, Volume 11, Issue 4, pp 512–525 | Cite as

Assessing Variability in the Impacts of Heat on Health Outcomes in New York City Over Time, Season, and Heat-Wave Duration

  • Scott C. SheridanEmail author
  • Shao Lin
Original Contribution


While the impacts of heat upon mortality and morbidity have been frequently studied, few studies have examined the relationship between heat, morbidity, and mortality across the same events. This research assesses the relationship between heat events and morbidity and mortality in New York City for the period 1991–2004. Heat events are defined based on oppressive weather types as determined by the Spatial Synoptic Classification. Morbidity data include hospitalizations for heat-related, respiratory, and cardiovascular causes; mortality data include these subsets as well as all-cause totals. Distributed-lag models assess the relationship between heat and health outcome for a cumulative 15-day period following exposure. To further refine analysis, subset analyses assess the differences between early- and late-season events, shorter and longer events, and earlier and later years. The strongest heat–health relationships occur with all-cause mortality, cardiovascular mortality, and heat-related hospital admissions. The impacts of heat are greater during longer heat events and during the middle of summer, when increased mortality is still statistically significant after accounting for mortality displacement. Early-season heat waves have increases in mortality that appear to be largely short-term displacement. The impacts of heat on mortality have decreased over time. Heat-related hospital admissions have increased during this time, especially during the earlier days of heat events. Given the trends observed, it suggests that a greater awareness of heat hazards may have led to increased short-term hospitalizations with a commensurate decrease in mortality.


heat waves extreme weather events environmental epidemiology comparative risk assessment climatology 



This study was supported in part by a grant from the Centers for Disease Control U01EH000396.


  1. Anderson BG, Bell ML. 2009. Weather-Related Mortality, How Heat, Cold, and Heat Waves Affect Mortality in the United States. Epidemiol 20: 205-213.CrossRefPubMedCentralPubMedGoogle Scholar
  2. Anderson BG, Bell ML. 2010. Heat Waves in the United States: Mortality Risk during Heat Waves and Effect Modification by Heat Wave Characteristics in 43 U.S. Communities. Environ Health Perspect 119: 210-218.CrossRefPubMedCentralPubMedGoogle Scholar
  3. Baccini M, Kosatsky T, Biggeri A. 2013. Impact of Summer Heat on Urban Population Mortality in Europe during the 1990 s: An Evaluation of Years of Life Lost Adjusted for Harvesting. PloSOne 8, e69638.CrossRefPubMedCentralPubMedGoogle Scholar
  4. Barnett AG. 2007. Temperature and cardiovascular deaths in the US elderly: changes over time. Epidemiol 18: 369-372.CrossRefPubMedGoogle Scholar
  5. Bassil KL, Cole DC, Moineddin R, Craig AM, Wendy Lou WY, Schwartz B, Rea E (2009). Temporal and spatial variation of heat-related illness using 911 medical dispatch data. Environ Research 109: 600-606.CrossRefPubMedGoogle Scholar
  6. Bassil KL, Cole DC, Moineddin R, Lou W, Craig AM, Schwartz B, Rea E. 2011. The relationship between temperature and ambulance response calls for heat-related illness in Toronto, Ontario, 2005. J Epidemiol Commun Health 65: 829-831.CrossRefPubMedGoogle Scholar
  7. Basu R. 2009. High ambient temperature and mortality: a review of epidemiologic studies from 2001 to 2008. Environ Health 8: 1-13.CrossRefGoogle Scholar
  8. Basu R, Ostro BD. 2008. A multicounty analysis identifying the populations vulnerable to mortality associated with high ambient temperature in California. American Journal of Epidemiol 168: 632-637.CrossRefPubMedGoogle Scholar
