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Systematic Review

Climate Change and Occupational Risks in Outdoor Workers: A Systematic Review of the Health Effects of Extreme Temperatures

by
Maria Francesca Rossi
*,
Raimondo Leone
and
Umberto Moscato
Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
*
Author to whom correspondence should be addressed.
Atmosphere 2025, 16(7), 839; https://doi.org/10.3390/atmos16070839
Submission received: 27 May 2025 / Revised: 20 June 2025 / Accepted: 8 July 2025 / Published: 10 July 2025
(This article belongs to the Special Issue Advanced Studies on Climate Change in Urban Areas: Emerging Technologies and Strategies to Address Heat Waves and Improve Thermo-Hygrometric Comfort)
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Abstract

Climate change is one of the most important current threats to global health. Outdoor workers are among the most vulnerable people to its effects. The aim of this systematic review is to assess the occupational risks related to climate change, investigating health outcomes in outdoor workers and estimating its impact in the occupational context. The review was performed following PRISMA guidelines, screening three databases (PubMed, Web of Science, and Scopus). Studies written in English or Italian languages, performed on outdoor workers, assessing occupational risks linked to climate change, and reporting on health outcomes were included. A quality assessment was performed using the Newcastle–Ottawa Scale. Thirteen studies were included in the review, performed mostly on construction (seven studies, 53.8%) and agricultural (five studies, 38.5%) workers. Twelve of the included studies (92.3%) reported on occupational risks related to heat stress, one on the effects of cold weather. Four studies (30.8%) reported a high prevalence of heat-related symptoms, ranging from 64.0% to 90.3% of workers. This systematic review highlights heat-related stress in outdoor workers as an important occupational risk, but it also underlines an important gap in scientific knowledge regarding other occupational risks relating to climate change.

1. Introduction

Climate change is one of the most significant current threats to global health due to its impact on all aspects of human life, including the social, economic, psychological, and health-related dimensions [1]. Furthermore, climate change may have an impact on health, work and employment, housing, safety, and the ability to grow food [2]. According to World Health Organization (WHO) estimates, climate change could cause approximately 250,000 additional deaths per year by 2030–2050 due to malnutrition, malaria, diarrhoea, and heat stress alone; the direct health-related damage costs are estimated to range between two and four billion dollars per year by 2030 [3].
The economic impact of climate change has been reported in the scientific literature [4,5]. In particular, it has been highlighted that higher temperatures substantially reduce economic growth (a temperature increase of 1 °C leads to a reduction of 1% in economic growth in the long term) [6], with an impact on growth rates as well, and an alarming impact on agricultural output, industrial output, and political stability [5]. Moreover, it must be considered that the economic impact of climate change has been reported to be worse for poorer countries, further emphasizing the social inequities underlining this growing issue [4,5,7].
From an occupational health perspective, outdoor workers are among the most vulnerable populations to the effects of climate change [8,9]. Considering the profound changes that the occupational world has undergone in the COVID-19 and post-COVID-19 era [10,11,12,13], identifying and assessing emerging occupational risks is of paramount importance to implement prevention strategies and ensure the health and safety of workers [14]. In this context, preparedness strategies based on a One Health approach are essential to identify emerging environmental changes and counteract these challenges through a preventive approach [15,16].
Climate change’s effects on outdoor temperatures have been thoroughly documented [17]. It has been showcased that individuals working under heat stress, especially if performing physically strenuous tasks, are more likely to experience heat-related strain and illnesses, which can lead to heat stroke or even death, even in young and healthy workers [18]. Furthermore, a 2018 meta-analysis by Flouris et al., which included studies performed on a global scale, reported that individuals working a single shift under heat stress conditions were four times more likely to experience occupational heat strain [19].
However, heat risk is not the only occupational hazard affected by climate change. Climate change has an effect on the ozone layer, along with other contributing factors; a recent report from the European Commission has reported that during heatwaves the ozone levels are consistently above European Union limits (registered levels > 120 µg/m3 compared to the cut-off of 100 µg/m3) [20]. Moreover, the thinning of the ozone layer contributes to the increase in intensity of ultraviolet radiation (UV), with an increase in type A and B ultraviolet radiation of up to 35% during heatwaves [21]. Outdoor workers are, therefore, more exposed to ultraviolet radiation, leading to an increased risk of adverse eye effects and skin cancer [22]. A clear estimation of the occupational risk present in outdoor work is very difficult to generate, especially considering that skin cancer caused by occupational exposure seems to be underreported [23]; however, current scientific evidence indicates an increased risk of skin cancer and other dermatological issues for outdoor workers [24,25,26].
Furthermore, climate change is contributing to the increase in air pollution levels; according to the World Meteorological Organization, air quality and pollution worsen during heatwaves, with registered ozone levels above the cut-off (100 µg/m3) and an increase in particulate matter ≤ 2.5 μm (PM2.5) [27]. This could exacerbate the health issues that have been associated with air pollution in outdoor workers [28], and as their occupational exposure levels increase these problems could become more severe, with higher prevalence of occupational allergies and respiratory diseases [29,30,31].
In the context of global health and climate change, the aim of this systematic review is to assess the occupational hazards related to climate change, investigating health outcomes in outdoor workers in order to give an estimation of the impact of climate change in the occupational context.

