Article

Impact of Extreme Heat Events on Emergency Department Visits in North Carolina (2007–2011)

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Abstract

Extreme heat is the leading cause of w eather-related mortality in the U.S. Extreme heat also affects human health through heat stress and can exacerbate underlying medical conditions that lead to increased morbidity and mortality. In this study, data on emergency department (ED) visits for heat-related illness (HRI) and other selected diseases were analyzed during three heat events across North Carolina from 2007 to 2011. These heat events were identified based on the issuance and verification of heat products from local National Weather Service forecast offices (i.e. Heat Advisory, Heat Watch, and Excessive Heat Warning). The observed number of ED visits during these events were compared to the expected number of ED visits during several control periods to determine excess morbidity resulting from extreme heat. All recorded diagnoses were analyzed for each ED visit, thereby providing insight into the specific pathophysiological mechanisms and underlying health conditions associated with exposure to extreme heat. The most common form of HRI was heat exhaustion, while the percentage of visits with heat stroke was relatively low (<10 %). The elderly (>65 years of age) were at greatest risk for HRI during the early summer heat event (8.9 visits per 100,000), while young and middle age adults (18–44 years of age) were at greatest risk during the mid-summer event (6.3 visits per 100,000). Many of these visits were likely due to work-related exposure. The most vulnerable demographic during the late summer heat event was adolescents (15–17 years of age), which may relate to the timing of organized sports. This demographic also exhibited the highest visit rate for HRI among all three heat events (10.5 visits per 100,000). Significant increases (p < 0.05) in visits with cardiovascular and cerebrovascular diseases were noted during the three heat events (3–8 %). The greatest increases were found in visits with hypotension during the late summer event (23 %) and sequelae during the early summer event (30 %), while decreases were noted for visits with hemorrhagic stroke during the middle and late summer events (13–24 %) and for visits with aneurysm during the early summer event (15 %). Significant increases were also noted in visits with respiratory diseases (5–7 %). The greatest increases in this category were found in visits with pneumonia and influenza (16 %), bronchitis and emphysema (12 %), and COPD (14 %) during the early summer event. Significant increases in visits with nervous system disorders were also found during the early summer event (16 %), while increases in visits with diabetes were noted during the mid-summer event (10 %).

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... Fuhrmann led a team of expert researchers in efforts to craft a temporal analysis of heatrelated illnesses using the NC Detect state-wide syndromic surveillance system (Fuhrmann, Sugg, Konrad, & Waller, 2016). Compiling data from 2007-2011, their efforts were able to link national weather alerts for extreme heat to increased frequencies of ED visits for adverse health concerns (Fuhrmann et al., 2016). The team identified a positive correlation that included a rise in the reporting of heat exhaustion, heat stroke, and heat fatigue chief complaints (Fuhrmann et al., 2016). ...
... Compiling data from 2007-2011, their efforts were able to link national weather alerts for extreme heat to increased frequencies of ED visits for adverse health concerns (Fuhrmann et al., 2016). The team identified a positive correlation that included a rise in the reporting of heat exhaustion, heat stroke, and heat fatigue chief complaints (Fuhrmann et al., 2016). In addition to heat-related ailments, this study also examined the how extreme heat influenced the manifestation of various underlying health concerns (Fuhrmann et al., 2016). ...
... The team identified a positive correlation that included a rise in the reporting of heat exhaustion, heat stroke, and heat fatigue chief complaints (Fuhrmann et al., 2016). In addition to heat-related ailments, this study also examined the how extreme heat influenced the manifestation of various underlying health concerns (Fuhrmann et al., 2016). The most prevalent comorbidities identified included increases in cardiovascular conditions, nervous system disorders, and respiratory illnesses such as pneumonia, bronchitis, and emphysema (Fuhrmann et al., 2016). ...
Thesis
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The pertinent information synthesized by well-designed surveillance operations are essential to the planning, implementation, and evaluation of both public health and healthcare services. Divergent applications within existing surveillance initiatives have subsequently led to novel uses of health-related data becoming increasingly valuable. Heightened surveillance techniques, such as syndromic surveillance, have revealed pragmatic capabilities that adequately complement the dynamic nature of public health programming. As syndromic surveillance is still an emerging science, scholarly activities probing the utility of emergency department (ED)-based syndromic surveillance systems have remained noticeably narrow in scope. However, it is commonly speculated that the inherent multifaceted functionalities of ED-based syndromic surveillance systems equip them with the potential to meaningfully enhance surveillance capacities, across a broader assortment of public health and healthcare settings. The purpose of this dissertation study was to explore the utility of ED-based syndromic surveillance data for resolutions beyond infectious disease control and prevention. More specifically, this study examined ED utilization data, captured and forecasted by the Electronic Surveillance System for the Early Detection of Community-based Epidemics (ESSENCE), and its aptness for the early detection of ED crowding. Pre-existing data extracted from the ESSENCE syndromic surveillance system and the County Hospital Alert Tracking System (CHATS), were cross-classified to test the principal hypotheses of this study. A multiple logistic regression model was employed to assess whether the odds of reported ED crowding increased on days when actual ED utilization counts surpassed the expected utilization counts forecasted by ESSENCE. Findings from this investigative inquiry proved that ED-based syndromic surveillance data, may be able to serve as an early indicator of emergency department crowding. The increased odds observed in the multiple logistic regression supports our primary research hypothesis and warrants further exploration into the matter. This dissertation was tailored for use as a foundational piece, to drive a series of studies to follow. Future research should seek to improve upon the examination methods modeled in this study, for the creation of a gauge for heightened awareness or increased risk of ED crowding. Ultimately, this study contributes to an increased understanding and acknowledgment of the adroit capabilities that ED-based syndromic surveillance systems
... Of the remaining 17 studies, the majority utilized either a case-crossover design with conditional logistic regression [26][27][28], time series analysis utilizing Poisson regression [29][30][31][32][33][34], distributed lag nonlinear models [35], or generalized additive models [36]. Poisson regression and generalized linear regression [37,38], multiple stepwise regression analysis [39], canonical correlation analysis [40], and t-test [41,42] were also conducted. Detailed descriptions of the included studies can be found in Table 1. ...
... The five systematic reviews included studies from North America, Europe, Asia, and Australia. Single studies were conducted in the United States [26][27][28][29]33,40,41], Canada [34][35][36][37], Southern Europe [31,38,39], Northern Europe [30,32], and Eastern Europe [42]. ...
... Eight of the twenty-two studies exclusively examined extreme temperature exposure. Four studies exclusively examined heat wave effects (i.e., when maximum temperatures exceed a predefined threshold for consecutive days) [29,[40][41][42]; however, temperature thresholds ranged from the 90th to 99th percentile, while consecutive days needed at or above this threshold ranged from two to four. Three studies examined extreme heat events as defined by temperatures in the 99th percentile of temperature distribution for their respective locations (i.e., heat days) [31,33,34], and one study examined the effects of both heat waves and heat days (days exceeding the 95th percentile of temperature distribution) [28]. ...
Article
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The primary objective of this review was to synthesize studies assessing the relationships between high temperatures and cardiovascular disease (CVD)-related hospital encounters (i.e., emergency department (ED) visits or hospitalizations) in urban Canada and other comparable populations, and to identify areas for future research. Ovid MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, and Scopus were searched between 6 April and 11 April 2020, and on 21 March 2021, to identify articles examining the relationship between high temperatures and CVD-related hospital encounters. Studies involving patients with pre-existing CVD were also included. English language studies from North America and Europe were included. Twenty-two articles were included in the review. Studies reported an inconsistent association between high temperatures and ischemic heart disease (IHD), heart failure, dysrhythmia, and some cerebrovascular-related hospital encounters. There was consistent evidence that high temperatures may be associated with increased ED visits and hospitalizations related to total CVD, hyper/hypotension, acute myocardial infarction (AMI), and ischemic stroke. Age, sex, and gender appear to modify high temperature-CVD morbidity relationships. Two studies examined the influence of pre-existing CVD on the relationship between high temperatures and morbidity. Pre-existing heart failure, AMI, and total CVD did not appear to affect the relationship, while evidence was inconsistent for pre-existing hypertension. There is inconsistent evidence that high temperatures are associated with CVD-related hospital encounters. Continued research on this topic is needed, particularly in the Canadian context and with a focus on individuals with pre-existing CVD.
... It has been well known for many decades that days with anomalously high heat and humidity are associated with peaks in human mortality [1][2][3][4][5]. The strongest linkages generally have been found with respect to cardiovascular and respiratory diseases [6][7][8][9][10][11][12]. When extended periods of heat are examined, there is evidence of an additional effect associated with the prolonged exposure from the added thermal stress placed on the body coupled with the lack of respite from cooler conditions [13][14][15][16][17][18]. ...
... Considerably less research has been conducted on heat waves and morbidity [10,11,19]. With a warming climate, heat waves, by definition, will become longer and/or more extreme [20][21][22], although predicting the human response to these events is complex [23][24][25]. ...
... Many studies find an overall increase in all-cause or non-accidental admissions during or just after heat waves [27][28][29][30][31], whereas others find no increase [32]. Heat waves tend to have a greater impact on the elderly [11,28,29,33], but the impacts may vary over the course of the warm season [11]. Renal and respiratory admissions are commonly linked to heat waves [28,[34][35][36], although some studies have identified disease-specific local relationships that have not been replicated in other populations [37,38]. ...
Article
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Heat waves have been linked to increases in emergency-related morbidity, but more research is needed on the demographic and disease-specific aspects of these morbidities. Using a case-crossover approach, over 700,000 daily emergency department hospital admissions in Charlottesville, Virginia, U.S.A. from 2005⁻2016 are compared between warm season heat wave and non-heat wave periods. Heat waves are defined based on the exceedance, for at least three consecutive days, of two apparent temperature thresholds (35 °C and 37 °C) that account for 3 and 6% of the period of record. Total admissions and admissions for whites, blacks, males, females, and 20⁻49 years old are significantly elevated during heat waves, as are admissions related to a variety of diagnostic categories, including diabetes, pregnancy complications, and injuries and poisoning. Evidence that heat waves raise emergency department admissions across numerous demographic and disease categories suggests that heat exerts comorbidity influences that extend beyond the more well-studied direct relationships such as heat strokes and cardiac arrest.
... Emergency department (ED) patient volumes are usually seen to rise during episodes of extreme heat, which are typically defined as periods of temperature exceeding the 95th-99th percentile of region norms [5,6,14,15]. Unsurprisingly, visits for heat-related emergency conditions-a term used to encompass a spectrum of symptoms resulting from exposure to high temperatures [16]-are reported to increase by roughly 70% during these events [15,17]. Outside of extreme heat events, higher ambient temperatures are also harmful to human health [18]. ...
... The concern for heat-related emergency conditions is therefore no longer just limited to the warm season, and should be evaluated throughout the year. Further, past investigations into heat-related ED visits have generally included narrow populations of interest, with studies focused on populations in California, Florida, and North Carolina [17,19,21,27]. Even the largest sample analyses, looking at all adult Medicare beneficiaries or the 14 CDC public health tracking states, captured only a quarter of the United States population. ...
Article
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Exposure to high temperatures is detrimental to human health. As climate change is expected to increase the frequency of extreme heat events, and raise ambient temperatures, an investigation into the trend of heat-related emergency department (ED) visits over the past decade is necessary to assess the human health impact of this growing public health crisis. ED visits were examined using the Nationwide Emergency Department Sample. Visits were included if the diagnostic field contained an ICD-9-CM or ICD-10-CM code specific to heat-related emergency conditions. Weighted counts were generated using the study design and weighting variables, to estimate the national burden of heat-related ED visits. A total of 1,078,432 weighted visits were included in this study. The annual incidence rate per 100,000 population increased by an average of 2.85% per year, ranging from 18.21 in 2009, to 32.34 in 2018. The total visit burden was greatest in the South (51.55%), with visits increasing to the greatest degree in the Midwest (8.52%). ED visit volume was greatest in July (29.79%), with visits increasing to the greatest degree in July (15.59%) and March (13.18%). An overall increase in heat-related ED visits for heat-related emergency conditions was found during the past decade across the United States, affecting patients in all regions and during all seasons.
... 1. Extreme heat: having pre-existing diabetes or digestive disorders [50,71,72], teenagers and adolescents (under 18 years old) [51,[72][73][74], PM 10 , O 3 [50,71,75], latitude [50], medication usage (e.g. psychoactive, anticoagulants, nitrates, diuretics) [76][77][78], pregnancy [51,79,80], urbanicity [81][82][83], being confined to bed [54], not leaving home daily [54], being unable to care for oneself [84], patients living outside of retirement homes [54], taking extra showers during hot days [54], wind speed and direction [85], dew point [86], vapor pressure [87], cloud cover [88], public transit use [89], and ecoregion [90]. ...
