Occupational Safety and Health in Climate Change Epidemiology: A Systematic Review and Meta-analysis

Background

Climate-related exposures increasingly affect workers, especially in outdoor and heat-exposed occupations, but the overall burden across sectors has not been quantified. This study examined associations between temperature extremes, air pollution, wildfire smoke, extreme weather, vector-related exposures and occupational health outcomes.

Methods

A systematic review and meta-analysis following PRISMA guidelines, searched PubMed, Scopus, Embase and Web of Science for studies published from January 2000 to March 2026. Eligible studies reported quantitative associations between climate-related exposures and occupational health outcomes. Random-effects models pooled relative risks and incidence rate ratios with 95% confidence intervals. Heterogeneity was assessed with I², risk of bias with the Newcastle–Ottawa Scale and GRADE.

Results

Thirty-seven studies, including 4.2 million workers from 28 countries, were included. Occupational injury risk increased by 34% (95% CI:1.21–1.48) per 5 °C rise above regional heat thresholds. Agricultural workers had the highest heat-related mortality (RR 2.15, 95% CI:1.67–2.78) and increased renal dysfunction. Construction injuries rose by 18% during extreme heat events (95% CI:12–24%), while emergency responders had higher cardiovascular risk during wildfire smoke exposure (RR 1.42, 95% CI:1.18–1.71). Forestry workers in expanding transmission zones showed a 2.3-fold increase in vector-borne disease risk. Heterogeneity was substantial (I²=76%), was partly associated with protective equipment access, acclimatisation, and regulatory enforcement.

Conclusions

Climate-related exposures are associated with higher occupational risk across sectors, with the greatest burden among outdoor and precariously employed workers. The findings support heat prevention plans, climate-informed exposure standards and stronger occupational surveillance. Longitudinal studies are needed to assess the effectiveness of mitigation across settings.

Key messages

• The impacts of climate change on worker morbidity, mortality, and injury patterns, addressing critical gaps and informing public health adaptation strategies.

• Need for public health policy to focus on vulnerable worker populations by implementing adaptive workplace standards, cooling interventions, and climate-resilient occupational health infrastructure.