Skip to main content
SpringerLink
Log in

Heat Stress Illness Emergency Department Visits in National Environmental Public Health Tracking States, 2005–2010

  • Original Paper
  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

Variability of heat stress illness (HSI) by urbanicity and climate region has rarely been considered in previous HSI studies. We investigated temporal and geographic trends in HSI emergency department (ED) visits in CDC Environmental Public Health Tracking Network (Tracking) states for 2005–2010. We obtained county-level HSI ED visit data for 14 Tracking states. We used the National Center for Health Statistics Urban–Rural Classification Scheme to categorize counties by urbanicity as (1) large central metropolitan (LCM), (2) large fringe metropolitan, (3) small–medium metropolitan, or (4) nonmetropolitan (NM). We also assigned counties to one of six US climate regions. Negative binomial regression was used to examine trends in HSI ED visits over time across all counties and by urbanicity for each climate region, adjusting for pertinent variables. During 2005–2010, there were 98,462 HSI ED visits in the 14 states. ED visits for HSI decreased 3.0 % (p < 0.01) per year. Age-adjusted incidence rates of HSI ED visits increased from most urban to most rural. Overall, ED visits were significantly higher for NM areas (IRR = 1.41, p < 0.01) than for LCM areas. The same pattern was observed in all six climate regions; compared with LCM, NM areas had from 14 to 90 % more ED visits for HSI. These findings of significantly increased HSI ED visit rates in more rural settings suggest a need to consider HSI ED visit variability by county urbanicity and climate region when designing and implementing local HSI preventive measures and interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Basu, R. (2009). High ambient temperature and mortality: A review of epidemiologic studies from 2001 to 2008. Environmental Health, 8, 40. doi:10.1186/1476-069X-8-40.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Basu, R., & Samet, J. M. (2002). Relation between elevated ambient temperature and mortality: A review of the epidemiologic evidence. Epidemiologic Reviews, 24(2), 190–202. doi:10.1093/epirev/mxf007.

    Article  PubMed  Google Scholar 

  3. Gronlund, C. J., Zanobetti, A., Schwartz, J. D., Wellenius, G. A., & O’Neill, M. S. (2014). Heat, heat waves, and hospital admissions among the elderly in the United States, 1992–2006. Environmental Health Perspectives, 122(11), 1187–1192. doi:10.1289/ehp.1206132.

    PubMed  PubMed Central  Google Scholar 

  4. Guirguis, K., Gershunov, A., Tardy, A., & Basu, R. (2014). The impact of recent heat waves on human health in California. Journal of Applied Meteorology and Climatology, 53(1), 3–19.

    Article  Google Scholar 

  5. Knowlton, K., Rotkin-Ellman, M., King, G., et al. (2009). The 2006 California heat wave: Impacts on hospitalizations and emergency department visits. Environmental Health Perspectives, 117(1), 61–67. doi:10.1289/ehp.11594.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Anderson, G. B., Dominici, F., Wang, Y., McCormack, M. C., Bell, M. L., & Peng, R. D. (2013). Heat-related emergency hospitalizations for respiratory diseases in the medicare population. American Journal of Respiratory and Critical Care Medicine, 187(10), 1098–1103. doi:10.1164/rccm.201211-1969OC.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lin, S., Luo, M., Walker, R. J., Liu, X., Hwang, S. A., & Chinery, R. (2009). Extreme high temperatures and hospital admissions for respiratory and cardiovascular diseases. Epidemiology, 20(5), 738–746. doi:10.1097/EDE.0b013e3181ad5522.

    Article  PubMed  Google Scholar 

  8. Mastrangelo, G., Fedeli, U., Visentin, C., Milan, G., Fadda, E., & Spolaore, P. (2007). Pattern and determinants of hospitalization during heat waves: An ecologic study. BMC Public Health, 7, 200. doi:10.1186/1471-2458-7-200.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lippmann, S. J., Fuhrmann, C. M., Waller, A. E., & Richardson, D. B. (2013). Ambient temperature and emergency department visits for heat-related illness in North Carolina, 2007–2008. Environmental Research, 124, 35–42. doi:10.1016/j.envres.2013.03.009.

