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Objectives: To assess the population health impact of high temperatures on workplace health and safety by estimating the burden of heat‐attributable occupational injury in Australia. Study design, setting: Retrospective observational study; estimation of burden of occupational injury in Australia attributable to high temperatures during 2014–19, based on Safe Work Australia (work‐related traumatic injury fatalities and workers' compensation databases) and Australian Institute of Health and Welfare data (Australian Burden of Disease Study and National Hospital Morbidity databases), and a meta‐analysis of climate zone‐specific risk data. Main outcome measure: Burden of heat‐attributable occupational injuries as disability‐adjusted life years (DALYs), comprising the numbers of years of life lived with disability (YLDs) and years of life lost (YLLs), nationally, by Köppen–Geiger climate zone, and by state and territory. Results: During 2014–19, an estimated 42 884 years of healthy life were lost to occupational injury, comprising 39 485 YLLs (92.1%) and 3399 YLDs (7.9%), at a rate of 0.80 DALYs per 1000 workers per year. A total of 967 occupational injury‐related DALYs were attributable to heat (2.3% of occupational injury‐related DALYs), comprising 890 YLLs (92%) and 77 YLDs (8%). By climate zone, the heat‐attributable proportion was largest in the tropical Am (12 DALYs; 3.5%) and Aw zones (34 DALYs; 3.5%); by state and territory, the proportion was largest in New South Wales and Queensland (each 2.9%), which also included the largest numbers of heat‐attributable occupational injury‐related DALYs (NSW: 379 DALYs, 39% of national total; Queensland: 308 DALYs; 32%). Conclusion: An estimated 2.3% of the occupational injury burden in Australia is attributable to high ambient temperatures. To prevent this burden increasing with global warming, adaptive measures and industry‐based policies are needed to safeguard workplace health and safety, particularly in heat‐exposed industries, such as agriculture, transport, and construction. [ABSTRACT FROM AUTHOR]

Background: Occupational exposure to extreme heat without sufficient protection may not only increase the risk of heat-related illnesses and injuries but also compromise economic productivity. With predictions of more frequent and intense bouts of hot weather, workplace heat exposure is presenting a growing challenge to workers' health and safety. This study aims to investigate workers' perceptions and behavioural responses towards extreme heat exposure in a warming climate.Methods: A cross-sectional questionnaire survey was conducted in 2012 in South Australia among selected outdoor industries. Workers' heat risk perceptions were measured in the following five aspects: concerns about heat exposure, attitudes towards more training, policy and guideline support, the adjustment of work habits, and degree of satisfaction of current preventive measures. Bivariate and multivariate logistic regression analyses were used to identify factors significantly associated with workers' heat perceptions.Results: A total of 749 respondents participated in this survey, with a response rate of 50.9 %. A little more than half (51.2 %) of respondents were moderately or very much concerned about workplace heat exposure. Factors associated with workers' heat concerns included age, undertaking very physically demanding work, and the use of personal protective equipment, heat illness history, and injury experience during hot weather. Less than half (43.4 %) of the respondents had received heat-related training. Workers aged 25-54 years and those with previous heat-related illness/injury history showed more supportive attitudes towards heat-related training. The provision of cool drinking water was the most common heat prevention measure. A little more than half (51.4 %) of respondents were satisfied with the current heat prevention measures. About two-thirds (63.8 %) of respondents agreed that there should be more heat-related regulations and guidelines for working during very hot weather. More than two-thirds (68.8 %) of the respondents were willing to adjust their current work habits to adapt to the likely increasing extreme heat, especially those with previous heat illness experience.Conclusions: The findings suggest a need to strengthen workers' heat risk awareness and refine current heat prevention strategies in a warming climate. Further heat educational programmes and training should focus on those undertaking physically demanding work outdoors, in particular young workers and those over 55 years with low education levels. [ABSTRACT FROM AUTHOR]

