
struction activities. Through the implementation
of engineering controls in sand preparation task
within a foundry plant, the mean cancer risk of sil-
ica dust was lowered from 2.35E-05 to 5.18E-06,
thus reclassifying it as a "possible risk" (Sahihazar
et al., 2022). The ineffectiveness of protection and
control measures recommends that administrative
controls, such as job rotation, should be estab-
lished to decrease workers’ exposure to cement
dust. Using raw materials with a lower heavy metal
content could protect cement workers from cancer
risks.
The potential for non-cancer health effects from
exposure to AS, Cd, Cr, and Pb was evaluated by
HQ (Table 6 and Supplementary materials (Fig.
S2)). The HQ of metals was in the ascending order
of Cd < Pb < As < Cr. The mean HQ of Cr ranged
from 162.13 (in raw mill) to 558.73 (in pre-heater
and kiln), indicating an unacceptable high non-car-
cinogenic risk. As with Cr, the mean HQ of As was
significantly greater than 1 and ranged from 15.31 (in
packing plant) to 28.63 (in cement mill). The mean
HQ of Pb ranged from 3.89 (in packing plant) to 5.99
(in cement mill). The mean HQ of Cd in all stations
was less than 1 and ranged from 0.03 to 0.09, indicat-
ing that exposure to Cd does not pose a non-carcino-
genic risk. The HQ values of individual metals indi-
cate than the elevated values of hazard index (HI) in
the cement factory are primarily attributable to expo-
sure to Cr and As, with a small impact from Pb. The
mean HI varied from 89.02 (in raw mill) to 249.13
(in cement mill), indicating a noticeable risk of non-
carcinogenic effects. HQ values greater than 1 indi-
cate unacceptable exposure conditions linked with
considerable chronic non-cancer risks for the target

Vol:. (1234567890)
13
Environ Geochem Health (2023) 45:5961–5979 5973

Table 6  Summary of the Station Min Max Mean SD Percentile

non-cancer risk estimate
statistics 5th 50th 95th

Crusher HQ As 3.40 105.32 22.11 10.04 9.69 20.27 40.96

HQ Cd 0.004 0.16 0.04 0.01 0.02 0.04 0.07
HQ Cr 6.07 2,344.55 192.31 180.42 37.68 141.30 507.31
HQ Pb 0.03 197.17 5.06 8.22 0.43 2.67 17.27
HI 22.16 2,362.78 219.53 181.50 60.51 168.83 534.13
Cement mill HQ As 3.81 129.79 28.63 13.67 12.16 25.85 54.46
HQ Cd 0.02 0.47 0.09 0.04 0.04 0.08 0.16
HQ Cr 23.87 3,441.03 373.33 247.77 114.10 308.50 844.73
HQ Pb 0.32 75.48 5.99 5.17 1.32 4.49 15.69
HI 52.72 3,491.53 408.03 249.13 145.65 344.76 882.73
Pre-heater & Kiln HQ As 1.17 159.49 16.15 11.51 4.64 13.21 37.38
HQ Cd 0.003 0.30 0.04 0.02 0.01 0.03 0.08
HQ Cr 160.93 1,545.69 557.83 151.16 340.94 541.59 831.61
HQ Pb 1.63 11.19 5.05 1.25 3.19 4.94 7.28
HI 170.92 1,578.27 579.06 153.22 358.48 563.32 854.56
Raw mill HQ As 2.71 130.29 20.67 10.82 7.99 18.33 41.43
HQ Cd 0.01 0.11 0.04 0.01 0.02 0.04 0.06
HQ Cr 23.77 944.63 162.13 87.47 62.76 142.55 327.52
HQ Pb 1.26 15.14 4.90 1.65 2.66 4.65 7.90
HI 30.86 979.48 187.75 89.02 83.89 168.07 353.85
Packing plant HQ As 1.45 78.00 15.31 8.06 5.97 13.54 30.37
HQ Cd 0.0004 0.71 0.03 0.03 0.003 0.02 0.08
HQ Cr 17.38 3,226.46 226.40 161.96 65.34 185.49 524.48
HQ Pb 0.44 22.56 3.89 2.12 1.45 3.42 7.94
HQ: Hazard Quotient, HI: HI 27.11 3,256.29 245.63 162.90 82.23 204.67 544.58
Hazard Index

organs of the exposed population, as determined by
the USEPA.