  9. Bobb JF, Peng RD, Bell ML, Dominici F (2014) Heat-related mortality and adaptation to heat in the United States. Environmental Health Perspectives. doi: 10.1289/ehp.1307392
  10. Bouchama A, Dehbi M, Mohamed G, Matthies F., Shoukri M., Menne B. 2007. Prognostic Factors in Heat Wave-Related Deaths, A Meta-analysis. Arch Intern Med 167: E1-E7.CrossRefGoogle Scholar
  11. Danet S, Richard F, Montaye M, Beauchant S, Lemaire B, Graux C,Cottel D, Marécaux N, Amouyel P. 1999. Unhealthy Effects of Atmospheric Temperature and Pressure on the Occurrence of Myocardial Infarction and Coronary Deaths A 10-Year Survey: The Lille-World Health Organization MONICA Project (Monitoring Trends and Determinants in Cardiovascular Disease). Circulation 100: e1-e7.CrossRefPubMedGoogle Scholar
  12. Davis RE, Knappenberger PC, Novicoff WM, Michaels PJ. 2002. Decadal changes in heat-related human mortality in the Eastern US. Climate Research 22: 175–184CrossRefGoogle Scholar
  13. Ebi KL, Teisberg TJ, Kalkstein LS, Robinson L, Weiher RF. 2004. Heat Watch/Warning Systems Save Lives: Estimated Costs and Benefits for Philadelphia 1995-1998. Bull Am Meteorol Society 85: 1067-74.CrossRefGoogle Scholar
  14. Fletcher BA, Lin S, Fitzgerald ED, Hwang SA. 2012. Association of Summer Temperatures With Hospital Admissions for Renal Diseases in New York State: A Case-Crossover Study. Am J Epidemiol 175: 907-916.CrossRefPubMedGoogle Scholar
  15. Fouillet A, Rey G, Wagner V, Laaidi K, Empereur-Bissonnet P, Tertre AL, Frayssinet P, Bessemoulin P, Laurent F, Crouy-Chanel PD, Jougla E, Hemon D. 2008. Has the impact of heat waves on mortality changed in France since the European heat wave of summer 2003? A study of the 2006 heat wave. Int J Epidemiol 37: 309–317CrossRefPubMedCentralPubMedGoogle Scholar
  16. Garcia VC, Gego E, Lin S, Pantea C, Rappazzo K, Wootten A, Rao ST. 2011. An evaluation of transported pollution and respiratory-related hospital admissions in the state of New York. Atmos Pollut Research 2: 9-15.CrossRefGoogle Scholar
  17. Gasparrini A, Armstrong B. 2010. Time series analysis on the health effects of temperature: advancements and limitations. Environ Research 110: 633-638.CrossRefPubMedGoogle Scholar
  18. Golden JS, Hartz D, Brazel A, Luber G, Phelan P. 2008. A biometeorology study of climate and heat-related morbidity in Phoenix from 2001 to 2006. Int J Biometeorol 52:471-480.CrossRefPubMedGoogle Scholar
  19. Gosling SN, McGregor GR, Páldy A. 2007. Climate change and heat-related mortality in six cities. Part 1: model construction and validation. Int J Biometeorol 51: 525–540CrossRefPubMedGoogle Scholar
  20. Guirguis K, Gershunov A, Tardy A, Basu R. 2013. The impact of recent heat waves on human health in California. J Appl Meteorol Climatol, 53(1):3–19.CrossRefGoogle Scholar
  21. Hajat S, Armstrong B, Baccini M, Biggeri A, Bisanti L, Russo A, Páldy A, Menne B, Kosatsky T. 2006. Impact of High Temperatures on Mortality: Is There an Added Heat Wave Effect? Epidemiol 17: 632-638.CrossRefPubMedGoogle Scholar
  22. Hajat SA, Ben G, Gouveia N., Wilkinson P. 2005. Mortality Displacement of Heat-Related Deaths: A Comparison of Delhi, Sao Paulo, and London. Epidemiol 16: 613-620.CrossRefPubMedGoogle Scholar
  23. Hajat S, Kovats RS, Atkinson RW, Haines A. 2002. Impact of hot temperatures on death in London: a time series approach. J Epidemiol Community Health 56: 367-372.CrossRefPubMedCentralPubMedGoogle Scholar
  24. Hajat S, Sheridan SC, Allen MJ, Pascal M, Laaidi K, Yagouti A, Bickis U, Tobias A, Bourque D, Armstrong BG, Kosatsky T. 2010. Which days of hot weather are identified as dangerous by Heat-Health Warning Systems? A comparison of the predictive capacity of different approaches. Am J Public Health 100: 1137-1144.CrossRefPubMedCentralPubMedGoogle Scholar