Background The adverse effects of heat on workers' health and work productivity are well documented. However, the resultant economic consequences and productivity loss are less understood. This review aims to summarize the retrospective and potential future economic burden of workplace heat exposure in the context of climate change. Methods Literature was searched from database inception to October 2020 using Embase, PubMed, and Scopus. Articles were limited to original human studies investigating costs from occupational heat stress in English. Results Twenty studies met the criteria. Eighteen studies estimated costs from heat-induced labor productivity loss. Predicted global costs from lost worktime, in US$, were 280 billion in 1995, 311 billion in 2010 (≈0.5% of GDP), 2.5 trillion in 2030 (>1% of GDP) and up to 4.0% of GDP by 2100, with additional expenses after considering reduced work efficiency. Three studies estimated heat-related healthcare expenses from occupational injuries with averaged annual costs (US$) exceeding 1 million in Spain, 1 million in Guangzhou, China and 250,000 in Adelaide, Australia. Low- and middle-income countries and countries with warmer climates had greater losses as a proportion of GDP. Greater costs per worker were observed in outdoor industries, amongst males, and workers aged 25 to 44 years. Conclusions The estimated global economic burden of occupational heat stress is substantial. Climate change adaptation and mitigation strategies should be implemented to likely minimize future costs. Further research exploring the relationship between occupational heat stress and related expenses from lost productivity, decreased work efficiency and healthcare, and costs stratified by demographic factors, is warranted. Key messages The estimated retrospective and future economic burden from occupational heat stress is large. Responding to climate change is crucial to minimize this burden. Analyzing heat-attributable occupational costs may guide the development of workplace heat management policies and practices as part of global warming strategies. [ABSTRACT FROM AUTHOR]

Highlights • Relationship between heat and work injuries is strong but varies by work location and type of work. • Research is needed to characterize specific injuries, workers at risk and injury mechanisms. • There is a need for employers and workers to be aware of the health risks during hot weather. • Targeted interventions and workplace policies focussed on preventative strategies are needed. Abstract Rationale There is increasing concern about occupational illness, injury and productivity losses due to hot weather in a changing climate. Most of the current understanding appears to relate to heat-induced illness, and relatively little regarding injuries. Objectives This paper sought to summarise the evidence on the relationship between heat exposure and injuries, to describe aetiological mechanisms and to provide policy suggestions and further research directions. Methods A literature review was conducted using a systematic search for published and grey-literature using Embase, PubMed, Scopus, CINAHL, Science Direct and Web of Science databases as well as relevant websites. Results and conclusions There was a diversity of studies in terms of occupations, industries and methods utilised. The evidence suggests an imprecise but positive relationship between hot weather and occupational injuries, and the most likely mechanism involves fatigue, reduced psychomotor performance, loss of concentration and reduced alertness. The findings reflect an increased awareness of injury risk during hot weather and the economic benefits associated with averting injury, poor health outcomes and lost productivity. Implications More work is required to characterise specific injuries and the workers at risk. Policymakers and employers should be aware that heat exposure can lead to occupational injuries with information and training resources developed to aid prevention. [ABSTRACT FROM AUTHOR]