Table 5 summarizes the possible effect of using the
ventilation system, different masks, and the combina-
tion of the ventilation system and masks on reducing
non-cancer risks (HIc). According to Table 5, when
a ventilation system or its combination with masks
was used, none of the HI were lowered to less than
the standard level of 1. In other words, the simulta-
neous use of the ventilation system and mask with
filter dust, as the most efficient combination, dropped
the HI from 187.75 to 11.26 in the raw mill which is
again larger than the standard threshold. In a compa-
rable study conducted in a cement industry (Kamalu-
din et al., 2020), the adoption of protective and pre-
ventative measures in reducing the non-cancer effects
was not effective and the HQ of As and Cr dropped
from 109.17 to 1.64 and from 5235.41 to 78.53,
respectively. In a foundry plant setting, engineering
controls demonstrate greater efficacy in reducing
HQ values linked to silica exposure to levels below
1 compared to masks (Sahihazar et al., 2022). The
ineffectiveness of protection and control measures in
reducing the non-cancer effects of cement workers
again advises the planning for administrative controls
and utilizing low-content polluted raw material to
protect cement workers from non-cancer risks.
In general, the Rt and HI values indicated defi-
nite cancer risks and undesirable non-carcinogenic
effects for cement workers. The pre-heater and kiln
posed the greatest health risks in cement produc-
tion, followed by the cement mill, packing plant,
crusher, and raw mill. In other words, the manufac-
turing units (from kiln to packaging plant) posed
greater health risks than the preparation operations
(crusher and raw mill). Therefore, the implementa-
tion of a health risk control program for cement fac-
tory workstations could be prioritized and classified

Vol.: (0123456789)
13
 5974
as follows: pre-heater and kiln > cement mill > pack-
ing plant > crusher > raw mill. To protect and moni-
tor the health of cement workers exposed to cement
dust, it is strongly recommended to implement pre-
ventative measures, such as engineering and admin-
istrative controls, and to conduct health surveillance
examinations. Powdered Portland cement has an
aerodynamic diameter between 0.05 and 5 µm, allow-
ing it to reach the alveoli of the lungs (Schuhmacher
et al., 2004). During the kiln-baking process, ­Cr6+ is
oxidized to produce. Thus, following this procedure,
cement will include C ­ r6+. Long-term C ­ r6+ inhala-
tion may result in carcinogenesis, immunological
dysfunction, and fibrosis (Kamaludin et al., 2020).
The International Agency for Research on Cancer
(IARC) has designated ­Cr6+ as a human carcinogen
(Group I) with a focus on the lungs and sinonasal
cavities (Monographs on the evaluation of carcino-
genic risks to humans., 1990). It was discovered that
inhalation and ingestion of As greatly enhanced the
Fig. 4  Sensitivity analyses in different units of cement factory for total cancer risk (a) and hazard index (b)
Vol:. (1234567890)
13
Environ Geochem Health (2023) 45:5961–5979
incidence of lung cancer among the group at risk
(Smith et al., 2009). Our findings indicate that special
attention should be paid to controlling the exposure to
chromium and arsenic in cement workers in order to
reduce the associated health risks.
Sensitivity analysis
A sensitivity analysis was undertaken to determine
which input parameters contribute the most to the
risk. Figure 4a depicts the results of a sensitivity
analysis performed on parameters related to carcino-
genic risk values. The sensitivity of the parameters
differed among workers at various cement production
units. Concentration of Cr, concentration of As, body
weight (BW), daily exposure time (t), and exposure
frequency (Ef) were the significant contributors to
variance in carcinogenic risk, with the mean sensitiv-
ity of 78.5%, 8.4%, -8.14, 4.66%, 0.32%, respectively.
