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

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In recent years, the United States has experienced record-breaking summer heat. Climate change models forecast increasing US temperatures and more frequent heat wave events in the coming years. 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. Yet few studies have examined or characterized the incidence of occupational heat-related morbidity and mortality. There are no federal regulatory standards to protect workers from environmental heat exposure. With climate change as a driver for adaptation and prevention of heat disorders, crafting policy to characterize and prevent occupational heat stress for both indoor and outdoor workers is increasingly sensible, practical, and imperative.

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  • Adelakun A, Schwartz E, Blais L (1999) Occupational heat exposure. Appl Occup Environ Hyg 14(3):153–154

    Article  CAS  Google Scholar 

  • AFL-CIO Safety and Health Department (2011) Death on the job- the toll of neglect. A national and state-by-state profile of worker safety and health in the United States, 20th edn, AFL-CIO, Washington DC

  • American Conference of Governmental Industrial Hygienists (ACGIH) (2009) Heat stress and strain. TLVs. Available at:

  • Anderson GB, Bell ML (2011) Heat waves in the United States: mortality risk during heat waves and effect modification by heat wave characteristics in 43 US Communities. Environ Health Perspect 119(2):210–218

    Article  Google Scholar 

  • Basara JB, Basara HG, Illston BG, Crawford KC (2010) The impact of the urban heat island during an intense heat wave in Oklahoma City. Adv Meteorol. doi:10.1155/2010/230365

    Google Scholar 

  • Basu R, Malig B (2011) High ambient temperature and mortality in California: exploring the roles of age, disease, and mortality displacement. Environ Res 111(8):1286–1292

    Article  CAS  Google Scholar 

  • Bonauto D, Rauser E, Lim L (2010) Occupational health illness in Washington state, 2000–2009. Washington State Department of Labor & Statistics. Technical Report Number 59-2-2010. Available at:

  • Bouchama A, Dehbi M, Mohamed G, Matthies F, Shoukri M, Menne B (2007) Prognostic factors in heat wave-related deaths. Arch Intern Med 167(20):2170–2176

    Article  Google Scholar 

  • Budd GM (2008) Wet-bulb globe temperature (WBGT) – its history and its limitations. J Sci Med Sport 11(1):20–32

    Article  Google Scholar 

  • Bureau of Labor Statistics (BLS) (2011) Injuries, illnesses, and fatalities databases. Available at: Accessed: 9 September 2011

  • California Code of Regulations (2012) Title 8, section 3395. Heat illness prevention. Available at: Accessed: 20 March 2012

  • Carter R 3rd, Cheuvront SN, Williams JO et al (2005) Epidemiology of hospitalizations and deaths from heat illness in soldiers. Med Sci Sports Exerc 37(8):1338–1344

    Article  Google Scholar 

  • Centers for Disease Control and Prevention (CDC) (2010) Vital signs: state-specific obesity prevalence among adults—United States, 2009. Morb Mort Weekly Rep 59

  • Centers for Disease Control and Prevention (CDC) (2012) Statement by John Howard, M.D., Director, Naitonal Institute for Occupational Safety and Health (NIOSH), for Workers Memorial Day. Available at: Accessed: 8 May 2012

  • Chen ML, Chen CJ, Yeh WY, Huang JW, Mao IF (2003) Heat stress evaluation and worker fatigue in a steel plant. Am Ind Hyg Assoc J 64(3):352–359

    Article  Google Scholar 

  • Christensen JH, Hewitson B, Busuioc A et al (2007) Regional climate projections. In: Solomon S, Qin D, Manning M et al (eds) Climate Change 2007: the physical science basis. Contribution of Working Group I to the fourth assessment report of the Intergovernmental Panel on Climate Change. Cambridge University Press, Cambridge and New York, pp 847–940

    Google Scholar 

  • Crockford GW (1999) Protective clothing and heat stress: introduction. Ann Occup Hyg 43(5):287–288

    Article  CAS  Google Scholar 

  • Culp K, Tonelli S, Ramey SL, Donham K, Fuortes L (2011) Preventing heat-related illness among Hispanic farmworkers. AAOHNJ 59(1):23–32. doi:10.3928/08910162-20101228-01

    Article  Google Scholar 

  • Dellinger AM, Kachur PS, Sternberg E, Russell J (1996) Risk of heat-related injury to disaster relief workers in a slow-onset flood disaster. J Occup Environ Med 38(7):689–692

    Article  CAS  Google Scholar 

  • Donoghue AM (2004) Heat illness in the U.S. mining industry. Am J Ind Med 45(4):351–356

