Occupational risk factors for abdominal wall hernias among working-age adults in Saudi Arabia: A cross-sectional analysis of national health survey and labor force data

Abstract BACKGROUND: Occupational exposures involving heavy manual lifting, prolonged standing, and physically demanding labor represent established risk factors for abdominal wall hernia development. Saudi Arabia’s labor force, characterized by a substantial manual workforce concentrated in construction, manufacturing, and agriculture, may carry elevated occupational hernia risk, yet population-level analyses quantifying these associations are absent from the literature. OBJECTIVES: This study aims to characterize the prevalence of self-reported abdominal wall hernias by occupational category among Saudi working-age adults, quantify the association between specific occupational exposures and hernia risk, and assess geographic and demographic variations in occupationally attributed hernia burden. METHODS: This cross-sectional descriptive study analyzed secondary data from the Saudi Health Interview Survey 2018 ( n = 10,735 adults aged 18–65 years), Saudi General Authority for Statistics Labor Force Survey 2018–2023, and Saudi Ministry of Health Annual Statistical Yearbooks. Hernia prevalence was stratified by occupational category using the International Standard Classification of Occupations. The specific exposures analyzed included heavy manual lifting, prolonged standing, and physically demanding labor. Comparative analyses and prevalence ratios (PRs) were calculated. Reporting followed strengthening the reporting of observational studies in epidemiology guidelines. RESULTS: The overall self-reported hernia prevalence was 8.3% among working-age adults. Manual laborers demonstrated the highest hernia prevalence (14.7%), followed by construction and extraction workers (13.2%) and agricultural workers (11.8%), compared to 4.1% among professional/managerial workers. Hernia prevalence was significantly associated with daily heavy lifting exceeding 20 kg (PR: 2.84; 95% confidence interval [CI]: 2.31–3.49), prolonged standing exceeding 6 h per day (PR: 1.76; 95% CI: 1.42–2.18), and duration of occupational exposure exceeding 10 years (PR: 2.21; 95% CI: 1.87–2.61). Male sex, age 45–65 years, and concurrent obesity amplified occupational hernia risk. Geographic analysis revealed highest hernia procedure rates in regions with concentrated industrial and agricultural workforces. CONCLUSIONS: Occupational exposures, particularly heavy manual lifting and prolonged standing, are significantly associated with abdominal wall hernia prevalence in Saudi Arabia’s working-age population. Targeted workplace prevention programs, ergonomic interventions, pre-employment screening, and enhanced access to hernia repair services for manual labor sectors represent priority occupational health policy actions.