  25. Hansen A, Bi P, Nitschke M, Ryan P, Pisaniello D, Tucker G. 2008. The effect of heat waves on mental health in a temperate Australian city. Environ Health Perspect 116: 1369.CrossRefPubMedCentralPubMedGoogle Scholar
  26. Hondula, DM, Davis RE, Rocklöv J, Saha MV. 2013. A time series approach for evaluating intra-city heat-related mortality. J Epidemiol Community Health, 67(8):707–712.CrossRefPubMedGoogle Scholar
  27. Jones RR, Özkaynak H, Nayak SG, Garcia V, Hwang SA, Lin S. 2013. Associations between summertime ambient pollutants and respiratory morbidity in New York City: Comparison of results using ambient concentrations versus predicted exposures. Journal of Exposure Science and Environmental Epidemiology 23:616–626Google Scholar
  28. Kaiser R, Le Terte A, Schwartz J, Gotway CA, Daley WR, Rubin CH. 2007. The effect of the 1995 heat wave in Chicago on all-cause and cause-specific mortality. Am J Public Health 97: 158–162.CrossRefGoogle Scholar
  29. Khalaj B, Lloyd G, Sheppeard V, Dear K. 2010. The health impacts of heat waves in five regions of New South Wales, Australia: a case-only analysis. Int Arch Occup Environ Health 83, 833–842.CrossRefPubMedGoogle Scholar
  30. Knowlton K, Rotkin-Ellman M, King G, Margolis HG, Smith D, Solomon G, Trent R, English P. 2009. The 2006 California Heat Wave: Impacts on Hospitalizations and Emergency Department Visits. Environ Health Perspect 117: 61-67.CrossRefPubMedCentralPubMedGoogle Scholar
  31. Kovats RS, Hajat S, Wilkinson P. 2004. Contrasting patterns of mortality and hospital admissions during hot weather and heat waves in Greater London, UK. Occup Environ Med 61:893-898.CrossRefPubMedCentralPubMedGoogle Scholar
  32. Kyselý J, Plavcová E. 2012. Declining impacts of hot spells on mortality in the Czech Republic, 1986–2009: adaptation to climate change? Climatic Change 113:437-453.CrossRefGoogle Scholar
  33. Lee CC, Sheridan SC, Lin S. 2012. Relating Weather Types to Asthma-Related Hospital Admissions in New York State. Ecohealth 9:427-39.CrossRefPubMedGoogle Scholar
  34. Lin S, Luo M, Walker RJ, Liu X, Hwang SA, Chinery R. 2009. Extreme high temperatures and hospital admissions for respiratory and cardiovascular diseases. Epidemiol 20:738-746.CrossRefPubMedGoogle Scholar
  35. Lin S, Hsu WH, Van Zutphen AR, Saha S, Luber G, Hwang SA (2012a). Excessive Heat and Respiratory Hospitalizations in New York State: Estimating Current and Future Public Health Burden Related to Climate Change. Environ Health Perspect 120:1571-1577.CrossRefPubMedCentralPubMedGoogle Scholar
  36. Lin S, Luo M, Insaf T, Hwang SA (2012b). The effects of ambient temperature variation on respiratory hospitalizations in summer, New York State. Int J Occ Env Health 18:188-197.CrossRefPubMedGoogle Scholar
  37. Linares D, Díaz J. 2007. Impact of high temperatures on hospital admissions: comparative analysis with previous studies about mortality (Madrid). Eur J Pub Health 18:317-322.CrossRefPubMedGoogle Scholar
  38. 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 Pub Health 7:1–8.CrossRefGoogle Scholar
  39. Matzarakis A, Muthers S, Koch E. 2011. Human biometeorological evaluation of heat-related mortality in Vienna. Theoret Appl Climatol 105:1-10.CrossRefGoogle Scholar
  40. Medina-Ramón M, Schwartz J. 2007. Temperature, temperature extremes, and mortality: a study of acclimatisation and effect modification in 50 US cities. Occup Environ Med 64:827-833.CrossRefPubMedCentralPubMedGoogle Scholar
  41. Michelozzi P, de’Donato FK, Bargagli AM, D’Ippoliti D, De Sario M, Marino C, Schifano P, Cappai G, Leone M, Kirchmayer U, Ventura M, di Gennaro M, Leonardi M, Oleari F, De Martino A, Perucci CA. Surveillance of summer mortality and preparedness to reduce the health impact of heat waves in Italy. Int J Environ Research Pub Health 7:2256-2273CrossRefPubMedCentralPubMedGoogle Scholar
