Job exposure matrices for use in respiratory health in low- and middle-income countries: a commentary on relevance and future direction

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.