2. Materials and Methods

The review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement [32], screening three databases (PubMed, ISI Web of Knowledge, and Scopus). The P(E)CO model [33] was used to formulate the query: the Population identified was outdoor workers, the Exposure was climate change, and the Outcome was any health outcome correlated with occupational risks identified in the study. Due to the aim of the systematic review, no Control was chosen for the query.
Therefore, to make the research as comprehensive as possible, the query was structured to include synonyms and Medical Subject Headings (MeSH) terms for the following keywords: “outdoor workers”, “climate change”, and “occupational risk”.
The records found through this search were screened for duplicates through the online site Rayyan [34]. The screening by titles and abstracts was performed using triple-blind methodology through the same website in order to reduce selection bias [34]. The records unanimously included or excluded were not discussed further, while the articles for which the website showed conflict were openly discussed between the three researchers, and a unanimous decision about inclusion or exclusion was eventually reached. A full-text screening was then performed for all included records.
The study was carried out in accordance with the Declaration of Helsinki. The study protocol was not submitted to an Institutional Review Board, as this is a systematic review and does not involve human subjects.

2.1. Inclusion and Exclusion Criteria

Studies published up until the initial search was performed were included in the systematic review if they were performed on outdoor workers, assessed occupational risks related to climate change, and reported on health outcomes associated with these risks. Only manuscripts in English or Italian languages were included (languages spoken by the researchers), while manuscripts written in other languages were excluded from the review. Studies that did not assess climate change-related occupational risks or did not consider health outcomes were also excluded from the review. Study designs that did not report on primary data (editorials, literature reviews, commentaries, etc.) were excluded.

2.2. Data Extraction

Data was extracted from the included studies and reported in a Microsoft Excel sheet. The following data was gathered from each article: the first author, publication year, country, study timeframe, study design, work tasks of the workers included, sample size, gender ratio, mean age of the workers, type of occupational risk assessed in the study, health outcomes considered, and main results.
A quality assessment was performed on all included studies using the Newcastle–Ottawa Scale [35]. This quality assessment scale is divided into three sub-scales, evaluating the selection, comparability, and outcome criteria used in the study. The selection sub-scale comprises four questions assessing the representativeness of the sample (maximum 1 point), sample size (maximum 1 point), non-respondent reports (maximum 1 point), and methods used to assess the exposure or risk factor (maximum 2 points) for a maximum of 5 points. The comparability sub-scale comprises one question with a maximum of 2 points, assessing whether confounding factors were considered appropriately in the study. Finally, the outcome sub-scale comprises two items concerning outcome assessment (maximum 1 or 2 points) and the statistical tests used (maximum 1 point) for a maximum of 3 points. Therefore, each study can score from 0 to 10 points on this scale [35].