The costs of global warming are substantial. These include expenses from occupational illnesses and injuries (OIIs), which have been associated with increases during heatwaves. This study estimated retrospective and projected future heatwave-attributable OIIs and their costs in Australia. Climate and workers' compensation claims data were extracted from seven Australian capital cities representing OIIs from July 2005 to June 2018. Heatwaves were defined using the Excess Heat Factor. OIIs and associated costs were estimated separately per city and pooled to derive national estimates. Results were projected to 2030 (2016–2045) and 2050 (2036–2065). The risk of OIIs and associated costs increased during heatwaves, with the risk increasing during severe and particularly extreme heatwaves. Of all OIIs, 0.13% (95% empirical confidence interval [eCI]: 0.11–0.16%) were heatwave-attributable, equivalent to 120 (95%eCI:70–181) OIIs annually. 0.25% of costs were heatwave-attributable (95%eCI: 0.18–0.34%), equal to $AU4.3 (95%eCI: 1.4–7.4) million annually. Estimates of heatwave-attributable OIIs by 2050, under Representative Concentration Pathway [RCP]4.5 and RCP8.5, were 0.17% (95%eCI: 0.10–0.27%) and 0.23% (95%eCI: 0.13–0.37%), respectively. National costs estimates for 2030 under RCP4.5 and RCP8.5 were 0.13% (95%eCI: 0.27-0.46%) and 0.04% (95%eCI: 0.66-0.60), respectively. These estimates for extreme heatwaves were 0.04% (95%eCI: 0.02–0.06%) and 0.04% (95%eCI: 0.01–0.07), respectively. Cost-AFs in 2050 were, under RCP4.5, 0.127% (95%eCI: 0.27-0.46) for all heatwaves and 0.04% (95%eCI: 0.01-0.09%) for extreme heatwaves. Attributable fractions were approximately similar to baseline when assuming theoretical climate adaptation. Heatwaves represent notable and preventable portions of preventable OIIs and economic burden. OIIs are likely to increase in the future, and costs during extreme heatwaves in 2030. Workplace and public health policies aimed at heat adaptation can reduce heat-attributable morbidity and costs. [Display omitted] • Limited research on expenses from work injuries and illnesses during heatwaves. • Assessment of heatwave-attributable occupational injuries, illnesses and costs. • Increased injuries and illnesses during heatwaves both retrospectively and future. • Costs increased during heatwaves, with some evidence for projected increases. • Climate adaptation can potentially reduce occupational burden. [ABSTRACT FROM AUTHOR]

Increased risk of occupational injuries and illnesses (OI) is associated with ambient temperature. However, most studies have reported the average impacts within cities, states, or provinces at broader scales. We assessed the intra-urban risk of OI associated with ambient temperature in three Australian cities at statistical area level 3 (SA3). We collected daily workers' compensation claims data and gridded meteorological data from July 1, 2005, to June 30, 2018. Heat index was used as the primary temperature metric. We performed a two-stage time series analysis: we generated location-specific estimates using Distributed Lag Non-Linear Models (DLNM) and estimated the cumulative effects with multivariate meta-analysis. The risk was estimated at moderate heat (90th percentile) and extreme heat (99th percentile). Subgroup analyses were conducted to identify vulnerable groups of workers. Further, the OI risk in the future was estimated for two projected periods: 2016–2045 and 2036–2065. The cumulative risk of OI was 3.4% in Greater Brisbane, 9.5% in Greater Melbourne, and 8.9% in Greater Sydney at extreme heat. The western inland regions in Greater Brisbane (17.4%) and Greater Sydney (32.3%) had higher risk of OI for younger workers, workers in outdoor and indoor industries, and workers reporting injury claims. The urbanized SA3 regions posed a higher risk (19.3%) for workers in Greater Melbourne. The regions were generally at high risk for young workers and illness-related claims. The projected risk of OI increased with time in climate change scenarios. This study provides a comprehensive spatial profile of OI risk associated with hot weather conditions across three cities in Australia. Risk assessment at the intra-urban level revealed strong spatial patterns in OI risk distribution due to heat exposure. These findings provide much-needed scientific evidence for work, health, and safety regulators, industries, unions, and workers to design and implement location-specific preventative measures. • Western inland regions of Sydney and Brisbane are at greater risk of OI for workers. • Workers in regions with low NDVI and socio-economic status are vulnerable to heat. • Projected climate change (2016–3045, 2036–2065) will heighten heat-related OI risk. • Location-specific risk estimation of OI is crucial to mitigate the impacts of heat. [ABSTRACT FROM AUTHOR]

Background: Despite increasing concerns about the health effects of climate change, the extent to which workers are affected by hot weather is not well documented. This study aims to investigate the association between high temperatures and work-related injuries using data from a large subtropical city in China.Methods: We used workers' compensation claims to identify work-related injuries in Guangzhou, China during 2011-2012. To feature the heat effect, the study period was restricted to the warm seasons in Guangzhou (1 May-31 October). We conducted a time-stratified case-crossover study to examine the association between ambient outdoor temperatures, including daily maximum and minimum temperatures, and cases of work-related injury. The relationships were assessed using conditional Poisson regression models.Results: Overall, a total of 5418 workers' compensation claims were included over the study period. Both maximum and minimum temperatures were significantly associated with work-related injuries, but associations varied by subgroup. One °C increase in maximum temperature was associated with a 1.4% (RR = 1.014, 95%CIs 1.012-1.017) increase in daily injury claims. Significant associations were seen for male and middle-aged workers, workers in small and medium-sized enterprises, and those working in manufacturing sector. And 1 °C increase in minimum temperature was associated with 1.7% (RR = 1.017, 95%CIs 1.012-1.021) increase in daily injury claims. Significant associations were observed for female and middle-aged workers, workers in large-sized enterprises, and those working in transport and construction sectors.Conclusions: We found a higher risk of work-related injuries due to hot weather in Guangzhou, China. This study provides important epidemiological evidence for policy-makers and industry that may assist in the formulation of occupational safety and climate adaptation strategies. [ABSTRACT FROM AUTHOR]

