The epidemiology of occupational heat exposure in the United States: a review of the literature and assessment of research needs in a changing climate

Abstract

In recent years, the United States has experienced record-breaking summer heat. Climate change models forecast increasing U.S. temperatures and more frequent heat waves in coming years. This scoping review summarizes research findings that characterize U.S. occupational heat-related morbidity and mortality and identifies gaps in the existing research literature. Exposure to environmental heat is a significant, but overlooked, workplace hazard that has not been well-characterized or studied. The working population is diverse; job function, age, fitness level, and risk factors to heat-related illnesses vary. This review found that few studies examine or characterize the incidence of occupational heat-related illnesses and outcomes. More research on the effects of occupational heat exposure is needed to identify and implement evidence-based policies and interventions. Since heat-related health hazards at work can be anticipated before they manifest, preventive measures can be implemented before illness occurs. With no federal regulatory standards to protect workers from environmental heat exposure, and with climate change as a driver for adaptation and prevention of heat disorders, crafting policy to characterize and prevent occupational heat stress for all workers is increasingly sensible, practical, and imperative.

Impact of Extreme Heat Events on Emergency Department Visits in North Carolina (2007–2011)

“…A recent assessment of ED visits in New York City from 2005 to 2010 also found this demographic to be at high risk for HRI [32]. In North Carolina, many of the ED visits seen during the July event were likely work-related, as most occupations with high exposure to extreme heat employ individuals in these age categories [33]. Indeed, about onethird of all HRI visits in the NC DETECT dataset from 2008 to 2010 were work-related according to available triage notes [17].…”

“…Since we did not have access to any individual information on the circumstances surrounding each ED visit, we could not confirm what specific occupations were in fact associated with HRI. In general, more research is needed to better understand how workers of various occupations are uniquely impacted by extreme heat [33].…”

Air temperature exposure and agricultural occupational injuries in the Autonomous Province of Trento (2000–2013, North-Eastern Italy)

“…First of all, many agricultural activities are performed during the warm season, often requiring the use of personal protective equipment (PPE). As the wearing of PPEs increases physical strain and restricts heat loss from the body, it directly increases the risk for heat-related illness [3,5,22,32], at the same time prompting some workers to reduce their use, ultimately increasing the risk for incidents associated with the use of chemicals, such as pesticides and fertilizers [28]. Secondly, even though the mechanization of many agricultural activities has restrained the strenuous physical labor carried out by AWs, therefore reducing their vulnerability to environmental and exertional heath stress, many farming activities still requires manual work, also in high income countries (e.g., collection of apples and oranges).…”

Thermal stress, human performance, and physical employment standards

“…Projections of climate change over the coming century suggest increasing incidences of heat-related mortality in both the general public and in occupational settings (Gubernot et al 2014;Jay and Kenny 2010;Kjellstrom et al 2013;Lundgren et al 2013;Xiang et al 2014). Epidemiological studies also suggest that the highest risk of excessive heat exposure is in tropical and lower to middle-income countries, possibly attributable to a large informal work sector, location in a hot environment, and dense populations (Lucas et al 2014).…”