... 1. Extreme heat: having pre-existing diabetes or digestive disorders [50,71,72], teenagers and adolescents (under 18 years old) [51,[72][73][74], PM 10 , O 3 [50,71,75], latitude [50], medication usage (e.g. psychoactive, anticoagulants, nitrates, diuretics) [76][77][78], pregnancy [51,79,80], urbanicity [81][82][83], being confined to bed [54], not leaving home daily [54], being unable to care for oneself [84], patients living outside of retirement homes [54], taking extra showers during hot days [54], wind speed and direction [85], dew point [86], vapor pressure [87], cloud cover [88], public transit use [89], and ecoregion [90]. ...
Article
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Background Although the frequency and magnitude of climate change-related health hazards (CCRHHs) are likely to increase, the population vulnerabilities and corresponding health impacts are dependent on a community’s exposures , pre-existing sensitivities, and adaptive capacities in response to a hazard’s impact. To evaluate spatial variability in relative vulnerability, we: 1) identified climate change-related risk factors at the dissemination area level; 2) created actionable health vulnerability index scores to map community risks to extreme heat, flooding, wildfire smoke, and ground-level ozone; and 3) spatially evaluated vulnerability patterns and priority areas of action to address inequity. Methods A systematic literature review was conducted to identify the determinants of health hazards among populations impacted by CCRHHs. Identified determinants were then grouped into categories of exposure, sensitivity, and adaptive capacity and aligned with available data. Data were aggregated to 4188 Census dissemination areas within two health authorities in British Columbia, Canada. A two-step principal component analysis (PCA) was then used to select and weight variables for each relative vulnerability score. In addition to an overall vulnerability score, exposure, adaptive capacity, and sensitivity sub-scores were computed for each hazard. Scores were then categorised into quintiles and mapped. Results Two hundred eighty-one epidemiological papers met the study criteria and were used to identify 36 determinant indicators that were operationalized across all hazards. For each hazard, 3 to 5 principal components explaining 72 to 94% of the total variance were retained. Sensitivity was weighted much higher for extreme heat, wildfire smoke and ground-level ozone, and adaptive capacity was highly weighted for flooding vulnerability. There was overall varied contribution of adaptive capacity (16–49%) across all hazards. Distinct spatial patterns were observed – for example, although patterns varied by hazard, vulnerability was generally higher in more deprived and more outlying neighbourhoods of the study region. Conclusions The creation of hazard and category-specific vulnerability indices (exposure, adaptive capacity and sensitivity sub-scores) supports evidence-based approaches to prioritize public health responses to climate-related hazards and to reduce inequity by assessing relative differences in vulnerability along with absolute impacts. Future studies can build upon this methodology to further understand the spatial variation in vulnerability and to identify and prioritise actionable areas for adaptation.
... respiratory diseases (ICD-10-AM: J00-J99), and associated healthcare costs were used as the outcomes of interest in this study. These diseases have been shown to vary with temperature (either heat or cold) in Australia and other countries [6][7][8][9][10][11][23][24][25][26]. The daily ED visits and associated healthcare costs for each of these individual disease categories were aggregated for statistical analysis, and defined as 'temperature-related disease ED visits' and associated healthcare costs; therefore, the outcome variables represented these combined cause-specific daily ED visits and associated healthcare costs in Perth. ...
... This could be due to certain heat effects occurring immediately (lag 0-1 day) for ED visits, such as heat-related illnesses, mental health disorders and respiratory diseases, while simultaneously, the heat effects lasted for three to four weeks for mental health disorders. This is consistent with other studies that indicated the positive association between temperatures and heatrelated illnesses, mental health disorders and respiratory diseases [21,25,26,41]. In this study, we did not find significant heat effects on ischemic heart diseases and renal diseases. ...
Article
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Increasing temperature and its impact on population health is an emerging significant public health issue in the context of climate change in Australia. While previous studies have primarily focused on risk assessment, very few studies have evaluated heat-attributable emergency department (ED) visits and associated healthcare costs, or projected future health and economic burdens. This study used a distributed lag non-linear model to estimate heat attributable ED visits and associated healthcare costs from 13 hospitals in Perth, Western Australia, and to project the future healthcare costs in 2030s and 2050s under three climate change scenarios—Representative Concentration Pathways (RCPs)2.6, RCP4.5 and RCP8.5. There were 3697 ED visits attributable to heat (temperatures above 20.5 °C) over the study period 2012–2019, accounting for 4.6% of the total ED visits. This resulted in AU$ 2.9 million in heat-attributable healthcare costs. The number of ED visits projected to occur in the 2030s and 2050s ranges from 5707 to 9421 under different climate change scenarios, which would equate to AU$ 4.6–7.6 million in heat associated healthcare costs. The heat attributable fraction for ED visits and associated healthcare costs would increase from 4.6% and 4.1% in 2010s to 5.0%–6.3% and 4.4%–5.6% in 2030s and 2050s, respectively. Future heat attributable ED visits and associated costs will increase in Perth due to climate change. Excess heat will generate a substantial population health challenge and economic burdens on the healthcare system if there is insufficient heat adaptation. It is vital to reduce greenhouse gas emissions, develop heat-related health interventions and optimize healthcare resources to mitigate the negative impact on the healthcare system and population health in the face of climate change.
... Although HRI in the mountains of WNC are low compared to other regions of the state, HRIs peak at lower temperatures well-below National Warning Service heat advisory and heat warning thresholds. Heat can also trigger other health outcomes, with significant increases in NC emergency department visits for conditions like cardiovascular and cerebrovascular diseases, and respiratory diseases (e.g., hemorrhagic stroke, hypotension, aneurysm, COPD, bronchitis, emphysema) 13 . ...
... In general, higher temperatures will increase the threat of heat-related illnesses, particularly among the occupationally exposed, those with underlying medical issues, and rural populations in WNC 14,20 . Threats from high temperatures can impact heatrelated illness and exacerbate other illnesses including cardiovascular and cerebrovascular illnesses 13 . High temperatures can also increase the risk of mental health illnesses and crisis events 40 . ...
Article
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The frequency and severity of extreme weather events are expected to increase in the context of a changing climate. Populations across the globe are vulnerable and already experiencing the health effects of a changing climate. Western North Carolina (WNC) is no exception. The last decade was the warmest ever on record. This past year, 2019, broke historical records in North Carolina, and temperature anomalies in WNC largely drove this pattern. The indirect and direct effects of climate on human health are complicated and modulated by underlying social vulnerabilities that enhance the severity and sensitivity of population exposure to climate hazards. In this paper, we discuss the complex pathways through which climate hazards impact health in WNC and the ongoing efforts among the academic and public health community to address these emerging climate-related health threats. Specifically, we highlight the changing patterns in (1) temperature-related disease, (2) vector-borne disease, (3) natural hazards, (4) mental health impacts and the (5) built environment. Lastly, we identify important research needs and partnerships required to motivate effective and meaningful engagement with the public and policymakers around the regional impacts of climate change on human health, potential solutions, and co-benefits of resilience planning in WNC.
... Heat waves-multiple, consecutive, hot days-present a significant threat to human health. Both multicountry and smaller-scale regional studies demonstrate that heat waves result in elevated mortality and morbidity (e.g., Anderson & Bell, 2009;Burgess et al., 2011;Fuhrmann et al., 2016;Gasparrini et al., 2015;Lippmann et al., 2013;Merte, 2017;Son et al., 2012). Of the 11 most deadly natural hazards in the continental United States, heat waves (here including those coupled with drought) constitute a plurality (∼20%) of the mortality (Borden & Cutter, 2008). ...
... This effect might make mortality from compound days lower than that of heat wave days occurring long after prior events. Morbidity (e.g., emergency room visits) or occupational health hazards are less subject to displacement effects and so may relate more clearly to compound days (Fuhrmann et al., 2016). ...
Article
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The temporal structure of heat waves having substantial human impact varies widely, with many featuring a compound structure of hot days interspersed with cooler breaks. In contrast, many heat wave definitions employed by meteorologists include a continuous threshold-exceedance duration criterion. This study examines the hazard of these diverse sequences of extreme heat in the present, and their change with global warming. We define compound heat waves to include those periods with additional hot days following short breaks in heat wave duration. We apply these definitions to analyze daily temperature data from observations, NOAA Geophysical Fluid Dynamics Laboratory global climate model simulations of the past and projected climate, and synthetically generated time series. We demonstrate that compound heat waves will constitute a greater proportion of heat wave hazard as the climate warms and suggest an explanation for this phenomenon. This result implies that in order to limit heat-related mortality and morbidity with global warming, there is a need to consider added vulnerability caused by the compounding of heat waves.
... respiratory diseases (ICD-10-AM: J00-J99), and associated healthcare costs were used as the outcomes of interest in this study. These diseases have been shown to vary with temperature (either heat or cold) in Australia and other countries [6][7][8][9][10][11][23][24][25][26]. The daily ED visits and associated healthcare costs for each of these individual disease categories were aggregated for statistical analysis, and defined as 'temperature-related disease ED visits' and associated healthcare costs; therefore, the outcome variables represented these combined cause-specific daily ED visits and associated healthcare costs in Perth. ...
... This could be due to certain heat effects occurring immediately (lag 0-1 day) for ED visits, such as heat-related illnesses, mental health disorders and respiratory diseases, while simultaneously, the heat effects lasted for three to four weeks for mental health disorders. This is consistent with other studies that indicated the positive association between temperatures and heatrelated illnesses, mental health disorders and respiratory diseases [21,25,26,41]. In this study, we did not find significant heat effects on ischemic heart diseases and renal diseases. ...
Article
Full-text available
Climate change with increasing temperature is making a significant impact on human health, including more heat-related diseases, and increasing the burden on the healthcare system. Although many studies have explored the association between increasing temperatures and negative health outcomes, research on the associated costs of heat-related diseases remains relatively sparse. Furthermore, estimations of future costs associated with heat-attributable hospital healthcare have not been well explored. This study used a distributed lag nonlinear model to estimate heat-attributable hospital healthcare costs in Perth, Western Australia. Using 2006‒2012 as the baseline, future costings for 2026‒2032 and 2046‒2052 were estimated under RCP2.6, RCP4.5, and RCP8.5. Higher temperatures were found to be associated with increased hospital healthcare costs. The total hospital costs attributable to heat over the baseline period 2006‒2012 was estimated to be 79.5 million AUD, with costs for mental health hospitalizations being the largest contributor of the heat-related conditions examined. Costs are estimated to increase substantially to 125.8‒129.1 million AUD in 2026‒2032, and 174.1‒190.3 million AUD by midcentury under climate change scenarios. Our findings of a notable burden of heat-attributable healthcare costs now and in the future emphasize the importance of climate change adaptation measures to reduce the adverse health effects of increasing temperatures and heat exposure on the people of Perth.
... and the cumulative effect of lags 0-2 was also observed (OR 2.08, 95% CI: 1.05-4.09). Goldie et al., 2018;Stafoggia et al., 2006;Vaidyanathan et al., 2019;Liu et al., 2018;Gronlund et al., 2014;Williams et al., 2012b;Isaksen et al., 2015;Calkins et al., 2016;Nitschke et al., 2016;Khalaj et al., 2010;Ogbomo et al., 2017;Chen et al., 2017;Nitschke et al., 2011;Wang et al., 2012;Remigio et al., 2019;Wilson et al., 2013;Vaneckova and Bambrick, 2013;Huang et al., 2018;Campbell et al., 2019;Woodman and Mayner, 2016;Hansen et al., 2008;Xiao et al., 2017;Zhao et al., 2019a;Xu et al., 2019;Davis et al., 2020;Nitschke et al., 2007;Basagaña et al., 2011;Rey et al., 2007;Fuhrmann et al., 2016;Michelozzi et al., 2005;Knowlton et al., 2009;Semenza et al., 1999;Zhang et al., 2013;Bogdanovic et al., 2013;Percic et al., 2018;Ragettli et al., 2019;Fouillet et al., 2006;Gronlund et al., 2016;Hopp et al., 2018;Bobb et al., 2014;Lindstrom et al., 2013), with 42 of these focusing on the effects of high temperatures on kidney disease. Table 2 shows the pooled RRs per 1°C increase in temperature, 80% PI, heterogeneity, and Egger's test for funnel plot asymmetry. ...
