Job exposure matrices for use in respiratory health in low- and middle-income countries: a commentary on relevance and future direction
Quintero Santofimio V. Ma J. Vinnikov D. Jeebhay M.F. Buralli R. Nafees A. Kromhout H. Feary J.
1 March 2026Oxford University Press
Annals of Work Exposures and Health
2026#70Issue 2
Occupational exposures are critical yet often overlooked contributors to chronic respiratory disease. Job exposure matrices (JEMs) are widely used to assign occupational exposures where direct measurement is not feasible, particularly in large epidemiological studies. However, their applicability in low- and middle-income countries (LMICs) is limited by contextual, structural, and methodological challenges. Drawing on insights from a focus group of occupational respiratory health and exposure assessment experts, this commentary examines key limitations in applying existing JEMs to LMIC contexts, including high prevalence of informal employment, job variability, and higher exposure levels. The group identified priority areas for future refinement, including temporal and geographical calibration, and integration of mixed-role employment. While JEMs remain the most practical approach for large-scale exposure assessment, their contextual adaptation is essential to ensure valid exposure–response estimation, improve disease burden attribution, and promote greater equity in global occupational health research.
chronic respiratory diseases , job exposure matrix , LMIC , occupational exposures
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National Heart and Lung Institute, Imperial College London, Dovehouse St, London, SW3 6LY, United Kingdom
Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, 430030, China
Al-Farabi Kazakh National University, Al-Farabi Avenue 71, Almaty, 050040, Kazakhstan
Peoples Friendship University of Russia (RUDN University), Moscow, 117198, Russian Federation
University of Cape Town, Occupational Medicine Division and Centre for Environmental & Occupational Health Research, Rondebosch, 7700, South Africa
Department of Policy, Management and Health, School of Public Health, University of São Paulo, R. da Reitoria, 374 - Butantã, São Paulo, 05508-220, Brazil
Department of Community Health Sciences, Aga Khan University, Stadium Rd, POB 3500, Karachi, 74800, Pakistan
Utrecht University, Institute for Risk Assessment Science, Heidelberglaan 8, Utrecht, 3584 CS, Netherlands
NIHR Imperial Biomedical Research Centre, The Bays, Entrance, 2 S Wharf Rd, London, W2 1NY, United Kingdom
National Heart and Lung Institute
Department of Occupational and Environmental Health
Al-Farabi Kazakh National University
Peoples Friendship University of Russia (RUDN University)
University of Cape Town
Department of Policy
Department of Community Health Sciences
Utrecht University
NIHR Imperial Biomedical Research Centre
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