3. Results

The systematic search resulted in 1306 relevant articles from the three databases (PubMed, Web of Science, and Scopus). After removing duplicates, the initial search resulted in 965 eligible articles. Three researchers screened the articles by title and abstract using a blinded methodology, including 113 full-text records. The final full-text screening resulted in the 13 included studies [36,37,38,39,40,41,42,43,44,45,46,47,48] (Figure 1).
The included studies were performed in various countries and included various types of workers, mainly construction workers (seven studies, 53.8%) [36,37,38,39,42,44,46] and agricultural workers (five studies, 38.5%) [39,41,42,46,47]. Concerning study design, nine studies were cross-sectional studies (69.2%) [36,37,39,40,42,44,45,46,47], one was a case–control [48], one was a case series [43], one was a cohort study [38], and one was a trial [41] (each representing 7.7%). The largest study included over a thousand workers [39], while most studies included between a hundred and a thousand workers (nine studies, 69.2%) [36,37,38,40,41,45,46,47,48]; two studies (15.4%) [43,44] included fewer than one hundred workers [43,44], and one study did not report the number of participants [42].
Ten studies (76.9%) had a majority of male workers [36,37,38,39,41,43,45,46,47,48], while two (15.4%) had a majority of female workers [40,44], and one study did not report the gender ratio [42]. Concerning age, the studies included all working ages, meaning a differentiation based on age range or mean age was not possible.
Finally, all included studies except for one (12 studies, 92.3%) reported on the occupational risks related to heat stress [37,38,39,40,41,42,43,44,45,47,48]. One study investigated the effects of cold weather caused by climate change on the occupational hazards of outdoor workers [36].
The main results for each study included in this systematic review are reported in Table 1. A quality assessment using the Newcastle–Ottawa Scale was performed on all included studies. All studies showcased at least fair quality (six to seven points total) (Table 2).

3.1. Heat-Related Symptoms

Eight of the included studies (61.5%) investigated the presence of subjective symptoms related to heat stress.
Overall, the presence of heat-related symptoms in outdoor workers was reported as very high in four of the included studies: Venugopal et al. [46] reported symptoms in 96% of their included workers, and self-reported heat-related illnesses occurred in 90.3% of the workers [39] included in another study by the same authors; Bethel et al. [47] reported symptoms in 64.0% of workers in the week preceding their study; and Suter et al. [41] reported heavy sweating (the most common symptom) in 84.9% of their included workers. One study by Mansor et al. [40] reported heat-related illness in 47.5% of workers. The study by Phanprasit et al. highlighted that 39.0% of foundry workers and 22.0% of construction workers reported heat-related symptoms. Han et al. [37] reported heat-related illnesses in only 11.6% of workers.
Three of these studies investigated heat-related symptoms [38,41,46]. Phanprasit et al. [38] investigated working conditions related to heat in a population of construction and foundry workers in Thailand; the authors investigated body temperature and heart rate, relating these parameters to the workload. The study was limited by the sample (mostly males) and the short study period. The study by Venugopal et al. [46] analysed the health and productivity impacts of occupational heat stress in 442 Indian outdoor workers. The authors highlighted the fact that employees with higher workloads reported lower productivity and higher rates of heat-related issues. The outcomes considered, however, were not evaluated with objective parameters, but were based on self-reported symptoms. Furthermore, the samples for each sector were small and comprised mostly male workers (71%). Finally, the study by Suter et al. [41] examined heat-related health outcomes in 331 Indonesian workers. This study, however, had an exclusively male sample and the data gathering period was very short.
One of the studies measured heat-related illnesses. Mansor et al. [40] conducted a study to evaluate the role of hydration practices in determining the severity of heat-related illnesses in outdoor workers (gardeners and cleaners). The authors concluded that hydration practices were related to the severity of heat-related illness, highlighting the importance of drinking water throughout the day rather than only during breaks or when feeling thirsty. The study included workers who had reported heat-related symptoms; therefore, all the participants had reported symptoms in the previous week, so the study lacked a proper control group concerning hydration practices; in Table 1 we report heat-related illnesses before the study’s timeframe.
The study by Bethel et al. [47] measured both heat-related illnesses and symptoms. This study considered a population of migrant farmworkers, investigating whether they had experienced heat-related illnesses or symptoms. Interestingly, the authors also reported on the availability of water sources nearby (reported by 76.0% of workers), as well as the possibility of moving to cooler spots or shadowed areas when the heat was perceived as too high (60.0% reported that shaded areas were available). Furthermore, the authors reported that 52 participants had received heat-related hazard training. However, the sample size was relatively small (100 participants) and the survey was only performed on migrant workers, lacking a control sample.
The study by Han et al. [37] evaluated heat-related illnesses and injuries in construction workers. In this study, the authors considered possible prevention strategies enacted by the workers, who adjusted based on heat exposure, as well as the possible usage of personal protective equipment by the workers. The study, due to its cross-sectional nature, did not allow for the experimental measurement of injuries or illnesses caused by heat stress, but it did describe the reported heat-related injuries or illnesses that had occurred to the workers in the past; furthermore, the study had a mostly male sample (75.2%).
The study by Venugopal et al. [39] assessed multiple health-related outcomes, both self-reported and clinical. The study had a large sample and both genders were well represented. Furthermore, the assessment of body temperature rise, sweat rate, urine specific gravity, and reduced kidney function was performed through objective methods rather than self-reported assessments. Participation in the study was on a voluntary basis, which may have produced a selection bias; furthermore, heat-related symptoms were self-reported and were not correlated with other factors that may have influenced these symptoms (diet, genetic factors, and other non-occupational exposures).
Xiang et al. [45] conducted a study to investigate heat risk perception in 749 outdoor workers, evaluating four different aspects (i.e., concerns, policy, guidelines, preventive measures): 51.2% of the respondents reported concerns about workplace heat stress and 68.8% reported they would like to change their work habits to reduce the risk of negative health effects. However, most of the participants were males and were recruited on a voluntary basis, which may have introduced potential selection bias.