Cancer risks were most affected by the concentration
Environ Geochem Health (2023) 45:5961–5979
of Cr, which ranged from 64.8% (in the pre-heater and
kiln) to 86.8%. (in packing plant). Figure 4b depicts
the findings of a sensitivity analysis of non-carci-
nogenic risks. Among all exposure characteristics,
88.06% of the variance in non-carcinogenic risk was
attributable to the concentration of Cr. In addition,
body weight (-6.9%) and daily exposure time (3.9%)
were second and third, respectively. Analyses of sen-
sitivity found that the concentration of Cr may have
a considerable effect on both carcinogenic and non-
carcinogenic risks for cement workers. These results
show that the health risks of cement workers could be
substantially decreased by limiting the concentration
of Cr and, to a lesser extent, by reducing their daily
work hours. Similar to our results, the concentration
of heavy metal was the most influential parameters on
the health risk of workers. For instance, the concen-
tration of lead (Pb) was found to contribute to 83%
of the cancer risk among workers in the steelmaking
industry (Dehghani et al., 2021). The concentration of
cobalt (99.14%) and cadmium (99.31%) were found
to have a significant impact on the uncertainty of the
health risk assessment for traffic policemen (Wang
et al., 2020). Similarly, in health risk assessments
conducted for volatile organic compounds (VOCs)
in various work environments, the concentration of
VOCs was identified as the critical parameter affect-
ing the variances of health risks. For example, the
contribution of BTEX concentrations in non-cancer
risks of workers in composite manufacturing ranged
from 80.7% to 96.5% (Khoshakhlagh et al., 2023).
According to Hosseinzadeh et al., the concentration
of ethylbenzene (51.7% to 93.7%) contributed the
most to the variance in carcinogenic risk in different
workshops of a paint manufacturing plant (Hossein-
zadeh et al., 2023).
Conclusions
This study was conducted on cement factory work-
ers to better understanding of cancer and non-cancer
risks associated with heavy metals in the cement dust.
Among the four heavy metals studied, the mean con-
centration of As and Pb exceeded the OEL. Cement
mill was identified as the most polluted part of the
factory. Workers in cement mill were exposed to As
and Pb, 3.4 and 1.7 times the OELs, respectively.
The Monte Carlo-based probabilistic health risk
5975
assessment model was used to evaluate the health
risks of heavy metals and their contributing factors.
Exposure to chromium, arsenic, and cadmium posed
a definite cancer risk to all cement manufacturing
workers. Chromium had a higher cancer risk than the
other heavy metals, with a mean cancer risk ranging
from 835E-4 (in raw mill) to 2870E-4 (in pre-heater
and kiln). The mean cancer risk of Cd was lower than
the risks of both Cd and As, and its cancer risk was
somewhat higher than the standard level of 1E-4,
except for the packing plant. Heavy metal cancer risk
was considerably higher than the recommended limit
of 1E-4 and was not reduced below this level when
the ventilation system or its combination with masks
were used. Except for Cadmium, the non-cancer haz-
ard quotients of three other heavy metals exceeded 1.
Cr had the highest mean HQ at 558.73 (in pre-heater
and kiln), As at 28.63 (in cement mill), and Pb at
5.99 (cement mill). The mean HI calculated by add-
ing the HQ of individual heavy metals ranged from
89.02 (in raw mill) to 249.13 (in cement mill), indi-
cating a significant risk of non-carcinogenic effects.
When the dust control efficiency of the ventilation
system or its combination with masks was consid-
ered in the calculations, the non-cancer risks could
not be reduced to less than the standard level of 1.
Therefore, to protect cement workers from cancer and
non-cancer risks, administrative controls such as job
rotation and the use of raw materials with minimal
heavy metal contamination, especially Cr and As, are
recommended in addition to engineering controls and
personal protection.
Our findings may have significant implications
for strengthening the practice of industrial hygiene
in the cement industry. Previous research focused
on heavy metal contamination in the soil around
the cement factory (Jafari et al., 2019; Rahmanian
& Safari, 2020; Solgi & Khodabandelo, 2016), par-
ticulate matters pollution in the cement industry
(Mallongi et al., 2023), and the health effects on
the cement workers (Koh et al., 2011, 2013; Zeleke
et al., 2010). There has been a lack of research on
the health risk assessment of occupational expo-
sure to heavy metals from cement dust. There-
fore, the current study quantified the health risks
of occupational exposure to heavy metals from the
cement industry using the PRA model based on
Monte Carlo simulation. The uncertainty of tradi-
tional health risk assessment methodologies has
Vol.: (0123456789)
13
 5976
been significantly reduced by PRA models (Cui
et al., 2021). The risk assessment findings can help
cement plants improve their occupational health and
safety management in order to reduce dust-related
occupational diseases and damages (Tong et al.,
2019b). According to sensitivity analysis, the con-
centration of Cr may have a significant effect on
both carcinogenic and non-carcinogenic risks for
cement workers. As a result, managers should pri-
oritize measures such as dust suppression, mechani-
cal ventilation, job rotation, and other administra-
tive controls that successfully help mitigate related
risks. This study has limitations. Cement dust could
have other carcinogens like crystalline silica, which
could be incorporated into the risk assessment. The
air samples of the current study were collected in
the summer. Weather conditions, particularly wind
speed and direction, as well as relative humidity,
may influence worker exposure to heavy metals in
other seasons. Therefore, it is recommended that
future studies of the cement factory’s health risk
assessment include all hazardous chemicals meas-
ured over different seasons.