... For heatwave exposure, the reviewed studies (n = 40) used a range of temperature indicators (maximum, minimum, mean and apparent temperature) to define a heatwave, as well as varying heatwave intensities (relative threshold temperature and/or absolute temperature value), and duration (ranging from one to nine days) (McTavish et al., 2018;Gronlund et al., 2014;Williams et al., 2012b;Isaksen et al., 2015;Calkins et al., 2016;Nitschke et al., 2016;Khalaj et al., 2010;Ogbomo et al., 2017;Chen et al., 2017;Nitschke et al., 2011;Wang et al., 2012;Remigio et al., 2019;Wilson et al., 2013;Vaneckova and Bambrick, 2013;Huang et al., 2018;Campbell et al., 2019;Woodman and Mayner, 2016;Hansen et al., 2008;Xiao et al., 2017;Zhao et al., 2019a;Xu et al., 2019;Davis et al., 2020;Nitschke et al., 2007;Basagaña et al., 2011;Rey et al., 2007;Michelozzi et al., 2005;Bogdanovic et al., 2013;Percic et al., 2018;Ragettli et al., 2019;Fouillet et al., 2006;Gronlund et al., 2016;Hopp et al., 2018;Bobb et al., 2014;. In some studies, these heatwave indicators were not specified; instead, the health risk during a heatwave episode was compared to the health risk during non-heatwave days (Fuhrmann et al., 2016;Knowlton et al., 2009;Semenza et al., 1999;Zhang et al., 2013;Lindstrom et al., 2013). The details of the heatwave definitions used in the studies and the corresponding risk estimates of the association with kidney disease, are presented in Table B.1. ...
Article
Background The occurrence or exacerbation of kidney disease has been documented as a growing problem associated with hot weather. The implementation of effective prevention measures requires a better understanding of the risk factors that increase susceptibility. To fill gaps in knowledge, this study reviews the current literature on the effects of heat on kidney-disease outcomes (ICD-10 N00-N39), including morbidity and mortality. Methods Databases were systematically searched for relevant literature published between 1990 and 2020 and the quality of evidence evaluated. We performed random effects meta-analysis to calculate the pooled relative risks (RRs) of the association between high temperatures (and heatwaves) and kidney disease outcomes. We further evaluated vulnerability concerning contextual population characteristics. Results Of 2739 studies identified, 91 were reviewed and 82 of these studies met the criteria for inclusion in a meta-analysis. Findings showed that with a 1 °C increase in temperature, the risk of kidney-related morbidity increased by 1% (RR 1.010; 95% CI: 1.009–1.011), with the greatest risk for urolithiasis. Heatwaves were also associated with increased morbidity with a trend observed with heatwave intensity. During low-intensity heatwaves, there was an increase of 5.9% in morbidity, while during high-intensity heatwaves there was a 7.7% increase. There were greater RRs for males, people aged ≤64 years, and those living in temperate climate zones. Similarly, for every 1 °C temperature increase, there was a 3% (RR 1.031; 95% CI: 1.018–1.045) increase in the risk of kidney-related mortality, which also increased during heatwaves. Conclusions High temperatures (and heatwaves) are associated with an elevated risk of kidney disease outcomes, particularly urolithiasis. Preventive measures that may minimize risks in vulnerable individuals during hot spells are discussed.
... and the cumulative effect of lags 0-2 was also observed (OR 2.08, 95% CI: 1.05-4.09). Goldie et al., 2018;Stafoggia et al., 2006;Vaidyanathan et al., 2019;Liu et al., 2018;Gronlund et al., 2014;Williams et al., 2012b;Isaksen et al., 2015;Calkins et al., 2016;Nitschke et al., 2016;Khalaj et al., 2010;Ogbomo et al., 2017;Chen et al., 2017;Nitschke et al., 2011;Wang et al., 2012;Remigio et al., 2019;Wilson et al., 2013;Vaneckova and Bambrick, 2013;Huang et al., 2018;Campbell et al., 2019;Woodman and Mayner, 2016;Hansen et al., 2008;Xiao et al., 2017;Zhao et al., 2019a;Xu et al., 2019;Davis et al., 2020;Nitschke et al., 2007;Basagaña et al., 2011;Rey et al., 2007;Fuhrmann et al., 2016;Michelozzi et al., 2005;Knowlton et al., 2009;Semenza et al., 1999;Zhang et al., 2013;Bogdanovic et al., 2013;Percic et al., 2018;Ragettli et al., 2019;Fouillet et al., 2006;Gronlund et al., 2016;Hopp et al., 2018;Bobb et al., 2014;Lindstrom et al., 2013), with 42 of these focusing on the effects of high temperatures on kidney disease. Table 2 shows the pooled RRs per 1°C increase in temperature, 80% PI, heterogeneity, and Egger's test for funnel plot asymmetry. ...
... For heatwave exposure, the reviewed studies (n = 40) used a range of temperature indicators (maximum, minimum, mean and apparent temperature) to define a heatwave, as well as varying heatwave intensities (relative threshold temperature and/or absolute temperature value), and duration (ranging from one to nine days) (McTavish et al., 2018;Gronlund et al., 2014;Williams et al., 2012b;Isaksen et al., 2015;Calkins et al., 2016;Nitschke et al., 2016;Khalaj et al., 2010;Ogbomo et al., 2017;Chen et al., 2017;Nitschke et al., 2011;Wang et al., 2012;Remigio et al., 2019;Wilson et al., 2013;Vaneckova and Bambrick, 2013;Huang et al., 2018;Campbell et al., 2019;Woodman and Mayner, 2016;Hansen et al., 2008;Xiao et al., 2017;Zhao et al., 2019a;Xu et al., 2019;Davis et al., 2020;Nitschke et al., 2007;Basagaña et al., 2011;Rey et al., 2007;Michelozzi et al., 2005;Bogdanovic et al., 2013;Percic et al., 2018;Ragettli et al., 2019;Fouillet et al., 2006;Gronlund et al., 2016;Hopp et al., 2018;Bobb et al., 2014;. In some studies, these heatwave indicators were not specified; instead, the health risk during a heatwave episode was compared to the health risk during non-heatwave days (Fuhrmann et al., 2016;Knowlton et al., 2009;Semenza et al., 1999;Zhang et al., 2013;Lindstrom et al., 2013). The details of the heatwave definitions used in the studies and the corresponding risk estimates of the association with kidney disease, are presented in Table B.1. ...
... [1][2][3][4] Studies from different countries and years have shown that the numbers of patients presenting to the emergency department (ED), admitted to hospital from the ED, and dying all increase in extreme heat. [1,[5][6][7][8][9][10][11][12][13] ED presentations that are associated with cardiovascular, renal and mental causes increase significantly compared to other causes at such times. Elderly patients are particularly affected by extreme heat. ...
... Heat waves increase the numbers of patients presenting to the ED, and also cause an increase mortality rates, which is supported by studies from various countries. [1,[5][6][7][8][9][10][11][12][13] Our study shows that the number of patients presenting to the ED and the number of non-surviving patients increased significantly during the heat wave in the province of Izmir on the Aegean coast with its Mediterranean climate. These data are the first to be reported from our region, and they are consistent with previous results. ...
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Extreme heat wave increases the number of emergency department (ED) admissions and mortality rates. The purpose of our study is to investigate the effects of the heat wave experienced in Izmir province of Turkey on mortality.During a 9-day period between 17th and 25th June 2016 (study period), air temperature values were higher than the seasonal norms in Izmir, Turkey. In this cross-sectional study, nontraumatic admissions and in-hospital mortality rates were compared this historical interval of the extreme heat wave with the same period of the previous year and the other 21 days of June 2016.The average air temperature between 17th and 25th June 2016, was higher than the average air temperature of the previous year's same period and the average air temperature from the other 21 days of June 2016 (27.8 ± 3.6 °C, (24.5 ± 1.9°C, 24.1 ± 2.1°C, respectively) (P <.01)During the study period, the mean number of ED visits and mortality rates were significantly higher than the previous year's same period (320 ± 30/day vs 269 ± 27/day, [P <.01], and 1.6% vs 0.7%, [P <.01]).Although the admission rate was similar between the study period and the other 21 days of June 2016 (320 ± 30/day vs 310 ± 32/ day, [P = .445]); in-hospital mortality rate was significantly higher during study period (1.6% vs 0.7%, [P <.01]).During the extreme heat waves, ED admissions and in-hospital mortality rates are increased. Precautions should be addressed for adaptation of people to extreme hot weather.
... Emergency department (ED) patient volumes rise during episodes of extreme heat, which are typically defined as periods of temperature exceeding the 95 th -99 th percentile of region norms [5,6,14,15]. Unsurprisingly, visits for heat-related emergency conditions -a term used to encompass a spectrum of symptoms resulting from exposure to high temperatures [16] -are seen to increase by roughly 70% during these events [15,17]. Outside of extreme heat events, higher ambient temperatures are also harmful to human health [18]. ...
... The copyright holder for this preprint this version posted August 17, 2022 [17,19,21,27]. Even the largest scale analyses, looking at all adult Medicare beneficiaries or the 14 CDC public health tracking states, captured only a quarter of the United States population. ...
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Introduction: Exposure to high temperatures is detrimental to human health. As climate change is expected to increase the frequency of extreme heat events, as well as raise ambient temperatures, an investigation into the burden of heat–related emergency department visits is necessary to assess the human health impact of this growing public health crisis. Methods: Emergency department visits were sourced from the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. This dataset collects emergency department visit information from 989 facilities that represent a 20–percent stratified sample of United States hospital–owned emergency departments. Visits were included in this study if the medical diagnosis contained an ICD–9–CM or ICD–10–CM code specific to heat–related emergency conditions. Weighted heat–related emergency department visit counts were generated to estimate the total counts for heat–related emergency department visits across the United States. Visit year and month, hospital geographic region, patient age, and sex were recorded. Incidence rates per 100,000 US population, visit counts, and visit count percent change were analyzed on both a national scale and stratified by month, region, age, and sex. Results: A total of 1,007,134 weighted heat–related emergency department visits between 2008 – 2019 were included in this study. The annual incidence rate per 100,000 US population increased by an average of 5.73% (95% CI: 8.64% –20.1%) per year across the study period, rising from 20.56 in 2008 to 30.41 in 2019. For the twelve–year period, the burden of heat–related emergency department visits was greatest in the South (51.41%). Most cases occurred in July (29.56%), with visits increasing to the greatest degree in July (19.25%, 95% CI: 20.75% – 59.26%) and March (14.36%, 95% CI: 19.53% –48.25%). Conclusions: This study found a significant increase in emergency department visits for heat–related emergency conditions across the United States from the years 2008 to 2019.
... Extreme heat events, or heat waves, can also trigger other illnesses outside of heat-related illnesses. An analysis of extreme heat in North Carolina found significant increases in all-cause emergency department visits, as well as different disease categories (eg, cardiovascular and cerebrovascular diseases) [10]. Across the summer season, there are notable changes in demographics seeking care for heat, with the young (younger than 14) and elderly people (65 and older) experiencing higher rates in June with the onset of summer temperatures. ...
... Across the summer season, there are notable changes in demographics seeking care for heat, with the young (younger than 14) and elderly people (65 and older) experiencing higher rates in June with the onset of summer temperatures. The demographic most vulnerable to late-season extreme heat are adolescents (aged 15 to 17), which may relate to the onset of organized school sports [10]. These findings suggest that public health interventions for heat health should target different demographics and locations throughout the warm season. ...
... In North America, Madrigano et al. (2015) used the observed and interpolated data to investigate temperature, ozone, and mortality in 91 urban and non-urban counties. Fuhrmann et al. assessed the effect of three heat events on public health in North Carolina (Fuhrmann et al., 2016). Sheridan et al. presented an analysis of heat vulnerability across the Ohio and found there is no significantly difference of vulnerability to heat between rural and urban areas (Sheridan and Dolney, 2003). ...
... Previous studies (Gasparrini et al., 2015a;Patz et al., 2005) have stressed that extreme temperature have significant influence on several disease. Extreme heat event has a greater effect on respiratory disease (Ai et al., 2008;Le et al., 2006), such as pneumonia and influenza (Fuhrmann et al., 2016), and it can serve as stressors in individuals with pre-existing cardiovascular and cerebrovascular disease as well as can directly precipitate exacerbations. Compared with the heat event, extreme low temperature is often associated with cardiovascular disease (Kysely et al., 2009), such as stroke, chest pain, dysrhythmias and so on. ...