3.2. Heat-Related Clinical Outcomes

Six studies included in this review (46.1%) considered objective clinical outcomes [36,39,42,43,44,48]. One of these studies, by Venugopal et al. [39], was discussed in the previous section of this manuscript.
The study by Karthick et al. [36] was the only one that investigated health outcomes related to cold weather. The authors highlighted that outdoor workers had a 14.1% higher chance (OR 1.14, p value = 0.041) of developing respiratory issues due to cold weather, and a 21.7% (OR 1.217, p value = 0.032) higher chance of experiencing freezing of exposed parts compared to indoor workers. Furthermore, the authors highlighted that male workers had a 69.7% higher risk of respiratory issues and a 43.9% higher risk of freezing of exposed parts than female workers. However, the sample size was relatively small (100 participants) and the response rate was less than 50%. Furthermore, the cross-sectional design did not allow for tracking issues developed after the survey’s administration. Moreover, while the authors mentioned investigating some preventive habits in the population considered (i.e., wearing personal protective equipment against cold weather), they did not perform a correlation analysis concerning these responses.
Riley et al. [42] investigated two types of workers strongly affected by work-related heat stress (construction and agriculture) and evaluated two important outcomes, emergency department visits and hospitalizations. The study also evaluated data collected over five years, which is a valid period for an optimal evaluation of the considered outcomes. However, the large sample did not allow for consideration of additional factors, which can often be co-causes of heat-related illness. Furthermore, the authors did not report a precise sample size or a gender ratio, limiting the generalization of their results, since gender can greatly impact occupational risks [49].
Meade et al. [43], in their case report, analysed heat stress parameters (body core temperature, urine specific gravity) in four workers in the field of electrical utilities on two consecutive days in hot outdoor conditions, and highlighted a thermal strain increase in hot conditions even with decreased work activity. The study had a small, exclusively male sample and the period was limited to two consecutive days, so it did not consider the long-term effects of chronic exposure.
The study by Rahman et al. [44] investigated the tympanic temperature increase in eight pregnant outdoor workers before, during, and after heat exposure, to estimate the risk of miscarriages or foetal anomalies. The study was the only one that analysed this category of women. The authors highlighted how female outdoor workers had higher body temperatures than indoor ones. However, the sample size was very small and the body temperature measuring method may not have been very accurate due to factors (i.e., ear conformation, thermometer position, environmental factors) that can alter the measurement.
In their case–control study, Luo et al. [48] investigated the association between heat exposure and outdoor workers’ urolithiasis in a shipbuilding company in a subtropical city of China, analysing health data and adjusting important confounding variables (sex, nutrition, pre-existing heat-related health conditions). The results highlighted a strong connection between heat exposure and the considered outcome, with a higher incidence in outdoor workers and a dose–response relationship. This study did not collect information on family history, obesity, weight, BMI, social class, metabolic diseases, or smoking and drinking behaviours. Furthermore, the study had a mostly male sample (83%).

