title: Association between occupational heat stress and kidney disease among 37,816 workers in the Thai Cohort Study (TCS).
abstract: BACKGROUND
  We examined the relationship between self-reported occupational heat stress and incidence of self-reported doctor-diagnosed kidney disease in Thai workers.
  
  
  METHODS
  Data were derived from baseline (2005) and follow-up (2009) self-report questionnaires from a large national Thai Cohort Study (TCS). Analysis was restricted to full-time workers (n = 17 402 men and 20 414 women) without known kidney disease at baseline. We used logistic regression models to examine the association of incident kidney disease with heat stress at work, after adjustment for smoking, alcohol drinking, body mass index, and a large number of socioeconomic and demographic characteristics.
  
  
  RESULTS
  Exposure to heat stress was more common in men than in women (22% vs 15%). A significant association between heat stress and incident kidney disease was observed in men (adjusted odds ratio [OR] = 1.48, 95% CI: 1.01-2.16). The risk of kidney disease was higher among workers reporting workplace heat stress in both 2005 and 2009. Among men exposed to prolonged heat stress, the odds of developing kidney disease was 2.22 times that of men without such exposure (95% CI 1.48-3.35, P-trend <0.001). The incidence of kidney disease was even higher among men aged 35 years or older in a physical job: 2.2% exposed to prolonged heat stress developed kidney disease compared with 0.4% with no heat exposure (adjusted OR = 5.30, 95% CI 1.17-24.13).
  
  
  CONCLUSIONS
  There is an association between self-reported occupational heat stress and self-reported doctor-diagnosed kidney disease in Thailand. The results indicate a need for occupational health interventions for heat stress among workers in tropical climates.
authors.affiliation: Health Impact Assessment Division, Department of Health, Ministry of Public Health, Nonthaburi, Thailand. benjawan.tawatsupa@anu.edu.au
authors.forename: Benjawan
authors.initials: B
authors.lastname: Tawatsupa
authors.forename: Lynette L-Y
authors.initials: LL
authors.lastname: Lim
authors.forename: Tord
authors.initials: T
authors.lastname: Kjellstrom
authors.forename: Sam-ang
authors.initials: SA
authors.lastname: Seubsman
authors.forename: Adrian
authors.initials: A
authors.lastname: Sleigh
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D016273:Occupational Exposure / Q000009:adverse effects*; D016017:Odds Ratio; D012306:Risk; D012737:Sex Factors; D013785:Thailand / Q000453:epidemiology; D013997:Time Factors; D017132:Workplace; D055815:Young Adult