Occupational hearing loss and job stress among industrial workers in Markazi Province Iran using structural equation modeling

Occupational hearing loss is a common work‑related health problem with multifactorial etiology. This study aimed to estimate the prevalence of occupational hearing loss and to examine its associations with occupational, personal, and psychosocial factors. In addition, occupational stress was assessed as an associated psychosocial outcome among industrial workers in Markazi Province, Iran, using a cross‑sectional structural equation modeling approach. A cross‑sectional study was conducted between 2023 and 2024 among 1,058 industrial workers in Markazi Province, Iran, selected through multistage sampling. Data were collected using structured questionnaires, audiometric health records, workplace noise exposure measurements (ISO 9612:2009), and the Persian version of the HSE Job Stress Questionnaire. Hearing loss was assessed by pure‑tone audiometry, and NIHL was determined based on pure‑tone averages. Data were analyzed using SPSS v26 and SmartPLS. SEM was applied, and model fit and path coefficients were assessed at p < 0.05. Among 1,058 industrial workers, 19.5% had bilateral hearing loss, with higher prevalence among older workers, men, those with longer work experience, and individuals exposed to noise above the permissible level. Hearing status significantly deteriorated after employment (p < 0.001). Structural equation modeling showed that age, noise exposure above the TLV, gender, industry type, and use of personal protective equipment were significantly associated with hearing loss. Job stress was significantly related to noise and chemical exposure, industry and job type, and higher physical activity levels. The model explained 11.7% of the variance in hearing loss and 24.6% of the variance in job stress. Occupational hearing loss was common among industrial workers and showed significant associations with demographic and occupational characteristics, including age, work experience, gender, noise exposure, and industry type. Occupational stress was likewise associated with several occupational and individual factors. Given the limited proportion of variance explained by the model and the cross‑sectional design, causal inferences cannot be drawn. These findings highlight the importance of integrated occupational health strategies, including noise control, consistent PPE use, regular hearing assessments, and promotion of health‑oriented behaviors.