... The environmental health community appears to be approaching convergence regarding how heat and cold impact human mortality and morbidity. Anomalous heat event and heat wave impacts are evident across a variety of disease categories (Williams et al. 2012;Gronlund et al. 2014;Davis and Novicoff 2018), are especially harmful to the elderly (Mastrangelo et al. 2007;Wang et al. 2012;Fuhrmann et al. 2016), and occur at lags as short as a few days (Davis et al. 2003;Conti et al. 2005;Rocklöv and Forsberg 2010). Winter impacts of anomalously low temperatures are more muted (Huynen et al. 2001; Barnett et al. 2012;Linares et al. 2015) and dispersed over a larger number of days (Guo et al. 2014), with lags that are longer and less consistent (Díaz et al. 2005;Anderson and Bell 2009). ...
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An increasing number of epidemiological studies are finding statistical evidence that diurnal temperature range (DTR) is positively correlated to human morbidity and mortality despite the lack of clear clinical understanding. We examine a 14-year daily time series of emergency department (ED) admissions to the University of Virginia Medical Center in Charlottesville, Virginia, relative to long-term climate records from the Charlottesville/Albemarle County Airport weather station and the Spatial Synoptic Classification. DTR has a consistent strong positive correlation (r ~ 0.5) with maximum temperature in all months but only a weak, negative correlation (r ~− 0.1) with minimum temperature except in late summer (r ~− 0.4). Warm season DTR is highest on dry air mass days with low dew point temperatures. Cool season DTR is unrelated to morning temperature. Using a distributed lag non-linear model with an emphasis on DTR and its seasonal variation, after stratifying the models by season, we find that ED visits are linked to extreme cold events (cold days and nights) and high DTR in the cold season. In the warm season, ED visits are also linked to high DTR, but these are cool, dry, and pleasant days. The existing confusion regarding interpretation of DTR impacts on health might be rectified through a more careful analysis of the underlying physical factors that drive variations in DTR over the course of a year.
... Due to the adverse effects of heat on public health, a wealth of heat and health-related articles have been published over the last few decades (e.g., Fuhrmann et al., 2016;Gosling et al., 2009;Hondula et al., 2012;Hondula et al., 2015;McGeehin and Mirabelli, 2001;Noe et al., 2012). The impacts of heat on human health have sparked research on the best approach to measure, map, and predict heat exposure at the individual scale. ...
Article
The impacts of heat on human health has sparked research on different approaches to measure, map, and predict heat exposure at more accurate and precise spatiotemporal scales. Personal heat sensor studies rely on small sensors that can continuously measure ambient temperatures as individuals move through time and space. The comparison between different types of sensors and sensor placements have yet to be fully researched. The objective of this study is to assess the validity of personal ambient temperature sensors. To accomplish this objective, we evaluated the performance of multiple low-cost wearable sensors (HOBOs, iButton Thermochrons, iButton Hygrochrons, and Kestrel DROP D3FW Fire) for measuring ambient temperature in a (1) field exposure study by varying the placement on human subjects and in a (2) field calibration study by co-locating sensors with fixed site weather station monitors. A secondary aim involved investigating consensus between validation metrics that can be used in future sensor comparison studies. Bland-Altman analysis, correlation coefficients, and index of agreement statistics were used to quantify the difference between sensor and weather station ambient temperature measurements. Results demonstrated significant differences in measured temperatures for sensors based on sensor type and placement on participants. Future research should account for the differences in personal ambient temperature readings based on sensor type and placement.
... Our findings were largely consistent with similar studies in other locations around Australia, showing an association between heatwave events and increases in emergency department presentations [16,49]. Other international studies have demonstrated similar trends in associations between ED presentations and heatwave events [50][51][52]. ...
Article
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Heatwaves have been identified as a threat to human health, with this impact projected to rise in a warming climate. Gaps in local knowledge can potentially undermine appropriate policy and preparedness actions. Using a case-crossover methodology, we examined the impact of heatwave events on hospital emergency department (ED) presentations in the two most populous regions of Tasmania, Australia, from 2008-2016. Using conditional logistic regression, we analyzed the relationship between ED presentations and severe/extreme heatwaves for the whole population, specific demographics including age, gender and socioeconomic advantage, and diagnostic conditions that are known to be impacted in high temperatures. ED presentations increased by 5% (OR 1.05, 95% CI 1.01-1.09) across the whole population, by 13% (OR 1.13, 95% CI 1.03-1.24) for children 15 years and under, and by 19% (OR 1.19, 95% CI 1.04-1.36) for children 5 years and under. A less precise association in the same direction was found for those over 65 years. For diagnostic subgroups, non-significant increases in ED presentations were observed for asthma, diabetes, hypertension, and atrial fibrillation. These findings may assist ED surge capacity planning and public health preparedness and response activities for heatwave events in Tasmania, highlighting the importance of using local research to inform local practice.
... There are established links between mortality and extreme heat events in cities across the United States (Anderson and Bell 2011;Matte et al. 2016;Semenza et al. 1996). Additionally, there is growing evidence of increased morbidity associated with extreme heat events, especially for vulnerable populations (Fuhrmann et al. 2016;Zhang et al. 2015;Zottarelli et al. 2020). Localized forecasting and warning strategies have been developed to inform the public in an effort to mitigate the effects of heat-health hazards (Hawkins et al. 2017). ...
Article
Extreme heat events pose a threat to human health. Forecasting and warning strategies have been developed to mitigate heat-health hazards. Yet, studies have found that the public lacks knowledge about their heat-health risks and preventive actions to take to reduce risks. Local governmental websites are an important means to communicate preparedness to the public. The purpose of this study is to examine information provided to the public on municipal government web pages of the 10 most populous U.S. cities. A two-level document and content analyses were conducted. A direct content analysis was conducted using federal government websites and documents to create the Extreme Heat Event Public Response Rubric. The rubric contains two broad categories of populations and actions that are further specified. The rubric was then used to examine local government extreme heat event websites for the 10 most populous cities in the United States. The examination of the local government sites found that information included on the websites failed to identify the breadth of populations at greater risk for adverse heat-health outcomes and omitted some recommended actions designed to prevent adverse heat-health events. Local governments often communicated concrete and simple content to the public but more complex information was not included on their websites. Significance Statement Extreme heat is the leading weather-related cause of mortality in the United States annually. Public response to extreme heat events requires that the public understand their risk and know the actions to take to mitigate that risk. The public seeks information from local government websites. Our results found that many local government websites did not provide the information to the public on the array of conditions and factors that put people at a greater risk for an adverse heat-health event, nor did the websites include information on the variety of actions that the public should take in response to an extreme heat event in order to reduce their risks. Addressing the omission of the information on these websites may improve public response to extreme heat events.
... Regarding the heat, in this study the most substantial impacts occur in mid-summer. There is a slightly higher collective relative risk in June than in August, even though it is a cooler month overall, supporting other research regarding a greater vulnerability during early-season heat events (e.g., [10,13,26,27]), albeit weakly. We find particularly high levels of vulnerability in the southeastern US to cold events, similar to other research [15,21] using somewhat different approaches, supporting more broadly some other literature also showing cold impacts decreasing through the winter (e.g., [25]), as well as mortality spikes occurring with the passage of a mid-latitude cyclone that brings in extremely cold air [28]. ...
Article
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While the impact of absolute extreme temperatures on human health has been amply studied, far less attention has been given to relative temperature extremes, that is, events that are highly unusual for the time of year but not necessarily extreme relative to a location’s overall climate. In this research, we use a recently defined extreme temperature event metric to define absolute extreme heat events (EHE) and extreme cold events (ECE) using absolute thresholds, and relative extreme heat events (REHE) and relative extreme cold events (RECE) using relative thresholds. All-cause mortality outcomes using a distributed lag nonlinear model are evaluated for the largest 51 metropolitan areas in the US for the period 1975–2010. Both the immediate impacts and the cumulative 20-day impacts are assessed for each of the extreme temperature event types. The 51 metropolitan areas were then grouped into 8 regions for meta-analysis. For heat events, the greatest mortality increases occur with a 0-day lag, with the subsequent days showing below-expected mortality (harvesting) that decreases the overall cumulative impact. For EHE, increases in mortality are still statistically significant when examined over 20 days. For REHE, it appears as though the day-0 increase in mortality is short-term displacement. For cold events, both relative and absolute, there is little mortality increase on day 0, but the impacts increase on subsequent days. Cumulative impacts are statistically significant at more than half of the stations for both ECE and RECE. The response to absolute ECE is strongest, but is also significant when using RECE across several southern locations, suggesting that there may be a lack of acclimatization, increasing mortality in relative cold events both early and late in winter.
... Exposure to excessive heat, especially over an extended period, can cause heat exhaustion, heat stroke, dehydration, and death, along with more minor symptoms such as headache, nausea, sweating, and weakness (Luber and McGeehin, 2008). Those who have a reduced ability to thermoregulate (e.g., children and elderly), those who work outside or in a warm environment , and those who do not take adaptive measures are more at risk for heat-related health issues (Fuhrmann et al., 2016;Luber and McGeehin, 2008). ...
Article
Prior research demonstrates a link between heat risk perception and population response to a heat warning. Communicating a precise and understandable definition of “heat” or “heatwaves” can affect how a population perceives and responds to extreme heat. Still, little is known about how heat perception affects behavior changes to heat and heat communication across diverse populations. This scoping review aims to identify and describe the main themes and findings of recent heat perception research globally and map critical research gaps and priorities for future studies. Results revealed risk perception influences a person’s exposure to and behavioral response to excessive heat. Risk perception varied geographically along the rural-urban continuum and was typically higher among vulnerable subgroups, including populations who were low-income, minority, and in poor health. A more integrated approach to refining risk communication strategies that result in a behavioral change and incorporates the individual, social, and cultural components of impactful group-based or community-wide interventions is needed. Research employing longitudinal or quasi-experimental designs and advanced statistical techniques are required to tease apart the independent and interacting factors that causally influence risk communication, heat perception, and adaptive behaviors. We advance a framework to conceptualize the structural, environmental, personal, and social drivers of population heat risk perception and how they interact to influence heat perception and adaptive behaviors. Our findings map future research priorities needed for heat perception and a framework to drive future research design.
... Studies have been evaluating the effects of temperature on different health outcomes and population subgroups [4,5]. Additionally, extreme temperatures may increase the risk of hospitalizations and deaths due to respiratory diseases, not only because of exposure to heat but also due to exposure to cold temperatures [6][7][8]. ...
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Over the past decade, Brazil has experienced and continues to be impacted by extreme climate events. This study aims to evaluate the association between daily average temperature and mortality from respiratory disease among Brazilian elderlies. A daily time-series study between 2000 and 2017 in 27 Brazilian cities was conducted. Data outcomes were daily counts of deaths due to respiratory diseases in the elderly aged 60 or more. The exposure variable was the daily mean temperature from Copernicus ERA5-Land reanalysis. The association was estimated from a two-stage time series analysis method. We also calculated deaths attributable to heat and cold. The pooled exposure–response curve presented a J-shaped format. The exposure to extreme heat increased the risk of mortality by 27% (95% CI: 15–39%), while the exposure to extreme cold increased the risk of mortality by 16% (95% CI: 8–24%). The heterogeneity between cities was explained by city-specific mean temperature and temperature range. The fractions of deaths attributable to cold and heat were 4.7% (95% CI: 2.94–6.17%) and 2.8% (95% CI: 1.45–3.95%), respectively. Our results show a significant impact of non-optimal temperature on the respiratory health of elderlies living in Brazil. It may support proactive action implementation in cities that have critical temperature variations.
... The most severe heat wave (heat wave #1) is found to be centered on the Midwest during 17-22 July 2011. This time and place corresponds to a heat wave that generated a raft of news coverage and a dramatic spike in heat-related illness (Storm and Fowler 2011, Berry et al 2013, Fuhrmann et al 2016. The second most severe heat wave (heat wave #2) is identified as occurring over the same region during 12-15 July 1995. ...