Acknowledgements We were grateful for the cooperation of
all the participating workers, management of the cement fac-
tory for their assistance throughout the data collection.
Authors’ contributions MH and AJ designed the study. SA
collected data. MH, AJ, and ZMS analyzed the data and wrote
the initial draft. All of the authors revised and approved the
paper and supplementary information.
Funding This work was supported by the Urmia University
of Medical Sciences (UMSU) grant (Project No.11086).
Availability of data and materials The datasets used and/or
analyzed during the current study are available from the cor-
responding author.
Declarations
Conflict of interest The authors have no relevant financial or
non-financial interests to disclose.
Ethical approval This study was performed in line with the
principles of the Declaration of Helsinki. Approval was granted
by the Ethics Committee of Urmia University of Medical Sci-
ences (UMSU) (approval number: IR.UMSU.REC.1400.340).
Consent to participate All workers provided their written
informed consent to participate in the current study.
Consent to publish Informed consent was obtained from all
individual participants included in the study.
Vol:. (1234567890)
13
Environ Geochem Health (2023) 45:5961–5979
References
A blueprint for a climate friendly cement industry [Inter-
net]. 2008. Available from: https://​wwf.​panda.​org/​wwf_​
news/?​1 51621%​2 FA-​b luep​r int-​for-a-​c lima​t e-​f rien​d ly-​
cement-​indus​try.
Abimbola, A. F., Kehinde-Phillips, O. O., & Olatunji, A. S.
(2007). The Sagamu cement factory, SW Nigeria: Is the
dust generated a potential health hazard? Environmental
Geochemistry and Health., 29(2), 163–167.
Achternbosch, M., Bräutigam, K.-R., Hartlieb, N., Kupsch,
C., Richers, U., & Stemmermann, P. (2005). Impact
of the use of waste on trace element concentrations in
cement and concrete. Waste Management & Research.,
23(4), 328–337.
Ali N, Eqani SAMAS, Nazar E, Alhakamy NA, Rashid
MI, Shahzad K, et al. Arsenic and lead in the indoor
residential settings of different socio-economic sta-
tus; assessment of human health risk via dust expo-
sure. Environmental Science and Pollution Research.
2021;28(11):13288–99.
Ansari, N., & Seifi, A. (2013). A system dynamics model
for analyzing energy consumption and CO2 emission in
Iranian cement industry under various production and
export scenarios. Energy Policy, 58, 75–89.
Cheng C-A, Ching T-C, Tsai S-W, Chuang K-J, Chuang H-C,
Chang T-Y. Exposure and health risk assessment of
indoor volatile organic compounds in a medical univer-
sity. Environmental Research. 2022:113644.
Cohen, S. S., Sadoff, M. M., Jiang, X., Fryzek, J. P., &
Garabrant, D. H. (2014). A review and meta-analysis
of cancer risks in relation to Portland cement exposure.
Occupational and Environmental Medicine., 71(11),
796–802.
Cui, P., Zhang, T., Chen, X., & Yang, X. (2021). Levels,
Sources, and Health Damage of Dust in Grain Transpor-
tation and Storage: A Case Study of Chinese Grain Stor-
age Companies. Atmosphere, 12(8), 1025.
Dehghani, F., Omidi, F., Fallahzadeh, R. A., & Pourhassan,
B. (2021). Health risk assessment of occupational expo-
sure to heavy metals in a steel casting unit of a steel-
making plant using Monte-Carlo simulation technique.
