Evolution of Occupational Health Risks Among Waste Incinerator Workers: A Four-Decade Review

Occupational health risks among waste incinerator workers have undergone marked changes over the last four decades, paralleling advances in technology, regulatory frameworks, and waste composition. This comprehensive review synthesizes studies from 1980 to 2025, providing a historical lens on exposure trends, disease outcomes, and interventions in municipal, medical, and hazardous waste incineration settings worldwide. Early investigations highlighted severe exposures to dioxins and furans (PCDD/Fs), and heavy metals, resulting in high rates of respiratory illness, dermatological conditions, and increased cancer risk. While modern emission controls have greatly reduced overall exposures, persistent health risks, especially respiratory, cardiovascular, and neurological, remain evident, particularly in outdated facilities and developing regions. The emergence of new threats, including brominated flame retardants, perfluorinated compounds, and microplastics, highlights the evolving complexity of workplace hazards as waste streams change. Geographic disparities in risk and protection reflect gaps in technology transfer, regulatory stringency, and resource allocation. Despite substantial progress, this review finds that the complete elimination of occupational hazards in incineration work remains elusive. Integrated protective strategies, long-term cohort surveillance, and research into emerging contaminants are recommended to sustain and advance worker health globally.