Article
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The heat index, or apparent temperature, was never defined for extreme heat and humidity, leading to the widespread adoption of a polynomial extrapolation designed by the United States National Weather Service. Recently, however, the heat index has been extended to all combinations of temperature and humidity, presenting an opportunity to reassess past heat waves. Here, hourly temperature and humidity are used to evaluate the extended heat index over the contiguous United States during the years 1984 to 2020. It is found that the 99.9th percentile of the daily maximum heat index is highest over the Midwest. Identifying and ranking heat waves by the spatially integrated exceedance of that percentile, the Midwest once again stands out as home to the most extreme heat waves, including the top-ranked July 2011 and July 1995 heat waves. The extended heat index can also be used to evaluate the physiological stress induced by heat and humidity. It is found that the most extreme Midwest heat waves tax the cardiovascular system with a skin blood flow that is elevated severalfold, approaching the physiological limit. These effects are not captured by the National Weather Service's polynomial extrapolation, which also underestimates the heat index by as much as 10 degrees Celsius (20 degrees Fahrenheit) during severe heat waves.
... The non-optimum temperature, particularly its cold and hot extremes, poses higher mortality risks (Chen et al., 2018). Numerous studies showed that the extreme temperatures have marked impacts on human mortality (Gasparrini and Armstrong, 2011;Lippmann et al., 2013;Ma et al., 2014;Rocklöv et al., 2014;Sun et al., 2014;Fuhrmann et al., 2016). For example, the heat waves which swept through Europe during the summer of 2003 had a great impact on the public health in several European cities (Johnson et al., 2005;Michelozzi et al., 2005;Barbieri, 2008;Morabito et al., 2012), resulting in an excess heat-related deaths of >30,000 people in Western European countries (Charpentier, 2011). ...
Article
Global climate change increased air temperature variability and enhanced the frequency and intensity of extreme weather events, such as heat waves and cold spells with adverse impacts on public health. In this study, we examined the relationships of the daily air temperature with mortality in Shanghai in 2003, a record hot year. We found V-shaped associations between cause-specific mortality and daily air temperature. The temperature-mortality relationship well manifests in three temperature measures, but with varied temperature thresholds for different age groups and mortality categories. Two heat waves and one cold spell were identified in 2003 and brought out excess mortality. The first heat wave lasting for 19 days had a significant impact on total non-accidental, cardiovascular and respiratory deaths compared to the corresponding reference period. The second heat wave lasting for 14 days have resulted in excess mortality in three categories of mortality but without statistical significance. The cold spell lasting for 7 days only had a significant impact on total non-accidental and cardiovascular mortality. We also found the elderly are more sensitive to temperature variation. Our results suggest that air temperature is a significant factor influencing human mortality, particularly for the elderly.
... Heat waves increase the number of emergency department visits by patients with pneumonia, influenza, bronchitis, emphysema, and chronic obstructive pulmonary disease (COPD) [1]. High temperatures are associated with more respiratory symptoms [2] and hospitalisations, especially in the elderly population [3]. ...
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Background Patients with respiratory diseases are vulnerable to the effects of heat. Therefore, it is important to develop adaptation strategies for heat exposure. One option is to optimise the indoor environment. To this end, we equipped hospital patient rooms with radiant cooling. We performed a prospective randomised clinical trial to investigate potentially beneficial effects of the hospitalisation in rooms with radiant cooling on patients with a respiratory disease exacerbation. Methods Recruitment took place in June, July, and August 2014 to 2016 in the Charité – Universitätsmedizin Berlin, Germany. We included patients with COPD, asthma, pulmonary hypertension, interstitial lung disease, and pneumonia. 62 patients were allocated to either a standard patient room without air conditioning or a room with radiant cooling set to 23 °C (73 °F). We analysed the patients’ length of stay with a Poisson regression. Physiological parameters, fluid intake, and daily step counts were tested with mixed regression models. Results Patients hospitalised in a room with radiant cooling were discharged earlier than patients in standard rooms (p=0.003). The study participants in chambers with radiant cooling had a lower body temperature (p=0.002), lower daily fluid intake (p<0.001), higher systolic blood pressure (p<0.001), and an increased daily step count (p<0.001). Conclusion The results indicate that a radiant cooling system in hospital patient rooms provides clinical benefits for patients with respiratory disease exacerbations during the warm summer months, which may contribute to an earlier mobilisation. Radiant cooling is commended as a suitable adaptation strategy to reduce the clinical impact of climate warming.
... 1,2 This paper focuses on 2 kinds of weather extremes: extreme summer heat and extreme winter weather, which have been associated with higher morbidity and mortality, especially among socially vulnerable groups. [2][3][4] Previous studies have documented several physical health impacts of these extremes, including increased cardiovascular events, exacerbated respiratory conditions, hospitalization, and death. [5][6][7][8][9][10] Though fewer in number, previous studies have also documented mental health impacts of these extremes including greater anxiety, depression, and psychiatric admission. ...
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Objective Weather extremes are increasing with climate change and associated with higher morbidity and mortality. Promotion of social connections is an emerging area of research and practice for risk reduction during weather extremes. This study examines the practice of checking on neighbors during extreme summer heat and extreme winter weather. Objectives are to (1) describe the extent of neighbor checking during these extremes, and (2) examine factors associated with neighbor checking. Methods We analyze survey data (n = 442) from a primarily low- and moderate- income study sample in a Southeastern U.S. city, using descriptive statistics and logistic regression. Results About 17.6% of participants checked on neighbors during extreme summer heat, and 25.2% did so during extreme winter weather. Being middle or older aged and having more adverse physical health impacts were positively associated with neighbor checking, for both extremes. For winter only, having less education was positively associated with neighbor checking. Conclusions Community-based partnerships for reducing risk during weather extremes may consider people who are older or have experienced their own adverse health impacts as initial target groups for promoting neighbor checking. Future research should also examine the motivations for, details about, and impacts of neighbor checking in greater depth.
... There is consensus among the global scientific community that climate change is increasing the frequency of extreme weather events [1]. Among the various extreme weather events, a heat wave may not be visually spectacular, but it will not only increase energy consumption but also (perhaps most concerning of all) exact direct effects on human health [2][3][4][5][6]. Generally, heat waves are described as a period of prolonged abnormally hot weather generally with or without high humidity. ...
Article
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As a result of global climate change, the frequency and intensity of heat waves have increased significantly. According to the World Meteorological Organization (WMO), extreme temperatures in southwestern Pakistan have exceeded 54 °C in successive years. The identification and assessment of heat-health vulnerability (HHV) are important for controlling heat-related diseases and mortality. At present, heat waves have many definitions. To better describe the heat wave mortality risk, we redefine the heat wave by regarding the most frequent temperature (MFT) as the minimum temperature threshold for HHV for the first time. In addition, different indicators that serve as relevant evaluation factors of exposure, sensitivity and adaptability are selected to conduct a kilometre-level HHV assessment. The hesitant analytic hierarchy process (H-AHP) method is used to evaluate each index weight. Finally, we incorporate the weights into the data layers to establish the final HHV assessment model. The vulnerability in the study area is divided into five levels, high, middle-high, medium, middle-low and low, with proportions of 3.06%, 46.55%, 41.85%, 8.53% and 0%, respectively. Health facilities and urbanization were found to provide advantages for vulnerability reduction. Our study improved the resolution to describe the spatial heterogeneity of HHV, which provided a reference for more detailed model construction. It can help local government formulate more targeted control measures to reduce morbidity and mortality during heat waves.
... 139 In addition to increased mortality, decreased and increased temperatures resulting from climate change are predicted to boost demand for medical services. This has been reported for developed 140,141 and developing countries. 142 In the latter case, a study in China reported that, in 2011-2014, North-South variations in effect of temperature on admissions to emergency departments were observed, but admissions were greater at temperatures below the average than at temperatures above average. ...
Article
The composition of the air we breathe is determined by emissions, weather, and photochemical transformations induced by solar UV radiation. Photochemical reactions of many emitted chemical compounds can generate important (secondary) pollutants including ground-level ozone (O 3 ) and some particulate matter, known to be detrimental to human health and ecosystems. Poor air quality is the major environmental cause of premature deaths globally, and even a small decrease in air quality can translate into a large increase in the number of deaths. In many regions of the globe, changes in emissions of pollutants have caused significant changes in air quality. Short-term variability in the weather as well as long-term climatic trends can affect ground-level pollution through several mechanisms. These include large-scale changes in the transport of O 3 from the stratosphere to the troposphere, winds, clouds, and patterns of precipitation. Long-term trends in UV radiation, particularly related to the depletion and recovery of stratospheric ozone, are also expected to result in changes in air quality as well as the self-cleaning capacity of the global atmosphere. The increased use of substitutes for ozone-depleting substances, in response to the Montreal Protocol, does not currently pose a significant risk to the environment. This includes both the direct emissions of substitutes during use and their atmospheric degradation products (e.g. trifluoroacetic acid, TFA).
... Previous studies have reported that heat exposure could increase the risk of disease or death in vulnerable populations (Johnson & Wilson, 2009;White-Newsome et al., 2012). In addition, exposure to heat is closely related to increased mortality, incidence of accidents or injuries, and various diseases in the general population (Fuhrmann et al., 2016;Lin et al., 2009). ...
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Many studies have shown that heat waves can cause both death and disease. Considering the adverse health effects of heat waves on vulnerable groups, this study highlights their impact on workers. The present study thus investigated the association between heat exposure and the likelihood of hospitalization and death, and further identified the risk of heat‐related diseases or death according to types of heat and dose‐response modeling with heat threshold. Workers were selected from the Korean National Health Insurance Service‐National Sample Cohort 2002–2015, and regional data measured by the Korea Meteorological Administration were used for weather information. The relationship between hospitalization attributable to disease and weather variables was analyzed by applying a generalized additional model. Using the Akaike information criterion, we selected a model that presented the optimal threshold. Maximum daily temperature (MaxT) was associated with an increased risk of death and outdoor mortality. The association between death outdoors and MaxT had a threshold of 31.2°C with a day zero lag effect. History of medical facility visits due to the health effects of heat waves was evident in certain infectious and parasitic diseases (A and B), cardio and cerebrovascular diseases (I20–25 and I60–69), injury, poisoning, and other consequences of external causes (S, T). The study demonstrated that heat exposure is a risk factor for death and infectious, cardio‐cerebrovascular, and genitourinary diseases, as well as injuries or accidents among workers. The finding that heat exposure affects workers' health has future implications for decision makers and researchers.
... In the Northeast, three studies in North Carolina (Fuhrmann, Sugg, Konrad, & Waller, 2016;Lippmann, Fuhrmann, Waller, & Richardson, 2013;Rhea, Ising, Fleischauer, Deyneka, Vaughn- Batten, & Waller, 2012). Two studies were in New York, NY, (Centers for Disease Control and Prevention [CDC], 2013;Sheffield, Herrera, Kinnee, & Clougherty, 2018). ...
Article
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High ambient temperatures, extreme heat events (EHEs), or heat waves due to rising global temperatures from climate change have a dire impact on health outcomes. The aim of this review is to examine the literature addressing the impact of heat-related illnesses due to EHE on emergency department visit rates or costs in the United States.
Article
Background In addition to mortality data, hospital admission, emergency department visits, and emergency service calls data are used for the surveillance of heat-related morbidity. We report on heat-associated morbidity in Frankfurt am Main from 2014–2018 using the web-based care capacity proof system (IVENA) of the rescue service operations. Material and methods In the web-based IVENA system, all patients with prehospital emergency care are recorded in real time. The rescue service operations were evaluated in the summer months (June–August) from 2014–2018 in Frankfurt am Main as a whole and separately according to various heat-related diagnoses. The current temperature data of the Frankfurt East measuring station were obtained online as hourly values from the website of the Hessian Institute for Nature Conservation, Environment and Geology (www.hlnug.de). Temperature maxima ≥32 ℃ for at least 5 days were defined as a “heatwave.” Results From 2014–2018, three heatwaves occurred according to the definition above: in 2015, 2016, and 2018, with an extremely long heat period in 2018 (17 days). During the heatwave in 2015, the highest excess morbidity was noted: +17% total ambulance service operations and +198% emergency service operations due to heat-related disease disorders. The evaluation of the long heat period in 2018 showed that with increasing duration of the heat period, the emergency rescue service operations due to total heat-associated morbidity remained high with increasing emergency service operations due to exsiccosis and unclear fever. Conclusion The data obtained by the IVENA system enable a current and complete assessment of severe acute diseases in the city or in the respective rescue service area in real time. Health effects of heat events can thus be investigated in real time and the system can be used as an early warning system for prevention.
