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Original research
Hospitalised heat-related acute kidney injury in indoor and outdoor workers in the USA
  1. Dallas S Shi1,2,
  2. Virginia M Weaver1,3,
  3. Michael J Hodgson1,
  4. Aaron W Tustin1
  1. 1Office of Occupational Medicine and Nursing, Directorate of Technical Support and Emergency Management, Occupational Safety and Health Administration, Washington, District of Columbia, USA
  2. 2Rocky Mountain Center for Occupational and Environmental Health, University of Utah Health, Salt Lake City, Utah, USA
  3. 3Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Aaron W Tustin, Office of Occupational Medicine and Nursing, Directorate of Technical Support and Emergency Management, Occupational Safety and Health Administration, Washington, DC 20210, USA; tustin.aaron.w{at}dol.gov

Abstract

Objectives To characterise heat-related acute kidney injury (HR-AKI) among US workers in a range of industries.

Methods Two data sources were analysed: archived case files of the Occupational Safety and Health Administration’s (OSHA) Office of Occupational Medicine and Nursing from 2010 through 2020; and a Severe Injury Reports (SIR) database of work-related hospitalisations that employers reported to federal OSHA from 2015 to 2020. Confirmed, probable and possible cases of HR-AKI were ascertained by serum creatinine measurements and narrative incident descriptions. Industry-specific incidence rates of HR-AKI were computed. A capture–recapture analysis assessed under-reporting in SIR.

Results There were 608 HR-AKI cases, including 22 confirmed cases and 586 probable or possible cases. HR-AKI occurred in indoor and outdoor industries including manufacturing, construction, mail and package delivery, and solid waste collection. Among confirmed cases, 95.2% were male, 50.0% had hypertension and 40.9% were newly hired workers. Incidence rates of AKI hospitalisations from 1.0 to 2.5 hours per 100 000 workers per year were observed in high-risk industries. Analysis of overlap between the data sources found that employers reported only 70.6% of eligible HR-AKI hospitalisations to OSHA, and only 41.2% of reports contained a consistent diagnosis.

Conclusions Workers were hospitalised with HR-AKI in diverse industries, including indoor facilities. Because of under-reporting and underascertainment, national surveillance databases underestimate the true burden of occupational HR-AKI. Clinicians should consider kidney risk from recurrent heat stress. Employers should provide interventions, such as comprehensive heat stress prevention programmes, that include acclimatisation protocols for new workers, to prevent HR-AKI.

  • epidemiology
  • environment
  • climate

Data availability statement

OSHA's Severe Injury Reports (SIR) data are available in a public, open access repository. The OOMN data are available upon reasonable request.

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Data availability statement

OSHA's Severe Injury Reports (SIR) data are available in a public, open access repository. The OOMN data are available upon reasonable request.

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Footnotes

  • Contributors DSS assisted with the study design, cleaned and analysed the data, and contributed to the draft manuscript. VMW contributed to the study design and the draft manuscript and revisions. MJH assisted with the study design and analysis plan, and revised the draft manuscript. AWT designed the study, assisted with data cleaning and analysis, and drafted and revised the manuscript. AWT is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer This paper sets no new standards or regulations, creates no new legal obligations and makes no changes to existing OSHA policies.

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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