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|Title: ||Workers' health and productivity under occupational heat strain: a systematic review and meta-analysis|
|Authors: ||Flouris, Andreas|
Dinas, Petros C.
Ioannou, Leonidas G.
Kenny, Glen P.
|Issue Date: ||2018|
|Publisher: ||© The Authors. Published by Elsevier|
|Citation: ||FLOURIS, A. ... et al., 2018. Workers' health and productivity under occupational heat strain: a systematic review and meta-analysis. The Lancet Planetary Health, 2(12), pp. e521-e531.|
|Abstract: ||Background Occupational heat strain (ie, the effect of environmental heat stress on the body) directly threatens
workers’ ability to live healthy and productive lives. We estimated the effects of occupational heat strain on workers’
health and productivity outcomes.
Methods Following PRISMA guidelines for this systematic review and meta-analysis, we searched PubMed and
Embase from database inception to Feb 5, 2018, for relevant studies in any labour environment and at any level of
occupational heat strain. No restrictions on language, workers’ health status, or study design were applied.
Occupational heat strain was defined using international health and safety guidelines and standards. We excluded
studies that calculated effects using simulations or statistical models instead of actual measurements, and any grey
literature. Risk of bias, data extraction, and sensitivity analysis were performed by two independent investigators. Six
random-effects meta-analyses estimated the prevalence of occupational heat strain, kidney disease or acute kidney
injury, productivity loss, core temperature, change in urine specific gravity, and odds of occupational heat strain
occurring during or at the end of a work shift in heat stress conditions. The review protocol is available on PROSPERO,
registration number CRD42017083271.
Findings Of 958 reports identified through our systematic search, 111 studies done in 30 countries, including
447 million workers from more than 40 different occupations, were eligible for analysis. Our meta-analyses showed
that individuals working a single work shift under heat stress (defined as wet-bulb globe temperature beyond 22·0 or
24·8°C depending on work intensity) were 4·01 times (95% CI 2·45–6·58; nine studies with 11 582 workers) more
likely to experience occupational heat strain than an individual working in thermoneutral conditions, while their core
temperature was increased by 0·7°C (0·4–1·0; 17 studies with 1090 workers) and their urine specific gravity was
increased by 14·5% (0·0031, 0·0014–0·0048; 14 studies with 691 workers). During or at the end of a work shift under
heat stress, 35% (31–39; 33 studies with 13088 workers) of workers experienced occupational heat strain, while 30%
(21–39; 11 studies with 8076 workers) reported productivity losses. Finally, 15% (11–19; ten studies with 21721 workers)
of individuals who typically or frequently worked under heat stress (minimum of 6 h per day, 5 days per week, for
2 months of the year) experienced kidney disease or acute kidney injury. Overall, this analysis include a variety of
populations, exposures, and occupations to comply with a wider adoption of evidence synthesis, but resulted in large
heterogeneity in our meta-analyses. Grading of Recommendations, Assessment, Development and Evaluation analysis
revealed moderate confidence for most results and very low confidence in two cases (average core temperature and
change in urine specific gravity) due to studies being funded by industry.
Interpretation Occupational heat strain has important health and productivity outcomes and should be recognised as
a public health problem. Concerted international action is needed to mitigate its effects in light of climate change and
the anticipated rise in heat stress.|
|Description: ||This is an Open Access Article. It is published by Elsevier under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) licence. Full details of this licence are available at: https://creativecommons.org/licenses/by-nc-nd/4.0/|
|Sponsor: ||EU Horizon 2020 research and innovation programme.|
|Publisher Link: ||https://doi.org/10.1016/S2542-5196(18)30237-7|
|Appears in Collections:||Published Articles (Design School)|
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