Article
Background: With climate change, mean annual air temperatures are getting hotter and extreme weather events will become more and more common in most parts of the world. Objectives: As part of the EU funded project HEAT-SHIELD we conducted a systematic review to summarize the epidemiological evidence of the effects of global warming-related heat exposure on workers' health and productivity. Methods: Three separate searches, focused, respectively, on: i) heat-related illness (HRI), cardiovascular, respiratory and kidney diseases; ii) traumatic injuries; and iii) vector-borne diseases or vectors distribution, were conducted in PubMed. EMBASE was also consulted to retrieve relevant studies focused on the health effects of climate change. A fourth search strategy to assess the effects on work productivity was conducted both in PubMed and in the SCOPUS database. Results: A significant proportion of studies reported findings regarding the Mesoamerican nephropathy issue. This is a disease occurring especially among young and middle-aged male sugarcane workers, without conventional risk factors for chronic kidney disease. For injuries, there is a reversed U-shaped exposure-response relationship between Tmax and overall daily injury claims. Outdoor workers are at increased risk of vector-borne infectious diseases, as a positive correlation between higher air temperatures and current or future expansion of the habitat of vectors is being observed. As for productivity, agriculture and construction are the most studied sectors; a day with temperatures exceeding 32°C can reduce daily labour supply in exposed sectors by up to 14%. Conclusions: The present findings should inform development of further research and related health policies in the EU and beyond with regard to protecting working people from the effects of workplace heat during climate change.
Chapter
Exertional heat illness (EHI) is a cause for concern in athletic, military, occupational, and recreational settings where individuals are participating in physical activity, especially in hot environmental conditions. EHI includes a spectrum of medical conditions that range from non-life-threatening, such as heat syncope, to potentially fatal in the case of exertional heat stroke. Given the severity of the latter condition, it is prudent for clinicians providing medical care in the aforementioned settings to develop evidence-based protocols for the prevention, recognition, treatment and return to activity for each of the medical conditions falling under the classification of EHI. The aim of this chapter is to provide an overview of the classification and nomenclature of EHI, particularly the specific conditions contained within this general domain. We will discuss the current incidence and epidemiology of EHI to provide additional context surrounding the content covered within this text.
Article
Background Health disparities exist between urban and rural populations, yet research on rural-urban disparities in temperature-mortality relationships is limited. As inequality in the United States increases, understanding urban-rural and regional differences in temperature-mortality association is crucial. Objective We examined regional and urban-rural difference of the temperature-mortality association in North Carolina (NC), USA, and investigated potential effect modifiers. Methods We applied time-series models allowing nonlinear temperature-mortality associations for 17 years (2000–2016) to generate heat and cold county-specific estimates. We used second-stage analysis to quantify the overall effects. We also explored potential effect modifiers (e.g. social associations, greenness) using stratified analysis. Analysis considered relative effects (comparing risks at 99th to 90th temperature percentiles based on county-specific temperature distributions for heat, and 1st to 10th percentiles for cold) and absolute effects (comparing risks at specific temperatures). Results We found null effects for heat-related mortality (relative effect: 1.001 (95% CI: 0.995–1.007)). Overall cold-mortality risk for relative effects was 1.019 (1.015–1.023). All three regions had statistically significant cold-related mortality risks for relative and absolute effects (relative effect: 1.019 (1.010–1.027) for Coastal Plains, 1.021 (1.015–1.027) for Piedmont, 1.014 (1.006–1.023) for Mountains). The heat mortality risk was not statistically significant, whereas the cold mortality risk was statistically significant, showing higher cold-mortality risks in urban areas than rural areas (relative effect for heat: 1.006 (0.997–1.016) for urban, 1.002 (0.988–1.017) for rural areas; relative effect for cold: 1.023 (1.017–1.030) for urban, 1.012 (1.001–1.023) for rural areas). Findings are suggestive of higher relative cold risks in counties with less social association, higher population density, less green-space, higher PM2.5, lower education level, higher residential segregation, higher income inequality, and higher income (e.g., Ratio of Relative Risks 1.72 (0.68, 4.35) comparing low to high education). Conclusion Results indicate cold-mortality risks in NC, with potential differences by regional, urban-rural areas, and community characteristics.
Article
The most recent extreme heat recorded in Europe re-alerts the world to the threat of heat stress. Future extreme heat events are reported to be more frequent, long-lasting, and intense. The intense exposure to hot temperatures can cause an excess of heat-related deaths, leading to an increasing risk of heat-related health. In reducing Heat Health Risk (HHR), the use of fine-scale evidence-based mapping of heat-related health risk index (HHRI) and its underlying contributors is essential for policy-making and site-specific action plans. However, its use is still considered to be at an early stage, especially in high-density cities like Hong Kong. This study conducted a spatially explicit assessment of HHR in Hong Kong and constructed a HHRI based on indicators categorized through Principle Component Analysis (PCA) into four meaningful components representing social/language, social isolation, socioeconomic, and urbanization/environmental risks. The applicability of the index was validated against heat-related mortality data at the community level. The community-level maps of HHRI and its subcomponents revealed that portions of Kowloon Peninsula had always suffered exceptionally high HHR ten years ago and after, but the hot spots and problematic communities experienced displacement and the dominant underlying factors of their HHR also varied. Results also showed that HHRI correlated fairly well with the heat-related deaths ratio (R2 = 0.60) at the community level for most of Hong Kong (62.33% of all communities that contain 81.69% of total population). Our analysis results helped generate an evidence-based index to assess HHR in high-density cities like Hong Kong and provided fine-scale maps of the index and its subcomponents, with the aim of benefiting site-specific policy making and optimizing the existing action plans.
Article
The adverse influences of climate change are manifesting as health burdens relevant to clinical practice, affecting the very underpinnings of health and stressing the health care system. Emergency medicine is likely to bear a large burden, with its focus on urgent and emergency care, through its role as a safety-net provider for vulnerable populations and as a leader in disaster medicine. Clinically, climate change is affecting emergency medicine practice through the amplification of climate-related disease patterns and epidemiologic shifts for conditions diagnosed and treated in emergency departments (EDs), especially for vulnerable populations. In addition, climate-driven intensification of extreme weather is disrupting health care delivery in EDs and health care systems. Thus, there are significant opportunities for emergency medicine to lead the medical response to climate change through 7 key areas: clinical practice improvements, building resilient EDs and health care systems, adaptation and public health engagement, disaster preparedness, mitigation, research, and education. In the face of this growing health threat, systemwide preparation rooted in local leadership and responsiveness is necessary to efficiently and effectively care for our vulnerable communities.
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Compared with mortality, the impact of weather and climate on human morbidity is less well understood, especially in the cold season. We examined the relationships between weather and emergency department (ED) visitation at hospitals in Roanoke and Charlottesville, Virginia, two locations with similar climates and population demographic profiles. Using patient-level data obtained from electronic medical records, each patient who visited the ED was linked to that day’s weather from one of 8 weather stations in the region based on each patient’s ZIP code of residence. The resulting 2010–2017 daily ED visit time series were examined using a distributed lag non-linear model to account for the concurrent and lagged effects of weather. Total ED visits were modeled separately for each location along with subsets based on gender, race, and age. The relationship between the relative risk of ED visitation and temperature or apparent temperature over lags of one week was positive and approximately linear at both locations. The relative risk increased about 5% on warm, humid days in both cities (lag 0 or lag 1). Cold conditions had a protective effect, with up to a 15% decline on cold days, but ED visits increased by 4% from 2–5 days after the cold event. The effect of thermal extremes tended to be larger for non-whites and the elderly, and there was some evidence of a greater lagged response for non-whites in Roanoke. Females in Roanoke were more impacted by winter cold conditions than males, who were more likely to show a lagged response at high temperatures. In Charlottesville, males sought ED attention at lower temperatures than did females. The similarities in the ED response patterns between these two hospitals suggest that certain aspects of the response may be generalizable to other locations that have similar climates and demographic profiles.
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Quantifying the dynamical linkage, co‐evolution, and propagation of regional heatwaves is essential to minimize socio‐economic losses. Here, we investigate such network structure and propagation characteristics for warm period (May‐September) heatwaves over Conterminous United States (CONUS) using a Complex Network (CN) approach based on daily maximum temperature. The concept of Event Synchronization (ES) is applied to identify the source and sink regions primarily responsible for heatwave propagations and the strength of association between these regions. The network coefficients are derived to evaluate the extremal dependence, co‐evolution, and spatial propagation of large scale HW events. The topology and propagation of heatwaves are influenced by the spatial distribution of the zonal and meridional air mass transport. Furthermore, we demonstrated the application of ES metrics and the network coefficients for heatwave days prediction between source and sink regions with true positive rate of 63% at a lead time of 2 days.
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Objective Evidence on the relationship between ambient temperature and morbidity of different stroke subtypes in China is limited. This study aimed to assess the influence of ambient temperature on stroke risk in Shenzhen, China. Methods From 1 January 2003 to 31 December 2014, 114 552 stroke cases in Shenzhen were collected. A generalised additive model with quasi-Poisson regression combined with a distributed lag non-linear model was applied to evaluate the temperature effects on stroke subtypes. Furthermore, this study explored the variability of the effects across sex, age and education. Results The immediate heat effects on ischaemic stroke (IS) and the persistent effects of ambient temperature on intracerebral haemorrhage (ICH) were significant. Overall, the cold-related relative risks (RRs) of IS, ICH and subarachnoid haemorrhage (SAH) were 1.02 (0.97–1.07), 1.16 (1.04–1.30) and 1.12 (0.61–2.04), whereas the heat-related RRs were 1.00 (0.97–1.04), 0.80 (0.73–0.88) and 1.05 (0.63–1.78), respectively. For IS, a weakly beneficial cold effect was found among men while a detrimental heat effect among both men and women, the elderly and higher-educated population at lag0. However, regarding ICH, the temperature effects in men, the young and higher-educated population are stronger at lag0–4, lag0–7 as cold reveals threat and heat reveals protection. Conclusion Responses of diverse stroke subtypes to ambient temperature varied. Effective measures should be taken to increase public awareness about the effects of ambient temperature on stroke attack and to educate the public about self-protection.
Article
Background The health impacts of heatwaves are a growing public health concern with the frequency, intensity, and duration of heatwaves increasing with global climate change. However, little is known about the healthcare costs and the attributable morbidity associated with heatwaves Objective This study aims to examine the relationship between heatwaves and costs of emergency department (ED) presentations, and to quantify heat-attributable burden during the warm seasons of 2014-2017, in Adelaide, South Australia. Methods Daily data on ED presentations and associated costs for the period 2014-2017 were obtained from the South Australian Department of Health and Wellbeing. Heatwave intensity was determined using the excess heat factor (EHF) index, obtained from the Australian Bureau of Meteorology. A distributed lag non-linear model (DLNM) was used to quantify the cumulative risk of heatwave-intensity over a lag of 0-7 days on ED presentations and costs. Effects of heatwaves were estimated relative to no heatwave. The number of ED presentations and costs attributable to heatwaves was calculated separately for two EHF severity categories (low-intensity and severe/extreme heatwaves). Subgroup analyses by disease-diagnosis groups and age categories were performed. Results For most disease diagnosis and age categories, low-intensity and severe heatwaves were associated with higher rates of ED presentations and costs. We estimated a total of 1,161 (95% empirical confidence interval (eCI): 342, 1,944) heatwave-attributable all-cause ED presentations and associated healthcare costs (thousands) of AU$1,020.3 (95% eCI: 224.9, 1,804.7) during the warm seasons of 2014-2017. The heat-related illness was the disease category contributing most to ED presentations and costs. Age groups 0-14 and ≥ 65 years were most susceptible to heat. Conclusions Heatwaves produced a statistically significant case-load and cost burden to the ED. Developing tailored interventions for the most vulnerable populations may help reduce the health impacts of heatwaves and to minimise the cost burden to the healthcare system.
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Heatstroke is a serious heat-related illness that can even cause death. Heat alert systems play an important role in reducing the number of patients experiencing heat illness, as they encourage preventive actions such as the use of air conditioning, hydration, or other strategies. However, to date, the Japanese hazard classification has not considered seasonal and regional variations, despite clear differences in meteorological conditions across different regions in Japan. Moreover, several studies have reported a difference in thermoregulation between older and younger adults, implying that the hazard classification should also consider age differences. This study examined the relationship between the number of ambulance dispatches related to heat illness (ADRHI) and the Japanese heat hazard classification from 2010 to 2019, focusing on monthly and regional differences. Data from 47 prefectures during the 10-year period were collected and analyzed. ADRHI and wet bulb globe temperature (WBGT) data were collected from Japan's Ministry of Internal Affairs and Communications and the Ministry of the Environment Heat Illness Prevention Information website, respectively. The findings showed a significant relationship between ADRHI and WBGTmax (p < 0.05, r = 0.74). ADRHI per 100,000 people showed significant differences across months. The post hoc test detected the first steep increase in ADRHI at a WBGTmax of 23°C than at 22°C in June, and at a WBGTmax of 26°C, 27°C, and 25°C in July, August, and September, respectively. Moreover, the first significant increase in ADRHI per 100,000 people at WBGTmax differed across each region, at a WBGTmax of 24°C in Hokkaido-Tohoku, 25°C in Kanto, Kansai, and Chugoku, 26°C in Chubu, 27°C in Shikoku, and 28°C in Kyushu-Okinawa. Further, Poisson regression analysis revealed that the relative risks differed across each region and month. These results imply that the hazard classification should be adjusted according to region and month in Japan.