    Article  PubMed  CAS  Google Scholar 

  10. Lugo-Amador, N. M., Rothenhaus, T., & Moyer, P. (2004). Heat-related illness. Emergency Medicine Clinics of North America, 22(2), 315–327. doi:10.1016/j.emc.2004.01.004.

    Article  PubMed  Google Scholar 

  11. Batscha, C. (1997). Heat stroke: Keeping your clients cool in the summer. Journal of Psychosocial Nursing and Mental Health Services, 35(7), 12–17.

    PubMed  CAS  Google Scholar 

  12. Beggs, P. J., & Vaneckova, P. (2008). Admission to hospital for effects of heat and light: NSW, 1993–94 to 2003–04. New South Wales Public Health Bulletin, 19(7–8), 132–137.

    Article  PubMed  Google Scholar 

  13. Blum, L. N., Bresolin, L. B., & Williams, M. A. (1998). Heat-related illness during extreme weather emergencies. JAMA, 279(19), 1514.

    Article  PubMed  CAS  Google Scholar 

  14. Curriero, F. C., Heiner, K. S., Samet, J. M., Zeger, S. L., Strug, L., & Patz, J. A. (2002). Temperature and mortality in 11 cities of the Eastern U.S. American Journal of Epidemiology, 155(1), 80–87.

    Article  PubMed  Google Scholar 

  15. Hess, J. J., Saha, S., & Luber, G. (2014). Summertime acute heat illness in U.S. emergency departments from, 2006 through 2010: Analysis of a nationally representative sample. Environmental Health Perspectives, 122(11), 1209–1215. doi:10.1289/ehp.1306796.

    PubMed  PubMed Central  Google Scholar 

  16. Naughton, M. P., Henderson, A., Mirabelli, M. C., et al. (2002). Heat-related mortality during a 1999 heat wave in Chicago. American Journal of Preventive Medicine, 22(4), 221–227.

    Article  PubMed  Google Scholar 

  17. Pillai, S. K., Noe, R. S., Murphy, M. W., et al. (2013). Heat illness: Predictors of hospital admissions among emergency department visits—Georgia, 2002–2008. Journal of Community Health, 39(1), 90–98. doi:10.1007/s10900-013-9743-4.

    Article  Google Scholar 

  18. Rhea, S., Ising, A., Fleischauer, A. T., Deyneka, L., Vaughan-Batten, H., & Waller, A. (2012). Using near real-time morbidity data to identify heat-related illness prevention strategies in North Carolina. Journal of Community Health, 37(2), 495–500. doi:10.1007/s10900-011-9469-0.

    Article  PubMed  Google Scholar 

  19. Stollberger, C., Lutz, W., & Finsterer, J. (2009). Heat-related side-effects of neurological and non-neurological medication may increase heatwave fatalities. European Journal of Neurology, 16(7), 879–882. doi:10.1111/j.1468-1331.2009.02581.x.

    Article  PubMed  CAS  Google Scholar 

  20. Kirtman, B., Power, S. B., Adedoyin, J. A., et al. (2013). Near-term climate change: Projections and predictability. In T. F. Stocker, D. Qin, G. K. Plattner, M. Tignor, S. K. Allen, J. Boschung, A. Nauels, Y. Xia, V. Bex, & P. M. Midgley (Eds.), Climate change 2013: The physical science basis. contribution of working group I to the fifth assessment report of the intergovernmental panel on climate change (pp. 953–1028). New York: Cambridge University Press.

    Google Scholar 

  21. Bernard, S. M., & McGeehin, M. A. (2004). Municipal heat wave response plans. American Journal of Public Health, 94(9), 1520–1522.

    Article  PubMed  PubMed Central  Google Scholar 

  22. California Governor’s Office of Emergency Services. (2014). State of California contingency plan for excessive heat emergencies. Retrieved August 13, 2014, from http://www.calema.ca.gov/PlanningandPreparedness/Documents/Heat%20Contingency%20Plan%20Rev%20June%202014.pdf.

