8288691 The impact of climate change on occupational injuries: do temperature and outdoor pollution affect work-related accidents?

<h3>Objective</h3> To evaluate the relationship between environmental temperature, air pollution, and the frequency of work-related injury visits to the emergency department (ED) in Pavia (Italy) over a nine-year period, with a focus on thermal stress (WBGT index) and air pollution. <h3>Material and Methods</h3> This time-series study analyzed ED admissions due to occupational injuries from January 2014 to December 2022, excluding events related to violence, traffic, or animal/insect encounters. Meteorological data and pollutant concentrations (PM10, PM2.5, NO2, SO2, O3) were retrieved from local monitoring stations. Missing environmental data was imputed using Kalman smoothing. The Wet Bulb Globe Temperature (WBGT) was calculated and included as exposure variable. Distributed lag nonlinear models with cross-basis matrices were applied to account for delayed and non-linear effects, using negative binomial regression adjusted for seasonality, holidays, and long-term temporal trends. The goodness of fit was evaluated by means of Akaike information criterion (AIC). <h3>Results</h3> A total of 13,841 ED visits were recorded over 3,287 days. WBGT showed a significant positive association with injury rates especially at lower and higher values (at 0.5°C, compared to the median value 12.5°C:RR=1.17; 95% CI=1.09–1.24. At 25°C:RR=1.09; 95%CI=1.02; 1.16). Among air pollutants, NO2 was the only compound significantly associated with increased injury risk (at 50μg/m3, compared to the median value 24.3μg/m3:RR=1.18; 95% CI=1.07–1.30). In general, PM10, PM2.5, SO2, and O3 did not exhibit significant and consistent associations. Inclusion of WBGT covariate in all models with air pollutants improved model fit, as indicated by better goodness of fit (lower AIC values). <h3>Conclusion</h3> Thermal stress, as measured by WBGT, and ambient NO2 concentrations appear to be significantly associated with increased risk of occupational injuries. These findings underscore the need for integrating climate and air quality monitoring into occupational health policies, particularly in the context of climate change and increasing urban heat exposure.