Objective: To analysis the main types and prevalences of complications among pneumoconiosis patients, and to provide scientific basis for the prevention and treatment of pneumoconiosis. Methods: In January 2023, literatures on pneumoconiosis complications published before December 31, 2022 in China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Science & Technology Journal Database (VIP), PubMed and Web of Science were systematically searched. Literatures were selected according to inclusion and exclusion criteria, and relevant data were extracted. Quality assessment tool was used to evaluate the quality of the articles for this study. The combined prevalence of complications among pneumoconiosis patients was calculated by R 4.1.1 software. Subgroup analysis was carried out to explore the origin of heterogeneity. Results: Sixty-four eligible articles were selected from 2276 literatures related to pneumoconiosis and its complications. The combined prevalence of complications among pneumoconiosis patients was 21.1% (95% CI: 16.0%-26.3%, I(2)=99.9%). The combined prevalence of chronic obstructive pulmonary disease (COPD) was 26.4% (95%CI: 17.3%-35.6%, I(2)=97.1%), which was the highest among different types of complications among pneumoconiosis patients. Subgroup analyses revealed that the combined prevalence of tuberculosis among pneumoconiosis stage Ⅰ, Ⅱand Ⅲ were 13.8% (95%CI: 10.5%-17.2%, I(2)=99.6%), 18.4% (95% CI: 14.9%-22.0%, I(2)=99.3%) and 37.3% (95% CI: 30.7%-44.0%, I(2)=99.1%), respectively, showing a corresponding increasing tendency (P<0.05). The combined prevalence of tuberculosis among coal worker's pneumoconiosis patients was 12.9% (95% CI: 6.4%-19.3%, I(2)=97.9%), while the combined prevalence of tuberculosis among silicosis patients was 13.9% (95%CI: 10.0%-17.8%, I(2)=96.9%) . Conclusion: The prevalence of pneumoconiosis patients combined with different types of complications is high, and its prevalence increases with the severity of pneumoconiosis.