Toxicology and Industrial Health., 37(7), 431–440.
Eom, S.-Y., Cho, E.-B., Oh, M.-K., Kweon, S.-S., Nam,
H.-S., Kim, Y.-D., et al. (2017). Increased incidence of
respiratory tract cancers in people living near Portland
cement plants in Korea. International Archives of Occu‑
pational and Environmental Health., 90(8), 859–864.
Etim, M.-A., Babaremu, K., Lazarus, J., & Omole, D. (2021).
Health risk and environmental assessment of cement
production in Nigeria. Atmosphere, 12(9), 1111.
Fandi, N. F. M., Jalaludin, J., Latif, M. T., Abd Hamid, H.
H., & Awang, M. F. (2020). BTEX Exposure assessment
and inhalation health risks to traffic policemen in the
klang valley region. Malaysia. Aerosol and Air Quality
Research., 20(9), 1922–1937.
Fang W, Yang Y, Xu Z. PM10 and PM2. 5 and health risk
assessment for heavy metals in a typical factory for
cathode ray tube television recycling. Environmental
science & technology. 2013;47(21):12469–76.
Environ Geochem Health (2023) 45:5961–5979
Gizaw, Z., Yifred, B., & Tadesse, T. (2016). Chronic res-
piratory symptoms and associated factors among cement
factory workers in Dejen town, Amhara regional state,
Ethiopia, 2015. Multidisciplinary Respiratory Medi‑
cine., 11(1), 1–9.
Gupta S, Gupta SK. Application of Monte Carlo simulation
for carcinogenic and non-carcinogenic risks assessment
through multi-exposure pathways of heavy metals of
river water and sediment, India. 2022.
Hassan Bhat, T., Jiawen, G., & Farzaneh, H. (2021). Air pol-
lution health risk assessment (AP-HRA), principles and
applications. International Journal of Environmental
Research and Public Health., 18(4), 1935.
Hosseinzadeh M, Hemmatjo R, Moutab Sahihazar Z, Galvani
S, Hajaghazadeh M. Probabilistic health risk assessment
of occupational exposure to BTEX in a paint manufac-
turing plant using Monte-Carlo simulation. Human and
Ecological Risk Assessment: An International Journal.
2023:1–22.
Jackman J, Guerra de Castillo Z, Olafsson S. Stochastic flow
shop scheduling model for the Panama Canal. Journal of
the Operational Research Society. 2011;62(1):69–80.
Jafari, A., Ghaderpoori, M., Kamarehi, B., & Abdipour, H.
(2019). Soil pollution evaluation and health risk assess-
ment of heavy metals around Douroud cement factory.
Iran. Environmental Earth Sciences., 78(8), 1–9.
Jiménez-López, A. M., & Hincapié-Llanos, G. A. (2022).
Identification of factors affecting the reduction of VOC
emissions in the paint industry: Systematic litera-
ture review-SLR. Progress in Organic Coatings., 170,
106945.
Kamal, A., Malik, R. N., Martellini, T., & Cincinelli, A.
(2015). Exposure to dust-bound PAHs and associated car-
cinogenic risk in primitive and traditional cooking prac-
tices in Pakistan. Environmental Science and Pollution
Research., 22(16), 12644–12654.
Kamaludin, N. H., Jalaludin, J., Tamrin, S. B. M., Akim, A.
M., Martiana, T., & Widajati, N. (2020). Exposure to
Silica, Arsenic, and Chromium (VI) in Cement Workers:
A Probability Health Risk Assessment. Aerosol and Air
Quality Research., 20, 2347–2370.
Karimi Zeverdegani, S., Barakat, S., & Yazdi, M. (2016).
Chemical risk assessment in a chemical laboratory based
on three different techniques. Journal of Occupational
Health and Epidemiology., 5(3), 168–175.
Kermani M, Jonidi Jafari A, Gholami M, Arfaeinia H, Shahsa-
vani A, Fanaei F. Characterization, possible sources and
health risk assessment of PM2. 5-bound Heavy Metals in
the most industrial city of Iran. Journal of Environmental
Health Science and Engineering. 2021;19(1):151–63.
Khoshakhlagh, A. H., & Morais, S. (2022). Volatile organic
compounds in carpet manufacturing plants: Exposure lev-
els and probabilistic risk assessment using Monte-Carlo
simulations. Human and Ecological Risk Assessment: An
International Journal., 28(9), 972–982.
