Cold work and disease

A narrative review

Abstract

This narrative review aimed to describe how health risks associated with cold work are affected by age and disease. A systematic literature search was conducted in MEDLINE, Embase, and Web of Science for the period 1980–2023, including three main concepts: cold environment, work, and risk assessment. The search resulted in 6965 articles, of which 277 were reviewed in full text, and 13 were included in the review regarding risk assessment and risk management of cold work. In addition to the systematic literature search, a targeted literature search was conducted, focusing on ageing and diseases.

The systematic literature search showed that established methods for structured risk assessment of work in cold environments exist, although working environments can vary widely. Most report that both age and disease can affect the vulnerability to cold.

The targeted literature search identified several small experimental studies showing that vulnerability to cold increases with age. This vulnerability may be due to changes in heat production, insulating capacity, peripheral vasoregulation, and temperature discrimination.

For cardiovascular disease, there was scientific evidence that exposure to cold leads to higher blood pressure, both in those with and without anti-hypertensive medication. Subjects with pre-existing cardiovascular disease have a lower physical work capacity and an increased likelihood of acute ischemic heart events and arrhythmias when exposed to cold. Cold exposure also appears to increase the likelihood of stroke.

In obstructive airway disease, the literature indicated that exposure to cold can increase symptom burden in subjects with asthma or chronic obstructive pulmonary disease. In particular, exposure of the face to cold can induce obstructive airway symptoms. There is also some evidence that previously healthy subjects exposed to cold may develop obstructive airway disease.

In the case of diabetes, exposure to cold can lead to impaired metabolic control, increased risk of hypoglycemia, increased susceptibility to hypothermia, and possibly increased risk of local cold injury and abnormal cold sensitivity.

Regarding the musculoskeletal system, there were studies showing that working in the cold increases the likelihood of reporting pain in various parts of the body. Working in the cold can also increase the likelihood of reporting nerve-related disorders such as sciatica and carpal tunnel syndrome.

In summary, there is scientific evidence that cold work may be associated with increased health risks for older subjects and with chronic diseases. The impact of cold work on work capacity and prognosis is unclear. There are methods for structured risk assessment and risk management of cold work, as well as practical suggestions for workers, employers, and occupational health services. Identified knowledge gaps include the health effects of long-term, low-level occupational exposure to cold, sex differences, acclimatization, exposure-response relationships, and potential synergistic effects of cold and other exposures.