Assessment of Occupational Health Risks from Exposure to Titanium Alloys Based on the Results of Periodic Medical Examinations and Doctor’s Visits

Introduction: The titanium industry continues to build capacity and introduce innovative technologies driven by high demand for the metal and its alloys. High occupational risks of diseases of the respiratory and circulatory systems, diseases of the skin, and changes in hematological indices were established for titanium metal production workers.

The objective of our study was to assess the occupational risk from exposures to titanium in the composition of industrial aerosols for the health of workers in the modernized areas of metallurgical production.

Materials and methods: Our risk assessment was based on findings of periodic health examinations and doctor’s visits; we estimated the relative risk (RR) and used χ2 criterion to evaluate the statistical significance of the results. Results: We observed significantly higher incidence rates of diseases of the skin, ear, respiratory and musculoskeletal systems with temporary disability and higher rates of chronic diseases of the skin, respiratory and digestive systems in the titanium metal production workers compared to the workers of the same industrial enterprise unexposed to titanium and its alloys. Chronic diseases developed quicker in the exposed workers of all age groups than in the controls. The prevalence of hematologic disorders, such as high hemoglobin levels, thrombocytopenia, leukocytosis, lymphocytosis, and monocytosis was also higher in the exposed group. In the workers exposed to titanium concentrations exceeding the maximum permissible concentration (MPC) of 10 mg/m³ in the workplace air, we noted significantly higher rates of chronic diseases of the skin and digestive system, elevated hemoglobin levels, and a rising trend in the prevalence of chronic diseases of the circulatory system, high blood pressure, overweight, and thrombocytopenia in comparison with those working in permissible conditions.

Conclusions: We revealed a strong correlation between occupational exposures to airborne titanium and chronic skin diseases and a medium correlation for leukocytosis and monocytosis.

1. Roslaya NA, Fomin IN, Likhacheva EI, et al. [Occupational medicine in the production of titanium alloys.] In: Hygiene: the past, the present and the future: Proceedings of F.F. Erisman Federal Scientific Centre of Hygiene. Moscow, 2001. Issue 1. Pp. 364–366. (In Russian).

2. Roslaya NA, Likhacheva EI, Vagina ER, et al. [Clinical features of dust-induced lung diseases in titanium alloys smelter workers.] In: Current issues of preventive medicine in the Ural region: Collection of research papers. Yekaterinburg, 2002. Pp. 148–153. (In Russian).

3. Fomin IN. Condition of health of workers exposed to titanium alloy smelters according to the results of periodic medical examinations. In: Issues of occupational medicine and industrial ecology: Collection of research papers. Yekaterinburg, 2001. Pp. 23–26. (In Russian).

4. Hussain S, Thomassen LC, Ferecatu I, et al. Carbon black and titanium dioxide nanoparticles elicit distinct apoptotic pathways in bronchial epithelial cells. Part Fibre Toxicol. 2010; 7:10. https://doi.org/10.1186/1743-8977-7-10

5. Liao CM, Chiang YH, Chio CP. Model-based assessment for human inhalation exposure risk to airborne nano/fine titanium dioxide particles. Sci Total Environ. 2008; 407(1):165–177. https://doi.org/10.1016/j.scitotenv.2008.09.028

6. Ling MP, Chio CP, Chou WC, et al. Assessing the potential exposure risk and control for airborne titanium dioxide and carbon black nanoparticles in the workplace. Environ Sci Pollut Res Int. 2011; 18(6):877–89. https://doi.org/10.1007/s11356-011-0447-y

7. Current Intelligence Bulletin 63. Occupational exposure to titanium dioxide. DHHS (NIOSH) Publication No. 211–160, 2011. 160 p.

8. Shlyapnikov DM, Vlasova EM. The risk of developing workrelated circulatory diseases in workers of titanium and magnesium production. Sanitarnyi Vrach. 2015; (10):25–36. (In Russian).

9. Vorobeva AA, Vlasova EM. Respiratory treatment status for employees of titanium-magnesium production. Meditsina Truda i Ekologiya Cheloveka. 2019; (4):20–25. (In Russian).