Khoshakhlagh AH, Askari Majdabadi M, Yazdanirad S,
Carlsen L. Health risk assessment of exposure to benzene,
toluene, ethylbenzene, and xylene (BTEX) in a compos-
ite manufacturing plant: Monte-Carlo simulations. Human
and Ecological Risk Assessment: An International Jour-
nal. 2023:1–15.
5977
Koh, D.-H., Kim, T.-W., Jang, S. H., & Ryu, H.-W. (2011).
Cancer mortality and incidence in cement industry work-
ers in Korea. Safety and Health at Work., 2(3), 243–249.
Koh, D. H., Kim, T. W., Jang, S., & Ryu, H. W. (2013). Dust
exposure and the risk of cancer in cement industry work-
ers in Korea. American Journal of Industrial Medicine.,
56(3), 276–281.
Lahiri, S., Levenstein, C., Nelson, D. I., & Rosenberg, B. J.
(2005). The cost effectiveness of occupational health
interventions: Prevention of silicosis. American Journal of
Industrial Medicine., 48(6), 503–514.
Leidel NA, Busch KA, Lynch JR. Occupational exposure sam-
pling strategy manual: US Department of Health, Educa-
tion, and Welfare, Public Health Service, National Insti-
tute for Occupational Safety and Health. Publication no.
77–173; 1977.
Mallongi, A., Stang, S., Astuti, R., Rauf, A., & Natsir, M.
(2023). Risk assessment of fine particulate matter expo-
sure attributed to the presence of the cement industry.
Global Journal of Environmental Science and Manage‑
ment., 9(1), 43–58.
Mazaheri Tehrani A, Bahrami A, Leili M, Poorolajal J, Zafari
D, Samadi M, et al. Investigation of seasonal variation and
probabilistic risk assessment of BTEX emission in munic-
ipal solid waste transfer station. International Journal of
Environmental Analytical Chemistry. 2020:1–14.
Meo, S., Alsaaran, Z., & Alshehri, M. (2014). Effect of expo-
sure to cement dust on Fractional Exhaled Nitric Oxide
(FeNO) in non-smoking cement mill workers. European
Review for Medical and Pharmacological Sciences,
18(10), 1458–1464.
Mishra UC, Sarsaiya S, Gupta A. A systematic review on
the impact of cement industries on the natural environ-
ment. Environmental Science and Pollution Research.
2022:1–12.
Monographs on the evaluation of carcinogenic risks to humans.
Volume 49. Chromium, nickel, and welding. Lyon
(France): International Agency for Research on Cancer;
[Internet]. 1990.
NIOSH 7900,ARSENIC and compounds, as As, NIOSH
Manual of Analytical Methods (NMAM), Fourth Edition
[Internet]. 2003. Available from: https://​www.​cdc.​gov/​
niosh/​docs/​2003-​154/​pdfs/​7900.​pdf.
OSHA Method ID-121, Metal and metalloid particulates in
workplace atmospheres (atomic absorption) [Internet].
2002. Available from: https://​www.​osha.​gov/​sites/​defau​lt/​
files/​metho​ds/​osha-​id121.​pdf.
Ogunbileje, J., Sadagoparamanujam, V.-M., Anetor, J.,
Farombi, E., Akinosun, O., & Okorodudu, A. (2013).
Lead, mercury, cadmium, chromium, nickel, copper, zinc,
calcium, iron, manganese and chromium (VI) levels in
Nigeria and United States of America cement dust. Chem‑
osphere, 90(11), 2743–2749.
Pouransari, M. (2020). Risk assessment of occupational
exposure to heavy metals (lead, chromium, cadmium)
in cement respirable particles in a cement factory. Iran
Occupational Health., 17(1), 103–115.
Proctor, D. M., Bhat, V., Suh, M., Reichert, H., Jiang, X.,
& Thompson, C. M. (2021). Inhalation cancer risk
assessment for environmental exposure to hexavalent
chromium: Comparison of margin-of-exposure and
Vol.: (0123456789)
13
 5978
linear extrapolation approaches. Regulatory Toxicology
and Pharmacology., 124, 104969.