4. Discussion

The results of this systematic review highlight the fact that heat-related stress is well documented as an occupational risk associated with climate change. Twelve of the included studies investigated the effects of heat-related stress on outdoor workers, while one investigated the effects of cold weather. Four of the included studies reported a very high prevalence of heat-related symptoms, ranging from 64.0% to 90.3% of workers [39,41,46,47]. These results highlight occupational heat stress as a global public health concern that affects the well-being of different types of outdoor workers worldwide.
Higher temperatures have been highlighted as affecting the well-being of certain occupational groups of outdoor workers more than others: construction and agriculture workers have reportedly had a higher incidence of heat-related illness and death [50,51,52]. This is consistent with the direct exposure to sunlight and strenuous physical activities performed by these categories of workers, even on days with extreme temperatures. Furthermore, recent projections estimate that the number of days with extreme heat stress may double by 2050 in Southern Europe [53], a trend that would further increase the vulnerability of these groups of outdoor workers in the near future.
The studies included in this review highlight the fact that heat can also increase the risk of injuries. This may be due to factors such as fogging of protective glasses, sweating hands, dizziness, and reduced concentration, leading to additional hazards [22,23]. These results are consistent with the currently available literature and are reflected in the international guidelines available [50,51,52]. Furthermore, it has been demonstrated that heat-related illnesses are directly proportional to personal risk factors such as heat acclimation, dehydration, an age over 60 years, previous heat-related illness, specific medications, and a high body mass index [54].
The results of this systematic review are largely consistent with previous literature reviews that examined the effects of occupational heat exposure on outdoor workers [19,55]. Previous literature reviews have reported that environmental heat exposure is associated with an increased risk of heat-related illnesses, reduced work capacity, and elevated risk of occupational injuries in outdoor workers, particularly in the agriculture, construction, and mining sectors. Similarly, this systematic review found a high prevalence of heat-related symptoms, confirming the significant health burden associated with occupational heat stress.
However, our review adds to the existing evidence by including more recent studies and analyzing the role of climate change-related variables. In addition, some of the studies included in our review focused on biometeorological aspects, which are less frequently addressed in earlier reviews. Moreover, while most previous reviews have focused primarily on heat, our review also included one study addressing the potential occupational risks associated with cold exposure, highlighting the broader range of climate-related hazards affecting outdoor workers.
One of the studies included in this systematic review analyzed the impact of extreme cold temperatures on occupational health issues. While the majority of studies focused on heat-related occupational risks, it is important to acknowledge that climate change may also contribute to the occurrence of extreme cold events in certain regions [56]. Cold exposure can pose significant health and safety risks for outdoor workers, including hypothermia, frostbite, decreased manual dexterity, impaired cognitive function, and an increased risk of injuries [57,58,59]. Given this very limited assessment of the effects of extreme cold temperatures on climate change-related occupational risks, future studies should explore how climate variability may alter the frequency, duration, and severity of cold exposure, and should aim to identify vulnerable worker populations and implement adaptation strategies for occupational health protection in colder environments.
It has to be acknowledged that the use of the keyword “climate change”, which was used to unequivocally identify studies correlating occupational risks to this issue, may have contributed to the selection of studies reporting on the effects of climate change (i.e., extreme temperatures) that were perceived as having a direct impact on occupational risks (i.e., heat stress), and may have contributed to the exclusion of the indirect effects on occupational health that were highlighted in the Introduction section (i.e., occupational allergies).
As previously mentioned, no studies included in the review investigated occupational allergies, dermatologic illnesses, or ocular disorders, although an association with climate change has been highlighted in previous narrative studies [23,24,25,26,29]. This review highlights the need to perform studies that gather primary data on occupational risks related to climate change beyond temperature-related risks, showcasing a possible gap in the knowledge of scientific studies regarding pulmonary, dermatologic, and ocular disorders in outdoor workers in relation to the growing issue of climate change.
Although the Introduction section of this review highlighted other climate-related occupational hazards, such as ultraviolet radiation and air pollution, no eligible studies that specifically investigated these exposures met the inclusion criteria. This research gap may reflect several factors. First, while the health risks related to these factors are well established in the general population, their investigation in occupational settings and outdoor occupations, within the context of climate change, remains limited. This may be due to the complex interplay between environmental exposures, variability across geographic regions, and difficulties in accurately assessing individual occupational exposure levels over time (since these exposures are related to long-term health issues rather than short-term ones, contrary to heat stress). This gap in the current knowledge underlines the need to perform long-term evaluations of the effects of outdoor occupational exposures related to climate change in order to assess the possible health issues related to these factors.
This review should be considered in light of some limitations and strengths. The use of the keyword “climate change” and its synonyms may have led to the exclusion of studies that did not use this keyword but considered effects (dermatological, respiratory, etc.) that may be indirectly correlated with climate change. Furthermore, most of the included studies were cross-sectional and, therefore, could not assess the long-term effects of climate change-related occupational risks, nor was a causal inference possible. Future research should include cohort and intervention-based studies in order to enrich the current scientific knowledge available in this field. Despite these limitations, the systematic approach ensured the methodological soundness of this study. The review included studies performed in many different countries, giving a global overview of the issue. The growing interest in climate change underlines the need to provide a comprehensive overview of the topic, and this review provides insight into the direct effects of climate change on the health of outdoor workers worldwide.

