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Case-crossover analysis of heat-coded deaths and vulnerable subpopulations: Oklahoma, 1990–2011

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Abstract

The extent of the association between temperature and heat-coded deaths, for which heat is the primary cause of death, remains largely unknown. We explored the association between temperature and heat-coded deaths and potential interactions with various demographic and environmental factors. A total of 335 heat-coded deaths that occurred in Oklahoma from 1990 through 2011 were identified using heat-related International Classification of Diseases codes, cause-of-death nomenclature, and narrative descriptions. Conditional logistic regression models examined the association between temperature and heat index on heat-coded deaths. Interaction by demographic factors (age, sex, marital status, living alone, outdoor/heavy labor occupations) and environmental factors (ozone, PM10, PM2.5) was also explored. Temperatures ≥99 °F (the median value) were associated with approximately five times higher odds of a heat-coded death as compared to temperatures <99 °F (adjusted OR = 4.9, 95% CI 3.3, 7.2). The effect estimates were attenuated when exposure to heat was characterized by heat index. The interaction results suggest that effect of temperature on heat-coded deaths may depend on sex and occupation. For example, the odds of a heat-coded death among outdoor/heavy labor workers exposed to temperatures ≥99 °F was greater than expected based on the sum of the individual effects (observed OR = 14.0, 95% CI 2.7, 72.0; expected OR = 4.1 [2.8 + 2.3–1.0]). Our results highlight the extent of the association between temperature and heat-coded deaths and emphasize the need for a comprehensive, multisource definition of heat-coded deaths. Furthermore, based on the interaction results, we recommend that states implement or expand heat safety programs to protect vulnerable subpopulations, such as outdoor workers.

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Authors and Affiliations

  1. Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA

    Brianna F. Moore

  2. Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA

    G. Brooke Anderson & Sheryl Magzamen

  3. Merck, Fort Washington, PA, USA

    Matthew G. Johnson

  4. Oklahoma State Department of Health, Injury Prevention Service, Oklahoma City, OK, USA

    Sheryll Brown & Kristy K. Bradley

Authors
  1. Brianna F. Moore
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  2. G. Brooke Anderson
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  3. Matthew G. Johnson
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  4. Sheryll Brown
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  5. Kristy K. Bradley
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  6. Sheryl Magzamen
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Correspondence to Brianna F. Moore.

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Moore, B.F., Brooke Anderson, G., Johnson, M.G. et al. Case-crossover analysis of heat-coded deaths and vulnerable subpopulations: Oklahoma, 1990–2011. Int J Biometeorol 61, 1973–1981 (2017). https://doi.org/10.1007/s00484-017-1387-0

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  • DOI: https://doi.org/10.1007/s00484-017-1387-0

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