  23. Changnon, S. A., Kunkel, K. E., & Reinke, B. C. (1996). Impacts and responses to the 1995 heat wave: A call to action. Bulletin of the American Meteorological Society, 77(7), 1497–1506.

    Article  Google Scholar 

  24. Missouri Department of Health and Senior Services. (2014). Data and statistical reports | hyperthermia. Retrieved July 25, 2014 from http://health.mo.gov/living/healthcondiseases/hyperthermia/data.php.

  25. Semenza, J. C., Rubin, C. H., Falter, K. H., et al. (1996). Heat-related deaths during the July 1995 heat wave in Chicago. New England Journal of Medicine, 335(2), 84–90.

    Article  PubMed  CAS  Google Scholar 

  26. McGeehin, M. A., & Mirabelli, M. (2001). The potential impacts of climate variability and change on temperature-related morbidity and mortality in the United States. Environmental Health Perspectives, 109(Suppl 2), 185–189.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Centers for Disease Control and Prevention National Environmental Public Health Tracking Program. (2013). Centers for disease control and prevention standards for nationally consistent data and measures within the environmental public health tracking network. Retrieved July 21, 2014, from http://ephtracking.cdc.gov/docs/CDC_NCDM_v3.pdf.

  28. Centers for Disease Control and Prevention National Environmental Public Health Tracking Program. (2014). Environments climate change indicators—CDC tracking network. Retrieved July 25, 2014, from http://ephtracking.cdc.gov/showClimateChangeIndicators.action.

  29. Centers for Disease Control and Prevention. (2014). Environmental public health tracking network. state emergency department visits data. Retrieved February 5, 2014, from http://www.cdc.gov/ephtracking.

  30. Centers for Disease Control and Prevention. (2014). National vital statistics system. bridged-race population estimates. Accessed from environmental public health tracking network. Retrieved February 10, 2014, from http://www.cdc.gov/ephtracking.

  31. Ingram, D. D., & Franco, S. J. (2014). 2013 NCHS urban-rural classification scheme for counties. National Center for Health Statistics. Vital Health Statistics, 2(166). http://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdf.

  32. Centers for Disease Control and Prevention National Center for Health Statistics. (2014). Data access—Urban–rural classification scheme for counties. Retrieved June 4, 2014, from http://www.cdc.gov/nchs/data_access/urban_rural.htm.

  33. United States Census Bureau. (2014). American community survey. Socioeconomic measures. Accessed from environmental public health tracking network. Retrieved December 16, 2014, from http://www.cdc.gov/ephtracking.

  34. Karl, T. R., & Koss, W. J. (1984). Regional and national monthly, seasonal, and annual temperature weighted by area, 1895–1983. Asheville: National Climatic Data Center.

    Google Scholar 

  35. National Oceanic and Atmospheric Administration. (2014). Climate at a glance: Time series | National Climatic Data Center (NCDC). Retrieved May 21, 2014, from http://www.ncdc.noaa.gov/monitoring-references/maps/us-climate-regions.php.

  36. Mitchell, K. E., Lohmann, D., & Houser, P. R. (2004). The multi-institution North American Land Data Assimilation System (NLDAS): Utilizing multiple GCIP products and partners in a continental distributed hydrological modeling system. Journal of Geophysical Research, 109, D07S90. doi:10.1029/2003jd003823.

    Google Scholar 

  37. Rothfusz, L. P. (1990). The heat index “equation” (or, more than you wanted to know about heat index) (SR 90-23). Fort Worth: National Weather Service Southern Region Headquarters.

    Google Scholar 

  38. Klein, R. J., & Schoenborn, C. A. (2001). Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, 20, 1–12.

    Google Scholar 

  39. Ahmad, O. B., Boschi-Pinto, C., Lopez, A. D., Murray, C. J., Lozano, R., & Inoue, M. (2001). Age standardization of rates: A new WHO standard. World Health Organization. Retrieved February 10, 2014, from http://www.who.int/healthinfo/paper31.pdf.