The adverse effects of heat on workers' health and work productivity are well documented. However, the resultant economic consequences and productivity loss are less understood. This review aims to summarize the retrospective and potential future economic burden of workplace heat exposure in the context of climate change. Literature was searched from database inception to October 2020 using Embase, PubMed, and Scopus. Articles were limited to original human studies investigating costs from occupational heat stress in English. Twenty studies met criteria for inclusion. Eighteen studies estimated costs secondary to heat-induced labor productivity loss. Predicted global costs from lost worktime, in US$, were 280 billion in 1995, 311 billion in 2010 (≈0.5% of GDP), 2.4–2.5 trillion in 2030 (>1% of GDP) and up to 4.0% of GDP by 2100. Three studies estimated heat-related healthcare expenses from occupational injuries with averaged annual costs (US$) exceeding 1 million in Spain, 1 million in Guangzhou, China and 250,000 in Adelaide, Australia. Low- and middle-income countries and countries with warmer climates had greater losses as a proportion of GDP. Greater costs per worker were observed in outdoor industries, medium-sized businesses, amongst males, and workers aged 25–44 years. The estimated global economic burden of occupational heat stress is substantial. Climate change adaptation and mitigation strategies should be implemented to likely minimize future costs. Further research exploring the relationship between occupational heat stress and related expenses from lost productivity, decreased work efficiency and healthcare, and costs stratified by demographic factors, is warranted. Key messages. The estimated retrospective and future economic burden from occupational heat stress is large. Responding to climate change is crucial to minimize this burden. Analyzing heat-attributable occupational costs may guide the development of workplace heat management policies and practices as part of global warming strategies. [ABSTRACT FROM AUTHOR]

• 24 studies assessed the effects of heat exposure on occupational injuries. • Both hot temperatures and heatwaves increase the risk of occupational injuries. • High-risk climate zones include Humid Subtropical and Oceanic Climates. • Young workers and male workers were identified as high-risk workers. • High-risk industries include agriculture, forestry, construction and manufacturing. 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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

• Foreign-born workers were less likely to make a repeat claim than native workers. • Foreign-born workers were generally less likely to have time off work. • The time interval of repeat claims was shorter in foreign-born workers. • Repeat claims indicates room for improvement to reduce work-related injuries. Several studies have explored the factors associated with repeat workers' compensation claims, however, none investigated the impact of migration status on repeat claims among injured workers. Using South Australian workers' compensation claims data from 2000 to 2014, generalized estimating equation models were used to compare the differences in repeat claims between foreign-born workers (FBW) and Australian-born workers. Time intervals between repeat claims, compensation costs, and working days lost by region of birth, as well as the change of severity between repeat claims were examined. Amongst 464,596 accepted compensation claims, repeat claims for FBW (50.5%) was lower than that of Australian-born workers (57.4%, incidence-rate ratio, IRR = 0.83, 95% CI 0.82–0.84). However, region-specific analysis showed that European-born migrant workers were 19% more likely to make repeat claims than Australian-born workers (IRR = 1.19, 95% CI 1.17–1.22), including burns, digestive diseases, fractures, infectious diseases, mental disorders, musculoskeletal diseases, and skin injuries. The time interval between repeat claims was shorter for FBW compared to Australian-born workers and compensation payments of repeat claims were higher. Regardless of birth region, time intervals between repeat claims showed a decreasing temporal trend, while it was the opposite in terms of injury severity. Foreign-born workers were generally less likely to make a repeat claim than Australian-born workers, but with birth region differences. This may be attributable to underreporting from some workers. Foreign-born workers were generally less likely to have time off work but the overall costs were higher. These differences should be considered in future injury prevention strategies. [ABSTRACT FROM AUTHOR]

