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Despite the scale of this workforce, no quantitative synthesis of spirometric and symptomatic evidence from this population has previously been conducted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A pre\u2010registered systematic review and meta\u2010analysis (OSF: 10.17605\/OSF.IO\/ZARDP) was conducted by searching MEDLINE, Embase, Scopus, Web of Science, and CINAHL. Cross\u2010sectional studies comparing spirometry or respiratory symptom prevalence between informal sector workers and healthy controls in South Asia were eligible. Screening was conducted independently by two reviewers using Rayyan. Risk of bias was assessed with the AXIS tool and the JBI cross\u2010sectional checklist. Pooled mean differences (MD) and odds ratios (OR) were estimated using random\u2010effects models with restricted maximum likelihood (REML) estimation and the Knapp\u2013Hartung (HKSJ) correction. Heterogeneity was quantified by I\n                      <jats:sup>2<\/jats:sup>\n                      and prediction intervals (PIs); meta\u2010regression examined smoking prevalence, mean age, occupational sector, geographic region, and exposure measurement method as moderators. Certainty of evidence was graded using GRADE.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty\u2010eight studies (33 poolable; ~7880 participants) were included, spanning occupational sectors. There was significant between\u2010study heterogeneity, with I\n                      <jats:sup>2<\/jats:sup>\n                      values of 97%\u201399% for the main spirometry variables and wide PIs reflecting large interstudy variation in effect sizes by occupation. Brick kiln workers and sawmill workers had the highest and most consistent FEV\n                      <jats:sub>1<\/jats:sub>\n                      deficits. Overall pooled analyses showed lower FEV\n                      <jats:sub>1<\/jats:sub>\n                      (MD: \u22120.59\u2009L, 95% CI: \u22120.84 to \u22120.33), lower FVC (MD: \u22120.53\u2009L, 95% CI: \u22120.71 to \u22120.35), and lower FEV\n                      <jats:sub>1<\/jats:sub>\n                      \/FVC ratio (MD: \u22125.5%, 95% CI: \u22129.21 to \u22121.78), although PIs crossed the null for some outcomes. Exposed workers were more likely to have respiratory symptoms, such as chronic cough or breathlessness, across all analyses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Occupational particulate exposure in South Asian informal sector workers is consistently associated with substantial meaningful reductions in lung function and substantially elevated respiratory symptom burden. Very low evidence certainty underscores the need for high\u2010quality prospective research and targeted respiratory surveillance programmes for this underprotected workforce.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ajim.70143","type":"journal-article","created":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T10:35:31Z","timestamp":1791023731000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pulmonary Function Impairment From Occupational Particulate Exposure Among Informal Sector Workers in South Asia: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-0242-6974","authenticated-orcid":false,"given":"Debanjan","family":"Chakraborty","sequence":"first","affiliation":[{"name":"Ergonomics and Occupational Physiology Laboratory, Department of Physiology University of Kalyani Kalyani West Bengal India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1622-1224","authenticated-orcid":false,"given":"Aditya","family":"Nath","sequence":"additional","affiliation":[{"name":"Ergonomics and Occupational Physiology Laboratory, Department of Physiology University of Kalyani Kalyani West Bengal India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-6744-2531","authenticated-orcid":false,"given":"Lipika","family":"Mondal","sequence":"additional","affiliation":[{"name":"Ergonomics and Occupational Physiology Laboratory, Department of Physiology University of Kalyani Kalyani West Bengal India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6622-7695","authenticated-orcid":false,"given":"Indranil","family":"Saha","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, and Nodal Scientist of MRHRU, VRDL ICMR \u2010 National Institute for Research in Bacterial Infections, Indian Council of Medical Research Kolkata West Bengal India"},{"name":"Department of Medical Research Academy of Scientific and Innovative Research (AcSIR) Ghaziabad Uttar Pradesh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1584-4551","authenticated-orcid":false,"given":"Subhashis","family":"Sahu","sequence":"additional","affiliation":[{"name":"Ergonomics and Occupational Physiology Laboratory, Department of Physiology University of Kalyani Kalyani West Bengal India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,3]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"Women and Men in the Informal Economy: A Statistical Picture","author":"International Labour Organization","year":"2018"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.128.5.3590"},{"key":"e_1_2_13_4_1","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/0-306-47181-7_22","volume-title":"Health Effects of the New Labour Market","author":"Loewenson R.","year":"2002"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdw085"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30925-9"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.07-1405"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12982-025-00724-1"},{"key":"e_1_2_13_9_1","volume-title":"Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013\u20132020","author":"World Health Organization","year":"2013"},{"key":"e_1_2_13_10_1","unstructured":"World Health Organization. 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