5. Conclusions

This systematic review highlights heat-related stress in outdoor workers as an important occupational risk, but it also highlights an important gap in scientific knowledge regarding certain age or gender categories, with the majority of studies being performed on male workers and not stratified for age. Future studies should investigate the impact of climate change on the most vulnerable occupational categories while including at-risk populations (i.e., older workers, female workers, migrant workers, etc.). Furthermore, future scientific research should evaluate the knowledge and attitudes of these vulnerable workers regarding climate change, heat stress, and occupational exposure.
Mitigation and prevention strategies should be developed and implemented at the company, national, and supra-national levels, to ensure the safety and well-being of outdoor workers worldwide. These interventions should focus on educating workers about the occupational risks caused by heat stress, as well as climate change and heatwaves in general; furthermore, training programs on the preventive measures already available to mitigate these risks (sunscreen, water intake, appropriate work wear, etc.) should be implemented.

Author Contributions

Conceptualization: M.F.R. and U.M.; data curation: M.F.R.; investigation: M.F.R., R.L. and U.M.; methodology: M.F.R.; supervision: U.M.; writing—original draft: M.F.R.; writing—review and editing: U.M. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Data Availability Statement

No new data were created or analyzed in this study.

Conflicts of Interest

The authors declare no conflicts of interest.