Raffetti, E., Treccani, M., & Donato, F. (2019). Cement plant
emissions and health effects in the general population: A
systematic review. Chemosphere, 218, 211–222.
Rahmanian M, Safari Y. Contamination factor and pollution
load index to estimate source apportionment of selected
heavy metals in soils around a cement factory, SW Iran.
Archives of Agronomy and Soil Science. 2020:1–11.
Ramírez, N., Cuadras, A., Rovira, E., Borrull, F., & Marcé, R.
M. (2012). Chronic risk assessment of exposure to vola-
tile organic compounds in the atmosphere near the largest
Mediterranean industrial site. Environment International.,
39(1), 200–209.
Rivera Velasquez, M. F., Fallico, C., Guerra, I., & Straface,
S. (2013). A Comparison of deterministic and probabil-
istic approaches for assessing risks from contaminated
aquifers: An Italian case study. Waste Management and
Research., 31(12), 1245–1254.
Rostami, R., Fazlzadeh, M., Babaei-Pouya, A., Abazari, M.,
Rastgho, L., Ghasemi, R., et al. (2021). Exposure to
BTEX concentration and the related health risk assess-
ment in printing and copying centers. Environmental Sci‑
ence and Pollution Research., 28(24), 31195–31206.
Sah, D., Verma, P. K., Kumari, K. M., & Lakhani, A. (2019).
Chemical fractionation of heavy metals in fine particulate
matter and their health risk assessment through inhala-
tion exposure pathway. Environmental Geochemistry and
Health., 41(3), 1445–1458.
Sahihazar, Z. M., Ghahramani, A., Galvani, S., & Hajaghaza-
deh, M. (2022). Probabilistic health risk assessment of
occupational exposure to crystalline silica in an iron
foundry in Urmia. Iran. Environmental Science and Pollu‑
tion Research., 29(54), 82014–82029.
Sakizadeh, M., Ahmadpour, E., & Sharafabadi, F. M. (2019).
Spatial analysis of chromium in southwestern part of Iran:
Probabilistic health risk and multivariate global sensitivity
analysis. Environmental Geochemistry and Health., 41(5),
2023–2038.
Schiavo B, Meza-Figueroa D, Vizuete-Jaramillo E, Robles-
Morua A, Angulo-Molina A, Reyes-Castro PA, et al. Oxi-
dative potential of metal-polluted urban dust as a potential
environmental stressor for chronic diseases. Environmen-
tal Geochemistry and Health. 2022:1–22.
Schuhmacher, M., Domingo, J. L., & Garreta, J. (2004). Pol-
lutants emitted by a cement plant: Health risks for the
population living in the neighborhood. Environmental
Research., 95(2), 198–206.
Sepahi Zoeram, F., Ebrahimi, A. A., Mehrparvar, A. H., Sar-
sangi Aliabad, A., Fallah Zadeh, H., Mehri, H., et al.
(2022). Health risk assessment of inhalational exposure to
heavy metals in drivers working in an urban desert city in
the Middle East. Environmental Monitoring and Assess‑
ment., 194(8), 1–9.
Shomar, B., & Rashkeev, S. N. (2021). A comprehensive risk
assessment of toxic elements in international brands of
face foundation powders. Environmental Research., 192,
110274.
Smailyte, G., Kurtinaitis, J., & Andersen, A. (2004). Mortality
and cancer incidence among Lithuanian cement producing
Vol:. (1234567890)
13
Environ Geochem Health (2023) 45:5961–5979
workers. Occupational and Environmental Medicine.,
61(6), 529–534.
Smith, A. H., Ercumen, A., Yuan, Y., & Steinmaus, C. M.
(2009). Increased lung cancer risks are similar whether
arsenic is ingested or inhaled. Journal of Exposure Sci‑
ence & Environmental Epidemiology., 19(4), 343–348.
Solgi E, Khodabandelo H. Cadmium and lead disruption in
soils around the hegmatan cement factory, Iran. Health
Scope. 2016;5(2).
Sultana Z, Rehman MYA, Khan HK, Malik RN. Health risk
assessment associated with heavy metals through frac-
tioned dust from coal and chromite mines in Pakistan.
Environmental Geochemistry and Health. 2022.
Tong, R., Cheng, M., Ma, X., Yang, Y., Liu, Y., & Li, J.