Article
Extreme heat is a leading cause of weather-related human mortality throughout much of the world, posing a significantly heavy burden on the development of healthy and sustainable cities. To effectively reduce heat health risk, a better understanding of where and what risk factors should be targeted for intervention is necessary. However, little research has examined how different risk factors for heat-related mortality operate at varying spatial scales. Here, we present a novel application of the multiscale geographically weighted regression (GWR) approach to explore the scale of effect of each underlying risk factor using Hong Kong as a case study. We find that a hybrid of global and local processes via multiscale GWR yields a better fit of heat-related mortality risk than models using GWR and ordinary least squares (OLS) approaches. Predictor variables are categorized by the scale of effect into global variables (i.e., age and education attainment, socioeconomic status), intermediate variables (i.e., work place, birth place and language), and local variables (i.e., thermal environment, low income). These findings enrich our understanding of the spatial scale-dependent risk factors for heat-related mortality and shed light on the importance of hierarchical policy-making and site-specific planning processes in effective heat hazard mitigation and climate adaptation strategies.
Article
Currently, the world has a population nearing eight billion people, with projections for nearly 10 billion by 2050. Many questions and concerns persist regarding how we will manage limited resources and take care of humanity, all while not further degrading the natural environment. In 2015, world leaders came together at the United Nations General Assembly and reached agreement on 17 Sustainable Development Goals (SDGs) for moving forward on tackling the complex challenges facing the world. Each of the lofty goals has a focus on improving the health and wellbeing of citizens around the world, while pursuing a more equitable distribution of resources to include: ending poverty in all forms; eliminating hunger and food insecurity through sustainable agricultural practices; reducing social inequities (education, gender, racial, occupational, etc.); and addressing environmental concerns (land, water, consumption/production) associated with climate change, among others. Each of these 17 SDGs have direct impacts with western North Carolina and the Appalachia region as a whole and provide direction moving forward. In this paper, I examine what the terms ‘sustainable’ and ‘health’ mean for the 21st century, the numerous connections between sustainability and human health, and the short-term and long-term challenges facing western North Carolina and the Appalachia region, which are intricately connected to sustainability and health. Lastly, I present principles and approaches from the fields of sustainable development, community development, and public health, which are grounded in the SDGs, that communities should seek to utilize in moving forward in the 21st century.
Article
Background Research on temperature and respiratory hospitalizations is lacking in the southeastern U.S. where cold weather is relatively rare. This retrospective study examined the association between cold waves and pneumonia and influenza (P&I) emergency department (ED) visits and hospitalizations in three metro-Atlanta hospitals. Methods We used a case-crossover design, restricting data to the cooler seasons of 2009–2019, to determine whether cold waves influenced ED visits and hospitalizations. This analysis considered effects by race/ethnicity, age, sex, and severity of comorbidities. We used generalized additive models and distributed lag non-linear models to examine these relationships over a 21-day lag period. Results The odds of a P&I ED visit approximately one week after a cold wave were increased by as much as 11%, and odds of an ED visit resulting in hospitalization increased by 8%. For ED visits on days with minimum temperatures >20 °C, there was an increase of 10–15% in relative risk (RR) for short lags (0–2 days), and a slight decrease in RR (0–5%) one week later. For minimum temperatures <0 °C, RR decreased at short lags (5–10%) before increasing (1–5%) one week later. Hospital admissions exhibited a similar, but muted, pattern. Conclusion Unusually cold weather influenced P&I ED visits and admissions in this population.
Article
Background: Latino/a workers may experience higher fatal occupational injury rates than non-Latino/a workers. In North Carolina, the Latino/a population more than doubled between 2000 and 2017. We examined fatal occupational injuries among Latino/a and non-Latino/a workers in North Carolina over this period. Methods: Information on fatal occupational injuries was abstracted from records of the North Carolina Office of the Chief Medical Examiner and the death certificate records held by the North Carolina Office of Vital Records. Estimates of the working population were derived from the decennial census and American Community Survey. Estimates of annual rates of fatal occupational injury for the period January 1, 2000 to December 31, 2017 were derived for Latino/a workers and compared to Black and White workers not identified as Latino/a. Results: Over the study period, 1,783 fatal occupational injuries were identified among non-Latino/a workers and 259 fatal occupational injuries among Latino/a workers in North Carolina. The majority of fatal occupational injuries among Latino/a workers occurred among males employed in construction and agriculture. While the fatal occupational injury rate among Latino/a workers declined over the study period, the rate among Latino/a workers was higher than among non-Latino/a White and Black workers; moreover, fatal occupational injury rates for Latino/a workers trended upwards during the most recent years of the study period. Conclusions: Latino/a workers in North Carolina have the highest fatal occupational injury rate of any race/ethnicity group.
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Heatwaves are durations of relatively extreme high temperatures. The literature presents multiple methods and criteria of identifying heatwaves based on Temperature exceedance parameter, and a duration parameter. All these presented criteria when applied result in different characteristics measures of heatwaves. Heatwaves are usually studied to identify their impact on one of the affected sectors (Human health, Energy consumption, Ecological conditions, urban air quality, environmental conditions, and any other sector that might be impacted). However, the literature provides little assistance in selecting which criteria to use for which purpose. In this work the idea of using different criterion based on the impacted sector being studied was introduced, we also defined a best fit heatwave criterion to assess the impact of heatwaves on human health based on the existing literature. We then use this criterion to identify heatwaves in 13 stations in Jordan and study the spatial, temporal, and spatiotemporal distributions and development of these heatwaves throughout the study duration (1970-2005). The result of the study shows a dramatic increase in heatwaves characteristics across Jordan. The area subjected to the highest change was the Jordanian capital (Amman), with an increase of 7 folds in number of heatwave days per year, 3 folds in number of heatwaves per year, and a 10% increase in the average temperature in the yearly maximum heatwave. The trends showed no signs of slowing down in the heatwaves’ characteristic change. When projected Amman is expected to have 41 heatwave days and 9.8 heatwaves per year by 2050.
Article
Heat waves can provide detrimental impacts on human society and the environmental system, and thus have received substantial attention in scientific research. Since heat waves are relevant to a wide range of stakeholders, definitions for heat wave events vary in terms of threshold values, durations, and utilized variables. While there is a value in this diversity of perspectives, the various definitions often complicate the assessment of heat wave risk, thereby underscoring the improved utility of a unified definition. In this study, we examine the interannual variability of heat wave patterns by using a proposed copula-based framework. From five observed temperature-related variables, this study first evaluates the individual changes of fifteen previously published heat wave indices focused on heat wave events across the Korean Peninsula for the last 49 years (1973–2021). We then extract the integrated signals to understand the overall trend patterns using the multiple heat wave indices. Results indicate that different heat wave definitions present distinctive attributes (e.g., in the magnitude of temporal changes) depending on the locations, implying that the diversity of heat wave definitions leads to potentially inconsistent conclusions. Using the integrated analysis, we identify that the expected heat wave day has increased across the majority of the regions in the Korean Peninsula. To be specific, substantial increases are shown in North Korea, while rapid increases in heat wave events have been observed after the year 2010 over South Korea. Finally, through the sensitivity analysis, we demonstrate the importance of choosing the heat wave definition in the integrated analysis.
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Background: Exposure to extreme temperatures is associated with increased emergency department (ED) presentations. The resulting burden on health service costs and the potential impact of climate change is largely unknown. This study examines the temperature-EDs/cost relationships in Adelaide, South Australia and how this may be impacted by increasing temperatures. Methods: A time series analysis using a distributed lag nonlinear model was used to explore the exposure-response relationships. The net-attributable, cold-attributable and heat-attributable ED presentations for temperature-related diseases and costs were calculated for the baseline (2014-2017) and future periods (2034-2037 and 2054-2057) under three climate representative concentration pathways (RCPs). Results: The baseline heat-attributable ED presentations were estimated to be 3600 (95% empirical CI (eCI) 700 to 6500) with associated cost of $A4.7 million (95% eCI 1.8 to 7.5). Heat-attributable ED presentations and costs were projected to increase during 2030s and 2050s with no change in the cold-attributable burden. Under RCP8.5 and population growth, the increase in heat-attributable burden would be 1.9% (95% eCI 0.8% to 3.0%) for ED presentations and 2.5% (95% eCI 1.3% to 3.7%) for ED costs during 2030s. Under the same conditions, the heat effect is expected to increase by 3.7% (95% eCI 1.7% to 5.6%) for ED presentations and 5.0% (95% eCI 2.6% to 7.1%) for ED costs during 2050s. Conclusions: Projected climate change is likely to increase heat-attributable emergency presentations and the associated costs in Adelaide. Planning health service resources to meet these changes will be necessary as part of broader risk mitigation strategies and public health adaptation actions.
Article
Background: Extreme-heat events are increasing as a result of climate change. Prior studies, typically limited to urban settings, suggest an association between extreme heat and cardiovascular mortality. However, the extent of the burden of cardiovascular deaths associated with extreme heat across the United States and in different age, sex, or race and ethnicity subgroups is unclear. Methods: County-level daily maximum heat index levels for all counties in the contiguous United States in summer months (May-September) and monthly cardiovascular mortality rates for adults ≥20 years of age were obtained. For each county, an extreme-heat day was identified if the maximum heat index was ≥90 °F (32.2 °C) and in the 99th percentile of the maximum heat index in the baseline period (1979-2007) for that day. Spatial empirical Bayes smoothed monthly cardiovascular mortality rates from 2008 to 2017 were the primary outcome. A Poisson fixed-effects regression model was estimated with the monthly number of extreme-heat days as the independent variable of interest. The model included time-fixed effects and time-varying environmental, economic, demographic, and health care-related variables. Results: Across 3108 counties, from 2008 to 2017, each additional extreme-heat day was associated with a 0.12% (95% CI, 0.04%-0.21%; P=0.004) higher monthly cardiovascular mortality rate. Extreme heat was associated with an estimated 5958 (95% CI, 1847-10 069) additional deaths resulting from cardiovascular disease over the study period. In subgroup analyses, extreme heat was associated with a greater relative increase in mortality rates among men compared with women (0.20% [95% CI, 0.07%-0.33%]) and non-Hispanic Black compared with non-Hispanic White adults (0.19% [95% CI, 0.01%-0.37%]). There was a greater absolute increase among elderly adults compared with nonelderly adults (16.6 [95% CI, 14.6-31.8] additional deaths per 10 million individuals per month). Conclusions: Extreme-heat days were associated with higher adult cardiovascular mortality rates in the contiguous United States between 2008 and 2017. This association was heterogeneous among age, sex, race, and ethnicity subgroups. As extreme-heat events increase, the burden of cardiovascular mortality may continue to increase, and the disparities between demographic subgroups may widen.
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Introduction: Researchers expect climate change to alter human health in important ways, with significant regional variations. This change has the potential to affect human health in many ways. Aim: To systematically review relevant literature in relation to the effect of climatic variables on cardiopulmonary function as an emerging health challenge. Materials and Methods: The present systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words “environment”, “weather”, “chronic obstructive pulmonary disease”, climate change” were used in combination with the Boolean operators “OR” and “AND”. We did electronic searches on PubMed, Science Direct, Springer Link and Google Scholar. The search was conducted with publication year limitation between January 2006 to June 2016. Results: A total of 1021 articles were extracted and 13 articles were selected for final review, based on the objective of the study. Results suggested that climate changes are not only an environmental and economic problem but also play a role in population health. Climate change parameters like temperature, humidity and air pollution can affect cardiopulmonary health. Conclusion: The study shows the effect of climate change on cardiopulmonary health, and identifies it as an emerging phenomenon that needs effective planning for emerging and reemerging concerns.