• Work-injury risk increases in hot weather and risk factors require investigation. • We examined stakeholder perspectives to identify work-injury risks in hot weather. • A survey of health and safety representatives examined heat risks and outcomes. • A range of modifiable work and organisational risk factors were identified. • Preventive efforts should encompass heat-related physical injuries as well as illness. Hot weather poses occupational health and safety concerns for people working in hot environments. It is known that work-related injuries increase during hot weather, yet there is an incomplete understanding of the underlying factors. A national online survey was conducted in Australia among health and safety representatives (HSRs) to better understand factors contributing to heat-related injuries in workplaces. Risk factors and preventive measures associated with reported injuries were identified using log-poisson regression models. In total, 222 HSRs completed the survey. Overall, 43% reported that injuries or incidents caused by hot/very humid weather occur sometimes or often in their workplace. Factors found to be associated with reported heat-related injuries included 'the wearing of personal protective equipment (PPE)' which can hinder the loss of body heat, and 'inadequate resources and facilities'. 'Piece-rate workers' and 'new workers' were identified as being at high risk. The most frequently adopted preventive measures for outdoor and indoor workers were the provision of PPE (despite some identified issues) and access to cool drinking water. HSRs reported that less injuries occurred in hot weather among outdoor workers if work was rescheduled to cooler times and shade was provided; and in indoor environments where there was adequate ventilation, heat sources were shielded and workers were able to self-pace. Organisational issues, workplace hazards, personal factors and preventive measures, are all determinants of heat-related injuries in Australian workplaces. Wider adoption of identified prevention measures could reduce the incidence of heat-related injuries in outdoor and indoor workplaces. [ABSTRACT FROM AUTHOR]

Hot workplace environments can lead to adverse health effects and contribute to a range of injuries. However, there is limited contextual understanding of heat-related injury occurrence. Gaining the perspectives of occupational health and safety professionals (HSPs) may elucidate the issue and inform targeted interventions. A cross-sectional national online survey was conducted in Australia to characterise HSP perceptions of heat-related injuries; current preventive measures; training, policies and guidelines; and perspectives on barriers for prevention. Results were analysed descriptively and a log-Poisson regression model was used to identify risk factors associated with HSP reported injury occurrence, assessed through prevalence ratio (PR). Of the 307 HSP survey participants, 74% acknowledged the potential for increased risk of occupational injuries in hot weather. A variety of injury types and mechanisms were reported, including manual handling injuries, hand injuries, wounds or lacerations, and loss of control of power tools. Correlates of reported heat-related injuries included working in the sun without shade [PR: 1.26; 95% CI: 1.07–1.48] and too few rest breaks [PR: 1.28; 95% CI: 1.04–1.44]. Other factors of significance were inadequate hydration; issues with personal protective equipment (PPE) and poor supervision of workers. Only 42% reported that adequate heat training was available and 54% reported the provision for outdoor work to cease in extreme temperatures. It was acknowledged that the frequency of injuries could be reduced with wider adoption of self-pacing, and work/rest regimes. Perceived barriers for prevention included: lack of awareness of physical injury risks, and management concerns about productivity loss and/or deadlines. The findings indicate a range of potentially modifiable work and organisational risk factors such as more suitable PPE and better supervision. More attention to these factors, in conjunction with traditional interventions to reduce heat effects, could enhance injury prevention and labour productivity in people working in hot environments. Unlabelled Image • Work injuries increase in hot weather but risk factors are poorly understood. • Stakeholders' perspectives were sought on injury risks to workers in hot weather. • An online survey of health and safety professionals across Australia was conducted. • Work and organisational factors contributed to occupational injury risks in the heat. • Attention to identified risk factors could enhance workplace injury prevention. [ABSTRACT FROM AUTHOR]