    Article  Google Scholar 

  • Donoghue ER, Grahan MA, Jentzen JM, Lifschultz B, Luke JL, Mirchandani HG (1997) Criteria for the diagnosis of heat-related deaths: National Association of Medical Examiners: Position paper. National Association of Medical Examiners Ad Hoc Committee on the Definition of Heat-Related Fatalities. Am J Forensic Med Pathol 18(1):11–14

    Article  CAS  Google Scholar 

  • Epstein Y, Moran DS, Shapiro Y, Sohar E, Shemer J (1999) Exertional heat stroke: a case series. Med Sci Sports Exerc 31(2):224–228

    Article  CAS  Google Scholar 

  • Falk H, Briss P (2011) Environmental and injury related epidemic-assistance investigations, 1946–2005. Am J Epidemiol 174(11 Suppl):S65–S79

    Article  Google Scholar 

  • Florida Department of Health (2011) Division of Environmental Health, Bureau of Environmental Public Health Medicine. Descriptive analysis of occupational heat-related illness treated in Florida hospitals and emergency departments. Available at:

  • Fredericks TK, Abudayyeh O, Choi SD, Wiersma M, Charles M (2005) Occupational injuries and fatalities in the roofing contracting industry. J Construct Eng Manage 131(11):1233–1240

    Article  Google Scholar 

  • Gabriel KMA, Endlicher WR (2011) Urban and rural mortality rates during heat waves in Berlin and Brandenburg, Germany. Environ Pollut 159(8–9):2044–2050

    Article  CAS  Google Scholar 

  • Gardner JW, Kark JA, Karnei K et al (1996) Risk factors predicting exertional heat illness in male Marine Corps recruits. Med Sci Sports Exerc 28(8):939–944

    Article  CAS  Google Scholar 

  • Hambling T, Weinstein P, Slaney D (2011) A review of frameworks for the developing environmental health indicators for climate change and health. Int J Environ Res Publ Health 8(7):2854–2875

    Article  Google Scholar 

  • Hanna EG, Kjellstrom T, Bennett C, Dear K (2011) Climate change and rising heat: population health implications for working people in Australia. Asia Pac J Public Health 23(2 Suppl):14S–26S. doi:10.1177/1010539510391457

    Article  Google Scholar 

  • Hollowell DR (2010) Perceptions of, and reactions to, environmental heat: a brief note on issues of concern in relation to occupational health. Glob Health Action 3. doi:10.3402/gha.v3i0.5632

  • Holmer I (2010) Climate change and occupational heat stress: methods for assessment. Glob Health Action 13:3. doi:10.3402/gha.v3i0.5719

    Google Scholar 

  • Hondula DM, Davis RE, Leisten MJ, Saha MV, Veazey LM, Wegner CR (2012) Fine-scale spatial variability of heat-related mortality in Philadelphia County, USA, from 1983 to 2008: a case-series analysis. Environ Health 11:16. doi:10.1186/1476-069x-11-16

    Article  Google Scholar 

  • Hyatt OM, Lemke B, Kjellstrom T (2010) Regional maps of occupational heat exposure: past, present and potential future. Global Health Action 2. doi:10.3402/gha.v3i0.5715

  • International Organization for Standardization (1989) ISO 7243:1989 Hot environments - Estimation of the heat stress on working man, based on the WBGT-index (wet bulb globe temperature). Available at:

  • Josseran L, Caillere N, Brun-Ney D et al (2009) Syndromic surveillance and heat wave morbidity: a pilot study based on emergency departments in France. BMC Med Inform Decis Mak 9:14

    Article  Google Scholar 

  • Kalkstein LS, Davis RE (1989) Weather and human mortality: an evaluation of demographic and interregional responses in the United States. Ann Assoc Am Geographers 79(1):44–64

    Article  Google Scholar 

  • Kandel W (2008) Profile of hired farmworkers, a 2008 update. USDA. Economic Research Service. Report No. 60. Available at:

  • Kilbourne EM (1992) Illness due to thermal extremes. In: Last JM, Wallace RB (eds) Public health and preventive medicine, 13th edn. Appleton Lang, Norwalk

    Google Scholar 

  • King BS, Gibbins JD (2011) Centers for Disease Control and Prevention. NIOSH. Health hazard evaluation of deepwater horizon response workers. Health hazard evaluation report HETA 2010–0115 & 2010-0129-3138. Available at:

  • Kjellstrom T, Holmer I, Lemke B (2009a) Workplace heat stress, health and productivity – an increasing challenge for low and middle-income countries during climate change. Glob Health Action. 2. doi:10.3402/gha.v2i0.2047

  • Kjellstrom T, Kovats S, Lloyd SL, Holt T, Tol RSJ (2009b) The direct impact of climate change on regional labor productivity. Arch Environ Occup Health 64(4):217–227