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This study examines the health impacts of recent heat waves statewide and for six subregions of California: the north and south coasts, the Central Valley, the Mojave Desert, southern deserts, and northern forests. By using canonical correlation analysis applied to daily maximum temperatures and morbidity data in the form of unscheduled hospitalizations from 1999 to 2009, 19 heat waves spanning 3-15 days in duration that had a significant impact on health were identified. On average, hospital admissions were found to increase by 7% on the peak heat-wave day, with a significant impact seen for several disease categories, including cardiovascular disease, respiratory disease, dehydration, acute renal failure, heat illness, and mental health. Statewide, there were 11 000 excess hospitalizations that were due to extreme heat over the period, yet the majority of impactful events were not accompanied by a heat advisory or warning from the National Weather Service. On a regional basis, the strongest health impacts are seen in the Central Valley and the north and south coasts. The north coast contributes disproportionately to the statewide health impact during heat waves, with a 10.5% increase in daily morbidity at heat-wave peak as compared with 8.1% for the Central Valley and 5.6% for the south coast. The temperature threshold at which an impact is seen varies by subregion and timing within the season. These results suggest that heat-warning criteria should consider local percentile thresholds to account for acclimation to local climatological conditions as well as the seasonal timing of a forecast heat wave.
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Background: Patients with acute heat illness present primarily to emergency departments (EDs), yet little is known regarding these visits. Objective: We aimed to describe acute heat illness visits to U.S. EDs from 2006 through 2010 and identify factors associated with hospital admission or with death in the ED. Methods: We extracted ED case-level data from the Nationwide Emergency Department Sample (NEDS) for 2006-2010, defining cases as ED visits from May through September with any heat illness diagnosis (ICD-9-CM 992.0-992.9). We correlated visit rates and temperature anomalies, analyzed demographics and ED disposition, identified risk factors for adverse outcomes, and examined ED case fatality rates (CFR). Results: There were 326,497 (95% CI: 308,372, 344,658) cases, with 287,875 (88.2%) treated and released, 38,392 (11.8%) admitted, and 230 (0.07%) died in the ED. Heat illness diagnoses were first-listed in 68%. 74.7% had heat exhaustion, 5.4% heat stroke. Visit rates were highly correlated with annual temperature anomalies (Pearson correlation coefficient 0.882, p = 0.005). Treat-and-release rates were highest for younger adults (26.2/100,000/year), whereas hospitalization and death-in-the-ED rates were highest for older adults (6.7 and 0.03/100,000/year, respectively); all rates were highest in rural areas. Heat stroke had an ED CFR of 99.4/10,000 (95% CI: 78.7, 120.1) visits and was diagnosed in 77.0% of deaths. Adjusted odds of hospital admission or death in the ED were higher among elders, males, urban and low-income residents, and those with chronic conditions. Conclusions: Heat illness presented to the ED frequently, with highest rates in rural areas. Case definitions should include all diagnoses. Visit rates were correlated with temperature anomalies. Heat stroke had a high ED CFR. Males, elders, and the chronically ill were at greatest risk of admission or death in the ED. Chronic disease burden exponentially increased this risk.
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In this study we characterized the relationship between temperature and mortality in central Arizona desert cities that have an extremely hot climate. Relationships between daily maximum apparent temperature (ATmax) and mortality for eight condition-specific causes and all-cause deaths were modeled for all residents and separately for males and females ages <65 and ≥65 during the months May-October for years 2000-2008. The most robust relationship was between ATmax on day of death and mortality from direct exposure to high environmental heat. For this condition-specific cause of death, the heat thresholds in all gender and age groups (ATmax = 90-97 °F; 32.2‒36.1 °C) were below local median seasonal temperatures in the study period (ATmax = 99.5 °F; 37.5 °C). Heat threshold was defined as ATmax at which the mortality ratio begins an exponential upward trend. Thresholds were identified in younger and older females for cardiac disease/stroke mortality (ATmax = 106 and 108 °F; 41.1 and 42.2 °C) with a one-day lag. Thresholds were also identified for mortality from respiratory diseases in older people (ATmax = 109 °F; 42.8 °C) and for all-cause mortality in females (ATmax = 107 °F; 41.7 °C) and males <65 years (ATmax = 102 °F; 38.9 °C). Heat-related mortality in a region that has already made some adaptations to predictable periods of extremely high temperatures suggests that more extensive and targeted heat-adaptation plans for climate change are needed in cities worldwide.
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There is an increasing awareness that heat is a major killer in many larger urban areas, and many municipalities have taken renewed interest in how they deal with oppressive heat. The implementation of sophisticated heat/health watch warning systems (HHWWS) is becoming more widespread, and these systems are becoming an important mechanism to save lives. One primary consideration in HHWWS development is the knowledge that response to heat varies through time and space. The more elaborate systems consider not only the intensity of heat, but the variability of the summer climate, which is closely related to urban population vulnerability. Thus, thresholds that induce negative health responses vary from one city to another, as well as over the season cycle at any one city. Warning system development involves a clear and consistent nomenclature (e.g. heat advisory, excessive heat warning), coordination between the agency issuing the warning and other stakeholders, public awareness of the system, targeted intervention procedures, and evaluation of effectiveness. This chapter describes these attributes in greater detail.
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Extreme heatwaves occurred in Adelaide, South Australia, in the summers of 2008 and 2009. Both heatwaves were unique in terms of their duration (15 days and 13 days respectively), and the 2009 heatwave was also remarkable in its intensity with a maximum temperature reaching 45.7 °C. It is of interest to compare the health impacts of these two unprecedented heatwaves with those of previous heatwaves in Adelaide. Using case-series analysis, daily morbidity and mortality rates during heatwaves (≥ 35 °C for three or more days) occurring in 2008 and 2009 and previous heatwaves occurring between 1993 and 2008 were compared with rates during all non-heatwave days (1 October to 31 March). Incidence rate ratios (IRRs) were established for ambulance call-outs, hospital admissions, emergency department presentations and mortality. Dose response effects of heatwave duration and intensity were examined. Ambulance call-outs during the extreme 2008 and 2009 events were increased by 10% and 16% respectively compared to 4.4% during previous heatwaves. Overall increases in hospital and emergency settings were marginal, except for emergency department presentations in 2008, but increases in specific health categories were observed. Renal morbidity in the elderly was increased during both heatwaves. During the 2009 heatwave, direct heat-related admissions increased up to 14-fold compared to a three-fold increase seen during the 2008 event and during previous heatwaves. In 2009, marked increases in ischaemic heart disease were seen in the 15-64 year age group. Only the 2009 heatwave was associated with considerable increases in total mortality that particularly affected the 15-64 year age group (1.37; 95% CI, 1.09, 1.71), while older age groups were unaffected. Significant dose-response relationships were observed for heatwave duration (ambulance, hospital and emergency setting) and intensity (ambulance and mortality). While only incremental increases in morbidity and mortality above previous findings occurred in 2008, health impacts of the 2009 heatwave stand out. These findings send a signal that the intense and long 2009 heatwave may have exceeded the capacity of the population to cope. It is important that risk factors contributing to the adverse health outcomes are investigated to further improve preventive strategies.
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We compared the ability of several heat-health warning systems to predict days of heat-associated mortality using common data sets. Heat-health warning systems initiate emergency public health interventions once forecasts have identified weather conditions to breach predetermined trigger levels. We examined 4 commonly used trigger-setting approaches: (1) synoptic classification, (2) epidemiologic assessment of the temperature-mortality relationship, (3) temperature-humidity index, and (4) physiologic classification. We applied each approach in Chicago, Illinois; London, United Kingdom; Madrid, Spain; and Montreal, Canada, to identify days expected to be associated with the highest heat-related mortality. We found little agreement across the approaches in which days were identified as most dangerous. In general, days identified by temperature-mortality assessment were associated with the highest excess mortality. Triggering of alert days and ultimately the initiation of emergency responses by a heat-health warning system varies significantly across approaches adopted to establish triggers.
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Because of the increasing concerns about climate change and deadly heatwaves in the past, the health effects of hot weather are fast becoming a global public health challenge for the 21st century. Some cities across the world have introduced public health protection measures, with the timely provision of appropriate home-based prevention advice to the general public being the most crucial point of intervention. In this Review, we report current epidemiological and physiological evidence about the range of health effects associated with hot weather, and draw attention to the interplay between climate factors, human susceptibility, and adaptation measures that contribute to heat burdens. We focus on the evidence base for the most commonly provided heat-protection advice, and make recommendations about the optimum clinical and public health practice that are expected to reduce health problems associated with current and future hot weather.
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This review examines recent evidence on mortality from elevated ambient temperature for studies published from January 2001 to December 2008. PubMed was used to search for the following keywords: temperature, apparent temperature, heat, heat index, and mortality. The search was limited to the English language and epidemiologic studies. Studies that reported mortality counts or excess deaths following heat waves were excluded so that the focus remained on general ambient temperature and mortality in a variety of locations. Studies focusing on cold temperature effects were also excluded. Thirty-six total studies were presented in three tables: 1) elevated ambient temperature and mortality; 2) air pollutants as confounders and/or effect modifiers of the elevated ambient temperature and mortality association; and 3) vulnerable subgroups of the elevated ambient temperature-mortality association. The evidence suggests that particulate matter with less than 10 um in aerodynamic diameter and ozone may confound the association, while ozone was an effect modifier in the warmer months in some locations. Nonetheless, the independent effect of temperature and mortality was withheld. Elevated temperature was associated with increased risk for those dying from cardiovascular, respiratory, cerebrovascular, and some specific cardiovascular diseases, such as ischemic heart disease, congestive heart failure, and myocardial infarction. Vulnerable subgroups also included: Black racial/ethnic group, women, those with lower socioeconomic status, and several age groups, particularly the elderly over 65 years of age as well as infants and young children. Many of these outcomes and vulnerable subgroups have only been identified in recent studies and varied by location and study population. Thus, region-specific policies, especially in urban areas, are vital to the mitigation of heat-related deaths.
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Climate models project that heat waves will increase in frequency and severity. Despite many studies of mortality from heat waves, few studies have examined morbidity. In this study we investigated whether any age or race/ethnicity groups experienced increased hospitalizations and emergency department (ED) visits overall or for selected illnesses during the 2006 California heat wave. We aggregated county-level hospitalizations and ED visits for all causes and for 10 cause groups into six geographic regions of California. We calculated excess morbidity and rate ratios (RRs) during the heat wave (15 July to 1 August 2006) and compared these data with those of a reference period (8-14 July and 12-22 August 2006). During the heat wave, 16,166 excess ED visits and 1,182 excess hospitalizations occurred statewide. ED visits for heat-related causes increased across the state [RR = 6.30; 95% confidence interval (CI), 5.67-7.01], especially in the Central Coast region, which includes San Francisco. Children (0-4 years of age) and the elderly (> or = 65 years of age) were at greatest risk. ED visits also showed significant increases for acute renal failure, cardiovascular diseases, diabetes, electrolyte imbalance, and nephritis. We observed significantly elevated RRs for hospitalizations for heat-related illnesses (RR = 10.15; 95% CI, 7.79-13.43), acute renal failure, electrolyte imbalance, and nephritis. The 2006 California heat wave had a substantial effect on morbidity, including regions with relatively modest temperatures. This suggests that population acclimatization and adaptive capacity influenced risk. By better understanding these impacts and population vulnerabilities, local communities can improve heat wave preparedness to cope with a globally warming future.
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We used medical examiner's records to identify heat-related fatalities (N=161) that occurred during the period January 1, 1977, to December 31, 2001, in North Carolina. Estimates of the population at risk were derived from US census data. Annual fatality rates increased with increases in average summer temperature and with the number of days per year at 90 degrees F or higher. Of the occupational heat-related fatalities (n=40), 45% occurred among farm laborers, many of whom died unnoticed and without medical attention.
Chapter
There is an increasing awareness that heat is a major killer in many larger urban areas, and many municipalities have taken renewed interest in how they deal with oppressive heat. The implementation of sophisticated heat/health watch warning systems (HHWWS) is becoming more widespread, and these systems are becoming an important mechanism to save lives. One primary consideration in HHWWS development is the knowledge that response to heat varies through time and space. The more elaborate systems consider not only the intensity of heat, but the variability of the summer climate, which is closely related to urban population vulnerability. Thus, thresholds that induce negative health responses vary from one city to another, as well as over the season cycle at any one city. Warning system development involves a clear and consistent nomenclature (e.g. heat advisory, excessive heat warning), coordination between the agency issuing the warning and other stakeholders, public awareness of the system, targeted intervention procedures, and evaluation of effectiveness. This chapter describes these attributes in greater detail.