Occupational health outcomes among migrant and non-migrant construction workers: A systematic review and narrative synthesis

Construction remains one of the world’s most hazardous industries, with migrants comprising a substantial part of its workforce. Little evidence exists on occupational health disparities between migrant and non-migrant construction workers. This review compares occupational health outcomes between these two groups to inform equitable worker protection strategies. Following PRISMA guidelines, we systematically searched fourteen electronic databases and gray literature for studies published from January 1990 to May 2025. Eligible studies reported quantitative occupational health outcomes for both groups. Study quality was appraised using adapted Joanna Briggs Institute criteria and results were narratively synthesized. Thirty-eight studies across fifteen high-, upper-middle, and lower-middle-income countries were included, totaling 55,615 adverse health outcomes among migrant construction workers and 566,643 among non-migrant construction workers. Most studies were of low to moderate quality and were primarily conducted in high-income settings. Migrant construction workers experienced higher rates of fatal and general occupational injury than non-migrants. While migrants had excess risk for fatal falls, traumatic brain injury, heat-related mortality, and ocular trauma, they experienced lower all-cause morbidity and mortality. Patterns of non-fatal injuries, musculoskeletal disorders, mental health problems, and cardiovascular and metabolic disease were mixed. Occupational and structural factors significantly associated with morbidity and/or mortality among migrants included fewer years of employment and work experience, type of work, limited safety training and briefing attendance, and lower educational attainment. Associated socio-demographic and cultural factors included poor language proficiency, ethnicity, gender, risk-taking attitudes, and low awareness of workplace hazards; the role of age varied across studies. Migrant status is a significant determinant of occupational health in the construction sector. Strengthening labor protections for migrant workers and providing multilingual safety training are likely to reduce harm. Disaggregating occupational safety and health surveillance data by migrant status will further strengthen the evidence needed to protect the most at-risk construction workers. Registration: PROSPERO CRD42014009154.