Objectives: Pneumoconiosis is the most common occupational respiratory disease in Turkey and is associated with chronic systemic inflammation. Both occupational dust exposure and heavy metals such as lead may contribute to inflammatory responses. Novel inflammatory indices, including the fibrinogen-to-albumin ratio (FAR), have gained attention; however, their supportive role in occupational lung diseases remains insufficiently defined. Material and methods: This retrospective study included 156 workers who presented to an Occupational Diseases Outpatient Clinic in Mersin, Turkey, in 2019–2023. Demographic, occupational, hematological, biochemical, and inflammatory parameters were collected. Pneumoconiosis was diagnosed based on occupational silica exposure and high-resolution computed tomography findings. Univariable and multivariable logistic regression analyses were performed to evaluate associations between pneumoconiosis and selected biomarkers. Receiver operating characteristic analysis was used to assess the discriminative performance of FAR. Results: Thirty-two workers (20.5%) were diagnosed with early-stage pneumoconiosis. Glass workers represented the largest subgroup (37.5%). Compared with non-pneumoconiosis participants, pneumoconiosis patients were older and had longer work duration, higher hemoglobin, fibrinogen, blood lead levels, and FAR, as well as lower platelet count, albumin, and glomerular filtration rate. In univariable analyses, lower albumin and higher fibrinogen and FAR were associated with pneumoconiosis. In multivariable analysis, only FAR remained independently associated with pneumoconiosis (OR = 1.1, 95% CI: 1.0–1.3, p = 0.004). Receiver operating characteristic analysis demonstrated that a FAR cut-off value >69.9 predicted pneumoconiosis with 73.9% sensitivity and 72.1% specificity (AUC = 0.741). Conclusions: Fibrinogen-to-albumin ratio was independently associated with pneumoconiosis, whereas albumin, fibrinogen, and blood lead did not retain significance after adjustment. Given its moderate discriminative ability, FAR should be considered a supportive and complementary biomarker reflecting systemic inflammation rather than a stand-alone diagnostic tool. Larger multicenter prospective studies are warranted to validate these findings. Int J Occup Med Environ Health. 2026;39(1)