    Article  Google Scholar 

  • Knowlton K, Rotkin-Ellman M, King G et al (2009) The 2006 California heat wave: impacts on hospitalizations and emergency department visits. Environ Health Perspect 117(1):61–67

    Article  Google Scholar 

  • Krake A, Mccullough J, King B (2003) Health hazards to park rangers from excessive heat at Grand Canyon National Park. Appl Occup Environ Hyg 18(5):295–317

    Article  Google Scholar 

  • Lin RT, Chan CC (2009) Effects of heat on workers’ health and productivity in Taiwan. Glob Health Action 2024. doi:10.3402/gha.v2i0.2024

  • Lowry SJ, Blecker H, Camp J et al (2010) Possibilities and challenges in occupational injury surveillance of day laborers. Am J Ind Med 53(2):126–134

    Article  Google Scholar 

  • Luginbuhl RC, Jackson LL, Castillo D, Loringer KA (2008) Heat-related deaths among crop workers – United States, 1992–2006. Morb Mortal Wkly Rep 57(24):649–653

    Google Scholar 

  • Maeda T, Kaneko SY, Ohta M, Tanaka K, Sasaki A, Fukushima T (2006) Risk factors for heatstroke among Japanese forestry workers. J Occup Health 48(4):223–229

    Article  Google Scholar 

  • Miller J (Chair) (2008) US House of Representatives: hidden tragedy: underreporting of workplace injuries and illnesses. A majority staff report by the Committee of Education and Labor. Available at:

  • Minard D, Belding HS, Kingston JR (1957) Prevention of heat casualties. J Am Med Assoc 165(14):1813–1818

    Article  CAS  Google Scholar 

  • Mine Safety and Health Administration (2012) National Mine Safety and Health Academy. Heat Stress in Mining. MSHA Safety Manual Number 6. Not dated. Available at: Accessed: 24 February 2012

  • Minnesota Administrative Rules (2012) 52050110. Indoor workroom ventilation and temperature. Available at Accessed: 20 March 2012

  • Mirabelli MC, Richardson DB (2005) Heat-related fatalities in North Carolina. Am J Public Health 95(4):635–637

    Article  Google Scholar 

  • National Institute of Occupational Safety and Health (NIOSH) (2006) Health hazard evaluation report. HETA#2004-0334-3017. Transportation security administration: Palm Beach International Airport, West Palm beach, Florida. Available at:

  • National Institutes for Occupational Safety and Health (NIOSH) (1972) Criteria for a recommended standard…Occupational Exposure to Hot Environments. Available at:

  • National Institutes for Occupational Safety and Health (NIOSH) (1986) Criteria for a recommended standard…Occupational exposure to hot environments revised criteria. Available at:

  • National Institutes for Occupational Safety and Health (NIOSH) (1998) National Occupational Research Agenda (NORA). Traumatic occupational injury research needs and prevention. NIOSH Publication No. 98–134. Available at:

  • National Oceanic and Atmospheric Administration (NOAA) (2005) National Weather Service. Heat wave: a major summer killer Available at: Accessed: 22 September 2011

  • National Oceanic and Atmospheric Administration (NOAA) (2011) National Weather Service. Heat: a major killer. Available at: Accessed: 22 November 2011

  • Nelson NG, Collins CL, Comstock RD, McKenzie LB (2011) Exertional heat-related injuries treated in emergency departments in the U.S., 1997–2006. Am J Prev Med 40(1):54–60

    Article  Google Scholar 

  • Occupational Safety & Health Administration (OSHA) (2011) We can help. Using the heat index: a guide for employers. Available at: Accessed: 10 October 2011

  • Occupational Safety & Health Administration (OSHA) (2012) Hazards associated with oil cleanup operations. Gulf Oil Response and Heat. Available at: Accessed 10 March 2012

  • Park EK, Hannaford-Turner K, Lee HJ (2009) Use of personal protective equipment in agricultural workers under hot and humid conditions. Ind Health 47(2):200–201

    Article  Google Scholar 

  • Patz JA, McGeehin MA, Bernard SM et al (2000) The potential health impacts of climate variability and change for the United States: executive summary of the report of the health sector of the U.S. National Assessment. Environ Health Perspect 108(4):367–376

    Article  CAS  Google Scholar 

  • Portier CJ, Thigpen Tart K, et al. (2010) A human health perspective on climate change: a report outlining the research needs on the human health effects of climate change. Research Triangle Park, NC. EHP/NIEHS. Available at:

