Extreme heat and occupational injuries in different climate zones: A systematic review and meta-analysis of epidemiological evidence

Syeda Hira Fatima, Paul Rothmore, Lynne C. Giles, Blesson M. Varghese, Peng Bi

Research output: Contribution to journalReview articlepeer-review

65 Citations (Scopus)
33 Downloads (Pure)


Background: The link between heat exposure and adverse health outcomes in workers is well documented and a growing body of epidemiological evidence from various countries suggests that extreme heat may also contribute to increased risk of occupational injuries (OI). Previously, there have been no comparative reviews assessing the risk of OI due to extreme heat within a wide range of global climate zones. The present review therefore aims to summarise the existing epidemiological evidence on the impact of extreme heat (hot temperatures and heatwaves (HW)) on OI in different climate zones and to assess the individual risk factors associated with workers and workplace that contribute to heat-associated OI risks. 

Methods: A systematic review of published peer-reviewed articles that assessed the effects of extreme heat on OI among non-military workers was undertaken using three databases (PubMed, Embase and Scopus) without temporal or geographical limits from database inception until July 2020. Extreme heat exposure was assessed in terms of hot temperatures and HW periods. For hot temperatures, the effect estimates were converted to relative risks (RR) associated with 1 °C increase in temperature above reference values, while for HW, effect estimates were RR comparing heatwave with non-heatwave periods. The patterns of heat associated OI risk were investigated in different climate zones (according to Köppen Geiger classification) based on the study locations and were estimated using random-effects meta-analysis models. 

Subgroup analyses according to workers’ characteristics (e.g. gender, age group, experience), nature of work (e.g. physical demands, location of work i.e. indoor/outdoor) and workplace characteristics (e.g. industries, business size) were also conducted. 

Results: A total of 24 studies published between 2005 and 2020 were included in the review. Among these, 22 studies met the eligibility criteria, representing almost 22 million OI across six countries (Australia, Canada, China, Italy, Spain, and USA) and were included in the meta-analysis. The pooled results suggested that the overall risk of OI increased by 1% (RR 1.010, 95% CI: 1.009–1.011) for 1 °C increase in temperature above reference values and 17.4% (RR 1.174, 95% CI: 1.057–1.291) during HW. 

Among different climate zones, the highest risk of OI during hot temperatures was identified in Humid Subtropical Climates (RR 1.017, 95% CI: 1.014–1.020) followed by Oceanic (RR 1.010, 95% CI: 1.008–1.012) and Hot Mediterranean Climates (RR 1.009, 95% CI: 1.008–1.011). Similarly, Oceanic (RR 1.218, 95% CI: 1.093–1.343) and Humid Subtropical Climates (RR 1.213, 95% CI: 0.995–1.431) had the highest risk of OI during HW periods. No studies assessing the risk of OI in Tropical regions were found. The effects of hot temperatures on the risk of OI were acute with a lag effect of 1–2 days in all climate zones. Young workers (age < 35 years), male workers and workers in agriculture, forestry or fishing, construction and manufacturing industries were at high risk of OI during hot temperatures. Further young workers (age < 35 years), male workers and those working in electricity, gas and water and manufacturing industries were found to be at high risk of OI during HW. 

Conclusions: This review strengthens the evidence on the risk of heat-associated OI in different climate zones. The risk of OI associated with extreme heat is not evenly distributed and is dependent on underlying climatic conditions, workers’ attributes, the nature of work and workplace characteristics. The differences in the risk of OI across different climate zones and worker subgroups warrant further investigation along with the development of climate and work-specific intervention strategies.

Original languageEnglish
Article number106384
Number of pages22
JournalEnvironment International
Early online date17 Jan 2021
Publication statusPublished - Mar 2021
Externally publishedYes


  • Work-related injuries and illnesses
  • Distributed lag non-linear models
  • Intra-city level
  • High temperatures
  • Urban environments
  • Attributable risk
  • Climate change
  • Heatwaves
  • Hot temperatures
  • Climate zones
  • Occupation injuries


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