Work- and hydration-related health outcomes prevalence among USA construction workers: evidence from the national survey

Background: Construction workers face elevated risks of heat-related illnesses, yet hydration and rest break policies remain inconsistent across regions and are not federally mandated. Objective: To evaluate the association between occupational conditions and hydration-related health outcomes among national construction workers, focusing on regional disparities and policy relevance amid increasing ambient temperatures. Methods: We analyzed 2023 National Health Interview Survey data, focusing on adults employed in the construction industry (n = 1,231) versus other industries (n = 16,241). We assessed participant self-reported back pain, diagnosed fatigue, cognitive difficulty, injury, and general health, while using regional indicators with higher temperatures, and the 2023-2024 national record-breaking heatwave, as hydration proxies. Weighted descriptive statistics, multivariate regression models, and sensitivity analyses were used to examine associations. Results: West region construction workers had the largest negative associations with back pain (β = -0.18), injury (β = -0.52), cognitive difficulty (β = -0.15), and better general health (β = -0.09), followed by the Midwest and Southern region workers for back pain and better general health. Workers' race, sex, educational attainment, Body Mass Index (BMI), and marital status play a crucial role in workers' reported health outcomes, with non-Hispanic Asians at higher odds of severe back pain, fatigue, and cognitive difficulty. Conclusion: Hydration access is a critical, yet underregulated factor in preventing heat-related health outcomes in occupational settings across the USA. There is an urgent need for enforceable national standards mandating water and rest breaks for construction workers, particularly in high-heat regions given recent policies that have removed water breaks in the Southern region.