Heatwave and work-related injuries and illnesses in Adelaide, Australia: a case-crossover analysis using the Excess Heat Factor (EHF) as a universal heatwave index

  • Blesson M. Varghese
  • Alana Hansen
  • Monika Nitschke
  • John Nairn
  • Scott Hanson-Easey
  • Peng Bi
  • Dino PisanielloEmail author
Original Article



Heatwaves, or extended periods of extreme heat, are predicted to increase in frequency, intensity and duration with climate change, but their impact on occupational injury has not been extensively studied. We examined the relationship between heatwaves of varying severity and work-related injuries and illnesses. We used a newly proposed metric of heatwave severity, the Excess Heat Factor (EHF), which accounts for local climate characteristics and acclimatization and compared it with heatwaves defined by daily maximum temperature.


Work-related injuries and illnesses were identified from two administrative data sources: workers’ compensation claims and work-related ambulance call-outs for the years 2003–2013 in Adelaide, Australia. The EHF metrics were obtained from the Australian Bureau of Meteorology. A time-stratified case-crossover regression model was used to examine associations between heatwaves of three levels of severity, workers’ compensation claims, and work-related ambulance call-outs.


There was an increase in work-related ambulance call-outs and compensation claims during low and moderately severe heatwaves as defined using the EHF, and a non-significant decline during high-severity heatwaves. Positive associations were observed during moderate heatwaves in compensation claims made by new workers (RR 1.31, 95% CI 1.10–1.55), workers in medium-sized enterprises (RR 1.15, 95% CI 1.01–1.30), indoor industries (RR 1.09, 95% CI 1.01–1.17), males (RR 1.13, 95% CI 1.03–1.23) and laborers (RR 1.21, 95% CI 1.04–1.39).


Workers should adopt appropriate precautions during moderately severe heatwaves, when the risks of work-related injuries and illnesses are increased. Workplace policies and guidelines need to consider the health and safety of workers during heatwaves with relevant prevention and adaptation measures.


Workers’ compensation claims Case-crossover design Heatwaves Occupational health Worker safety 



The authors would like to thank SafeWork SA, SA Health and the Australian Bureau of Meteorology for the provision of the workers’ compensation claims, work-related ambulance call-outs and meteorological data. Special thanks to Professor Adrian Barnett for advice on statistical analysis and Dr. Susan Williams for providing comments on the manuscript.


This research was funded by the Australian Government through the Australian Research Council’s Discovery Projects funding scheme (ARC Project ID DP160103059 to Dino Pisaniello). The views expressed herein are those of the authors and are not necessarily those of the Australian Government or Australian Research Council. B. M. V is supported by the University of Adelaide Faculty of Health Sciences Divisional Scholarship.

Compliance with ethical standards

Ethical statement

Ethics approval was obtained from the Human Research Ethics Committees of the University of Adelaide and SA Health.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Blesson M. Varghese
    • 1
  • Alana Hansen
    • 1
  • Monika Nitschke
    • 2
  • John Nairn
    • 3
    • 4
  • Scott Hanson-Easey
    • 1
  • Peng Bi
    • 1
  • Dino Pisaniello
    • 1
    Email author
  1. 1.School of Public Health, The University of AdelaideAdelaideAustralia
  2. 2.Public Health Services, Department for Health and AgeingAdelaideAustralia
  3. 3.Australian Bureau of MeteorologyAdelaideAustralia
  4. 4.School of Biological SciencesThe University of AdelaideAdelaideAustralia

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