(2019b). Quantitative health risk assessment of inhalation
exposure to automobile foundry dust. Environmental Geo‑
chemistry and Health., 41(5), 2179–2193.
Tong, R., Cheng, M., Yang, X., Yang, Y., & Shi, M. (2019d).
Exposure levels and health damage assessment of dust in
a coal mine of Shanxi Province. China. Process Safety
and Environmental Protection., 128, 184–192.
Tong, R., Zhang, L., Yang, X., Liu, J., Zhou, P., & Li, J.
(2019a). Emission characteristics and probabilistic health
risk of volatile organic compounds from solvents in
wooden furniture manufacturing. Journal of Cleaner Pro‑
duction., 208, 1096–1108.
Tong R, Yang Y, Shao G, Zhang Y, Dou S, Jiang W. Emission
sources and probabilistic health risk of volatile organic
compounds emitted from production areas in a petrochem-
ical refinery in Hainan, China. Human and Ecological
Risk Assessment: An International Journal. 2019c.
Tran, H. M., Bui, H. T. M., Thoumsang, S., Wangwongwa-
tana, S., Nguyen, H. P. A., & Phung, D. (2022). Health
risk assessment of volatile organic compounds exposure
among nail salon workers in Vietnam. Human and Eco‑
logical Risk Assessment: An International Journal., 28(2),
265–280.
USEPA. Risk Assessment Guidance for Superfund Volume I:
Human Health Evaluation Manual (Part F, Supplemen-
tal Guidance for Inhalation Risk Assessment). Office of
Superfund Remediation and Technology Innovation Envi-
ronmental Protection Agency. 2009;EPA-540-R-070–002.
USEPA. Risk Assessment Guidance for Superfund: Volume
I—Human Health Evaluation Manual (Part B, Develop-
ment of Risk‐Based Preliminary Remediation Goals).
EPA/540/R-92/003. 1991.
Wang, S., Ji, Y., Zhao, J., Zhang, L., & Li, Y. (2020). Sources
and exposure risk of trace elements for traffic policemen
in roadside locations. Transportation Research Part D:
Transport and Environment., 78, 102176.
Widziewicz K, Rogula-Kozłowska W, Loska K. Cancer risk
from arsenic and chromium species bound to PM2. 5 and
PM1–Polish case study. Atmospheric Pollution Research.
2016;7(5):884–94.
Yang, S. Y., Lin, J. M., Lin, W. Y., & Chang, C. W. (2018).
Cancer risk assessment for occupational exposure to chro-
mium and nickel in welding fumes from pipeline con-
struction, pressure container manufacturing, and shipyard
building in Taiwan. Journal of Occupational Health.,
60(6), 515–524.
Environ Geochem Health (2023) 45:5961–5979 5979

Yeheyis, M., Aguilar, G., Hewage, K., & Sadiq, R. (2012). volatile organic compounds (VOCs) at a petrochemical
Exposure to Crystalline Silica Inhalation Among Con- industrial park along the Yangtze River. Science of the
struction Workers: A Probabilistic Risk Analysis. Human Total Environment., 703, 135505.
and Ecological Risk Assessment: An International Jour‑
nal., 18(5), 1036–1050. Publisher’s Note Springer Nature remains neutral with regard
Zeleke, Z. K., Moen, B. E., & Bråtveit, M. (2010). Cement to jurisdictional claims in published maps and institutional
dust exposure and acute lung function: A cross shift study. affiliations.
BMC Pulmonary Medicine., 10(1), 19.
Zeverdegani SK, Ordudari Z, Karimi A, Esmaeili R, Khorvash
Springer Nature or its licensor (e.g. a society or other partner)
MK. Comparison of the chemical health risk assessment
holds exclusive rights to this article under a publishing
of exposure to metal fumes for the furnace operator of a
agreement with the author(s) or other rightsholder(s); author
foundry industry using quantitative and semi-quantitative
self-archiving of the accepted manuscript version of this article
methods. Heliyon. 2023:e12913.
is solely governed by the terms of such publishing agreement
Zheng, H., Kong, S., Yan, Y., Chen, N., Yao, L., Liu, X., et al.
and applicable law.
(2020). Compositions, sources and health risks of ambient

Vol.: (0123456789)
13