  40. Pan, W. (2001). Akaike’s information criterion in generalized estimating equations. Biometrics, 57(1), 120–125.

    Article  PubMed  CAS  Google Scholar 

  41. Sanchez, C. A., Thomas, K. E., Malilay, J., & Annest, J. L. (2010). Nonfatal natural and environmental injuries treated in emergency departments, United States, 2001–2004. Family and Community Health, 33(1), 3–10.

    Article  PubMed  Google Scholar 

  42. Knowlton, K., Rotkin-Ellman, M., Geballe, L., Max, W., & Solomon, G. M. (2011). Six climate change-related events in the United States accounted for about $14 billion in lost lives and health costs. Health Affairs, 30(11), 2167–2176. doi:10.1377/hlthaff.2011.0229.

    Article  PubMed  Google Scholar 

  43. O’Neill, M. S., Carter, R., Kish, J. K., et al. (2009). Preventing heat-related morbidity and mortality: New approaches in a changing climate. Maturitas, 64(2), 98–103. doi:10.1016/j.maturitas.2009.08.005.

    Article  PubMed  PubMed Central  Google Scholar 

  44. NOAA National Climate Data Center. (2010). State of the climate: Global analysis for June 2010. Retrieved August 1, 2014, from http://www.ncdc.noaa.gov/sotc/global/2010/6.

  45. NASA Goddard Space Flight Center Earth Observatory. (2010). How warm was summer 2010? NASA Goddard Space Flight Center. Retrieved August 1, 2014, from http://earthobservatory.nasa.gov/IOTD/view.php?id=46159&eocn=image&eoci=related_image.

  46. NASA Goddard Space Flight Center Earth Observatory. (2013). GISS surface temperature analysis: How warm was this summer? NASA Goddard Institute for Space Studies. Retrieved August 1, 2014, from http://data.giss.nasa.gov/gistemp/2010summer/.

  47. Missouri Department of Health and Senior Services. (2008). Rules of department of health and senior services division 20—Division of community and public health chapter 20—communicable diseases (19 CSR 20–20). St. Louis: Missouri State Government.

    Google Scholar 

  48. Choudhary, E., & Vaidyanathan, A. (2014). Heat stress illness hospitalizations—Environmental Public Health Tracking Program, 20 states, 2001–2010. Morbidity and Mortality Weekly Report Surveillance Summaries, 63(No. SS-13), 1–10.

    Google Scholar 

  49. Clarke, J. F. (1972). Some effects of the urban structure on heat mortality. Environmental Research, 5(1), 93–104.

    Article  PubMed  CAS  Google Scholar 

  50. Jones, T. S., Liang, A. P., Kilbourne, E. M., et al. (1982). Morbidity and mortality associated with the July 1980 heat wave in St. Louis and Kansas City, MO. JAMA, 247(24), 3327–3331.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank W. Dana Flanders for expert advice and consultation and the 14 National Environmental Public Health Tracking state programs that submitted the data used in the study. Funded by National Center for Environmental Health, Centers for Disease Control and Prevention.

Author information

Author notes

  1. Ethan D. Fechter-Leggett

    Present address: Field Studies Branch, Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1095 Willowdale Rd, Mailstop H2800, Morgantown, WV, 26505, USA

Authors and Affiliations

  1. Environmental Health Tracking Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop F-60, Chamblee, GA, 30341, USA

    Ethan D. Fechter-Leggett & Ambarish Vaidyanathan

  2. Epidemic Intelligence Service Program, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Ethan D. Fechter-Leggett

  3. Health Studies Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Ekta Choudhary

Authors
  1. Ethan D. Fechter-Leggett
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ambarish Vaidyanathan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ekta Choudhary
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ethan D. Fechter-Leggett.

Ethics declarations

Conflict of interest

None.

Additional information

Disclaimer The opinions expressed by authors contributing to this manuscript do not necessarily reflect the opinions of the Centers for Disease Control and Prevention or the institutions with which the authors are affiliated.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fechter-Leggett, E.D., Vaidyanathan, A. & Choudhary, E. Heat Stress Illness Emergency Department Visits in National Environmental Public Health Tracking States, 2005–2010. J Community Health 41, 57–69 (2016). https://doi.org/10.1007/s10900-015-0064-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-015-0064-7

Keywords

Search

Navigation