  • Ramsey JD (1995) Task performance in heat: a review. Ergonomics 38(1):154–165

    Article  CAS  Google Scholar 

  • Rey G, Fouillet A, Bessemoulin P, Frayssinet P, Dufour A, Jougla E, Hemon D (2009) Heat exposure and socio-economic vulnerability as synergistic factors in heat-wave-related mortality. Eur J Epidemiol 24(9):495–502

    Article  Google Scholar 

  • Rosenman KD, Kalush A, Reilly MJ, Gardiner JC, Reeves M, Luo Z (2006) How much work-related injury and illness is missed by the current national surveillance system? J Occup Environ Med 48(4):357–365

    Article  Google Scholar 

  • Sanchez CA, Thomas KE, Malilay J, Annest JL (2010) Nonfatal natural and environmental injuries treated in emergency departments, United States, 2001–2004. Fam Commun Health 33(1):3–10

    Article  Google Scholar 

  • Schulte PA, Chun HK (2009) Climate change and occupational safety and health: establishing a preliminary framework. J Occup Environ Hyg 6(9):542–554

    Article  CAS  Google Scholar 

  • Semenza JC, Rubin CH, Falter KH et al (1996) Heat-related deaths during the July 1995 heat wave in Chicago. N Engl J Med 335(2):84–90

    Article  CAS  Google Scholar 

  • Semenza JC, McCollough JE, Flanders D, McGeehin MA, Lumpkin JR (1999) Excess hospital admissions during the July 1995 heat wave in Chicago. Am J Prev Med 16(4):269–277

    Article  CAS  Google Scholar 

  • Son JY, Lee JT, Anderson GB, Bell ML (2012) The impact of heat waves on mortality in seven major cities in Korea. Environ Health Perspect 120(4):566–571

    Article  Google Scholar 

  • Stafoggia M, Forastiere F, Agostini et al (2006) Vulnerability to heat-related mortality; a multicity, population-based, case-crossover analysis. Epidemiology 17(3):315–323

    Article  Google Scholar 

  • Taiwo OA, Mobo BHP, Cantley L (2010) Recognizing occupational illnesses and injuries. Am Fam Physician 82(2):169–174

    Google Scholar 

  • Thomsen C, McClain J, Rosenman K, Davis L, Centers for Disease Prevention and Control (2007) Indicators for occupational health surveillance. MMWR Recomm Rep 56(RR-1):1–7

    Google Scholar 

  • Vallejos QM, Quandt SA, Grzywacz JG et al (2011) Migrant farmworkers’ housing conditions across an agricultural season in North Carolina. Am J Ind Med 54(7):533–544. doi:10.1002/ajim.20945

    Article  Google Scholar 

  • Washington State Department of Labor and Industries (WSDLI) (2008) Outdoor heat exposure. concise explanatory statement. Economic analyses. Heat-related illness small business economic impact statement. Available at: Accessed: 17 July 2012

  • Washington State Legislature (2012) General occupational health standards. Outdoor heat exposure WAC 296-62-095. Available at: Accessed: 20 March 2012

  • Weeks JL, Levy BS, Wagner GR (eds) (1991) Preventing occupational disease and injury. American Public Health Association Press, Washington, D.C

    Google Scholar 

  • Williams S, Nitschke M, Sullivan T et al (2012) Heat and health in Adelaide, South Australia: assessment of heat thresholds and temperature relationships. Sci Total Environ 414:126–133

    Article  CAS  Google Scholar 

  • World Health Assembly (WHA). 2008. Sixty-first world health assembly, WHA61.19. Climate change and health. Available at: Accessed: 3 August 2012

  • World Health Organization (1969) Health factors involved in working under conditions of heat stress. Report of a WHO Scientific group. Technical Report series No. 412. Geneva. Available at

  • World Health Organization (2009) Global health risks: mortality and burden of disease attributable to selected major risks. Geneva. Available at: Accessed: 4 November 2011

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The authors would like to thank David Michaels, PhD, MPH, Assistant Secretary of Labor for OSHA and Professor (on leave) in the Department of Environmental and Occupational Health, The George Washington University School of Public Health and Health Services for his valuable review and comments.

Conflict of interest statement

Diane Gubernot has no financial disclosures and is an employee of the US Food and Drug Administration. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the US FDA. Dr. Hunting has no financial disclosures. Dr. Anderson has no financial disclosures.


Dr. Anderson was supported by an R21020152 from the National Institute of Environmental Health Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Environmental Health Sciences or the National Institutes of Health.

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Gubernot, D.M., Anderson, G.B. & Hunting, K.L. The epidemiology of occupational heat exposure in the United States: a review of the literature and assessment of research needs in a changing climate. Int J Biometeorol 58, 1779–1788 (2014).

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