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Atmosphere 16 00839 g001
Figure 1. A PRISMA flowchart of the inclusion and exclusion processes.
Figure 1. A PRISMA flowchart of the inclusion and exclusion processes.
Atmosphere 16 00839 g001
Table 1. The data extracted from the included studies, ordered by year of publication and first author’s name (NR = not reported; SD = standard deviation; OR = odds ratio; CBT = core body temperature).
Table 1. The data extracted from the included studies, ordered by year of publication and first author’s name (NR = not reported; SD = standard deviation; OR = odds ratio; CBT = core body temperature).
CitationCountryStudy DesignStudy TimeframeWork TasksSample SizeGender Ratio (n,%)Age (Mean ± SD or Range) Occupational RisksOutcomes ConsideredResultsp Value
Karthick (2022) [36]USACross-sectionalNRConstruction100M = 87 (87.0%)Range from 21 to ≥60Cold weatherRespiratory issuesOR 1.1410.041
Freezing of exposed partsOR 1.2170.032
Han (2021) [37]ChinaCross-sectionalJuly–September 2020Construction318M = 239 (75.2%)Range from ≤24 to ≥55Heat stressHeat-related illness37 (11.6%)NR
Heat-related injury35 (11.0%)NR
Phanprasit (2021) [38]ThailandCohortMarch–June 2016Construction90M = 70 (77.8%)Range 20–60Heat stressHeat-related symptoms20 (22.0%)0.028
Foundry78M = 75 (96.2%)Range 20–46Heat-related symptoms30 (39.0%)0.028
Venugopal (2021) [39]IndiaCross-sectionalNRAgriculture, construction, brick making, salt pans1053M = 532 (50.5%)NRHeat stressSelf-reported heat-related illness951 (90.3%)<0.001
Rise in CBT > 1 °C189 (17.9%)<0.001
Sweat rate > 1/h282 (26.8%)<0.001
Urine specific gravity300 (28.5%)0.020
Reduced kidney function268 (48.2%)0.007
Mansor (2019) [40]MalaysiaCross-sectionalMarch–April 2016Cleaning, gardening320M = 148 (46.2%)43 ± 9.49Heat stressHeat-related illness152 (47.5%)<0.001
Suter (2019) [41]IndonesiaTrialOctober–November 2017Agriculture331M = 331 (100%)42.3 ± 11.0Heat stressSkin rush3 (1.7%)NR
Muscle cramps19 (11.0%)
Dizziness14 (8.1%)
Heavy sweating146 (84.9%)
Extreme weakness3 (1.7%)
Confusion6 (3.5%)
Riley (2018) [42]USACross-sectional2005–2010ConstructionNRNRNRHeat stressEmergency department visitsOR 1.023NR
HospitalizationsOR 1.035NR
Agriculture, forestry, fishing, hunting, miningHeat stressEmergency department visitsOR 1.080NR
HospitalizationsOR 0.907NR
Meade (2017) [43]USACase seriesTwo consecutive daysWork involving electrical utilities4 M = 4 (100%)38 ± 12Heat stressBody core temperature, dehydration, urine specific gravity NRNR
Rahman (2016) [44]BangladeshCross-sectionalMay 2014Construction8F = 8 (100%)24.67 ± 8.0Heat stressTympanic Temperature37.2 ± 0.4NR
Core temperature41.2NR
Metabolic rate (W/m2)280NR
Xiang (2016) [45]AustraliaCross-sectionalAugust–November 2012Miscellaneous (completely outdoor work)82M = 96.0%Range < 24 to >55Heat stressConcern for extreme heatOR 71.6 NR
Miscellaneous (mostly outdoor work)300OR 53.2 NR
Venugopal (2015) [46]IndiaCross-sectional2012–2013Metal work, security, agriculture, construction442M = 314 (71%)35.8 ± 12.7Heat stressHeat-related symptoms421 (96%)<0.001
Bethel (2014) [47]USACross-sectionalJuly–August 2013Agriculture100M = 60 (60.0%)31.8 ± 10.1Heat stressHeat-related illness27 (27.3%)NR
Heat-related symptoms (past week)64 (64.0%)NR
Luo (2013) [48]ChinaCase–control2003–2010Spray painting37M = 788 (83%)Range 20–59Heat stressUrolithiasisOR 4.4NR
Smelter work48OR 4.0NR
Welding178OR 3.7NR
Production security and quality inspection159OR 2.7NR
Planing machine operation12OR 4.0NR
Gas cutting work16OR 2.6NR
Assembly203OR 2.2NR
Table 2. A quality assessment of the included studies, performed using the Newcastle–Ottawa Scale.
Table 2. A quality assessment of the included studies, performed using the Newcastle–Ottawa Scale.
First Author (Year)SelectionComparabilityOutcomeTotal
Karthick (2022) [36]2226
Han (2021) [37]3216
Phanprasit (2021) [38]3227
Venugopal (2021) [39]4239
Mansor (2019) [40]4228
Suter (2019) [41]4239
Riley (2018) [42]3227
Meade (2017) [43]2237
Rahman (2016) [44]2237
Xiang (2016) [45]4239
Venugopal (2015) [46]3227
Bethel (2014) [47]3227
Luo (2013) [48]4239
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Rossi, M.F.; Leone, R.; Moscato, U. Climate Change and Occupational Risks in Outdoor Workers: A Systematic Review of the Health Effects of Extreme Temperatures. Atmosphere 2025, 16, 839. https://doi.org/10.3390/atmos16070839

AMA Style

Rossi MF, Leone R, Moscato U. Climate Change and Occupational Risks in Outdoor Workers: A Systematic Review of the Health Effects of Extreme Temperatures. Atmosphere. 2025; 16(7):839. https://doi.org/10.3390/atmos16070839

Chicago/Turabian Style

Rossi, Maria Francesca, Raimondo Leone, and Umberto Moscato. 2025. "Climate Change and Occupational Risks in Outdoor Workers: A Systematic Review of the Health Effects of Extreme Temperatures" Atmosphere 16, no. 7: 839. https://doi.org/10.3390/atmos16070839

APA Style

Rossi, M. F., Leone, R., & Moscato, U. (2025). Climate Change and Occupational Risks in Outdoor Workers: A Systematic Review of the Health Effects of Extreme Temperatures. Atmosphere, 16(7), 839. https://doi.org/10.3390/atmos16070839

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