10. Ufimtseva MA, Bochkarev YM, Struin NL, et al. Analysis of the results of periodic medical examinations by dermatovenereologist of workers employed at metallurgical enterprises of Sverdlovsk region. Zdorov′e Naseleniya i Sreda Obitaniya. 2018; (12(309)):19–23. (In Russian). https://doi.org/10.35627/22195238/2018-309-12-19-23

11. Alekseyev VB, Shlyapnikov DM, Vlasova EM, et al. Risk assessment and prevention of respiratory diseases in workers occupied in titanium and magnesium production. Gigiena i Sanitariya. 2016; 95(1):37–41. (In Russian). https://doi.org/10.18821/0016-9900-2016-95-1-37-41

12. Nosov AE, Vlasova EM, Novoselov VG, et al. Forecasting a risk of occupationally related diseases in workers engaged into titanium-magnesium production. Meditsina Truda i Promyshlennaya Ekologiya. 2016; (8):10–15. (In Russian).

13. Xu HD, Zhou JW, Tang SC, et al. [Evaluation of health effect among occupational population exposed to nanotitanium dioxide: a cross-sectional study.] Zhonghua Yu Fang Yi Xue Za Zhi. 2016; 50(11):976–981. (In Chinese). https://doi.org/10.3760/cma.j.issn.0253-9624.2016.11.011

14. Kang SJ, Kim BM, Lee YJ, et al. Titanium dioxide nanoparticles trigger p53-mediated damage response in peripheral blood lymphocytes. Environ Mol Mutagen. 2008; 49(5):399–405. https://doi.org/10.1002/em.20399

15. Kongseng S, Yoovathaworn K, Wongprasert K, et al. Cytotoxic and inflammatory responses of TiO2 nanoparticles on human peripheral blood mononuclear cells. J Appl Toxicol. 2016; 36(10):1364–1373. https://doi.org/10.1002/jat.3342

16. Bazarova EL, Fedoruk AA, Roslaya NA, et al. Assessment experience of occupational risk associated with exposure to industrial aerosols under the conditions of metallurgical enterprise modernization. Zdorov′e Naseleniya i Sreda Obitaniya. 2019; (1(310)):38–45. (In Russian). https://doi.org/10.35627/2219-5238/2019-310-1-38-45

17. Thomas P, Bandl WD, Maier S, et al. Hypersensitivity to titanium osteosynthesis with impaired fracture healing, eczema, and T-cell hyperresponsiveness in vitro: case report and review of the literature. Contact Dermatitis. 2006; 55(4):199–202. https://doi.org/10.1111/j.1600-0536.2006.00931.x

18. Nawaz F, Wall BM. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome: suspected association with titanium bioprosthesis. Am J Med Sci. 2007; 334(3):215–8. https://doi.org/10.1097/MAJ.0b013e318141f723

19. Hettige S, Norris JS. Mortality after local allergic response to titanium cranioplasty. Acta Neurochir (Wien). 2012; 154(9): 1725–6. https://doi.org/10.1007/s00701-012-1429-7

20. Coulter I, Lee M, Zakaria R, et al. Pin site allergic contact dermatitis: an unusual complication of halo fixation. Br J Neurosurg. 2012; 26(4):566–7. https://doi.org/10.3109/02688697.2012.683464

21. Danesh M, Murase JE. Titanium dioxide induces eyelid dermatitis in patients allergic to gold. J Am Acad Dermatol. 2015; 73(1):e21. https://doi.org/10.1016/j.jaad.2015.03.046

22. Dunford R, Salinaro A, Cai L, et al. Chemical oxidation and DNA damage catalysed by inorganic sunscreen ingredients. FEBS Lett. 1997; 418(1-2):87–90. https://doi.org/10.1016/s0014-5793(97)01356-2

23. Wamer WG, Yin JJ, Wei RR. Oxidative damage to nucleic acids photosensitized by titanium dioxide. Free Radic Biol Med. 1997; 23(6):851–858. https://doi.org/10.1016/s0891-5849(97)00068-3

24. Yoshioka Y, Kuroda E, Hirai T, et al. Allergic responses induced by the immunomodulatory effects of nanomaterials upon skin exposure. Front Immunol. 2017; 16(8):169. https://doi.org/10.3389/fimmu.2017.00169