Association of physical component score with high-risk lung nodules among Chinese Urban sanitation workers: a sex-specific analysis

Background: Sanitation workers face chronic occupational exposure to ambient air pollution and traffic-related particulate matter; however, the prevalence of high-risk lung nodules in this vulnerable population remains unclear. Furthermore, the potential association between physical health-related quality of life (HRQoL) and nodule risk, along with its sex-specific patterns, has not been adequately investigated. Methods: This cross-sectional study included 1,018 outdoor sanitation workers in Hohhot, Inner Mongolia Autonomous Region, China. All participants underwent low-dose computed tomography (LDCT) screening and completed the SF-8 Health Survey. Lung nodules were assessed by two independent radiologists in a blinded manner. High-risk lung nodules (Lung-RADS Category 4) were confirmed by at least two senior specialists. Multivariate logistic regression and interaction analyses were employed to evaluate the association between Physical Component Summary (PCS) scores and high-risk lung nodules, adjusting for age, sex, smoking status, and socioeconomic factors. Results: for interaction = 0.0407 and 0.0319, respectively). Interactions for age, income, smoking, BMI, and residence were non-significant. Conclusion: A higher PCS is inversely associated with high-risk lung nodules, demonstrating a generally approximate linear relationship. This inverse association is more pronounced in females and individuals with higher educational levels, suggesting potential effect modification by sex and education.