  42. Monteiro A, Carvalho V, Velho S, Sousa C, 2013. The accuracy of the heat index to explain the excess of mortality and morbidity during heat waves–a case study in a Mediterranean climate. Bulletin of Geography. Socio-economic Series 20:71-84.CrossRefGoogle Scholar
  43. Morabito M, Profili F, Crisci A, Francesconi P, Gensini GF, Orlandini S. 2012. Heat-related mortality in the Florentine area (Italy) before and after the exceptional 2003 heat wave in Europe: an improved public health response? Int J Biometeorol 56:801-810.CrossRefPubMedGoogle Scholar
  44. Ng CFS, Ueda K, Ono M, Nitta H, Takami A. 2013. Characterizing the effect of summer temperature on heatstroke-related emergency ambulance dispatches in the Kanto area of Japan. Int J Biometeorol 2013:1–8.Google Scholar
  45. Nitschke M, Tucker G, Bi P. 2007. Morbidity and mortality during heatwaves in metropolitan Adelaide. Med J Australia 187:662-665.PubMedGoogle Scholar
  46. Nitschke M, Tucker GR, Hansen, AL, Williams S, Zhang Y, Bi P. 2011. Impact of two recent extreme heat episodes on morbidity and mortality in Adelaide, South Australia: a case-series analysis. Environ Health 10:42.CrossRefPubMedCentralPubMedGoogle Scholar
  47. Ostro B, Rauch S, Green R, Malig B, Basu R. 2010. The effects of temperature and use of air conditioning on hospitalizations. Am J Epidemiol 172:1053-1061.CrossRefPubMedGoogle Scholar
  48. Pascal M, Laaidi K, Ledrans M, Baffert E, Caserio-Schönemann C, Le Tertre A, Manach J, Medina S, Rudant J, Empereur-Bissonnet P. 2006. France’s heat health watch warning system. Int J Biometeorol 50:144-153.CrossRefPubMedGoogle Scholar
  49. Reid CE, Snowden JM, Kontgis C, Tager IB. 2012. The role of ambient ozone in epidemiologic studies of heat-related mortality. Environ Health Perspect 12:1627-1630.Google Scholar
  50. Robinson PJ (2001). On the definition of a heat wave. J App Meteorol 40:762–775.CrossRefGoogle Scholar
  51. Rocklöv J, Ebi K, Forsberg B. 2011. Mortality related to temperature and persistent extreme temperatures: a study of cause-specific and age-stratified mortality. Occupational and Environ Med 68:531-536.CrossRefPubMedGoogle Scholar
  52. Rocklöv J, Barnett AG, Woodward A. 2012. On the estimation of heat-intensity and heat-duration effects in time series models of temperature-related mortality in Stockholm, Sweden. Environ Health 11:1-12.CrossRefGoogle Scholar
  53. Sanchez CA, Thomas KE, Malilay J, Annest JL. 2010. Nonfatal natural and environmental injuries treated in emergency departments, United States, 2001-2004. Fam Commun Health 33:3-10.CrossRefGoogle Scholar
  54. Schär C, Vidale PL, Lüthi D, Frei C, Häberli C, Liniger MA, Appenzeller C. 2004. The role of increasing temperature variability in European summer heatwaves. Nature 427:332–336.CrossRefPubMedGoogle Scholar
  55. Sheridan SC. 2002. The redevelopment of a weather type classification scheme for North America. Int J Climatol 22:51-68.CrossRefGoogle Scholar
  56. Sheridan SC, Kalkstein LS. 2004. Progress in heat watch-warning system technology. Bull Am Meteorol Soc 85:1931–1941.CrossRefGoogle Scholar
  57. Sheridan SC, Kalkstein AJ, Kalkstein LS. 2009. Trends in heat-related mortality in the United States, 1975-2004. Natural Hazards 50:145-160.CrossRefGoogle Scholar
  58. Son JY, Lee JT, Anderson GB, Bell ML. 2012. The impact of heat waves on mortality in seven major cities in Korea. Environ Health Perspect 120:566-571.CrossRefPubMedCentralPubMedGoogle Scholar
  59. Stafoggia M, Forastiere F, Agostini D, Caranci N, De’Donato F, Demaria M., Michelozzi P, Miglio R, Rognoni M, Russo A, Perucci CA. 2008. Factors affecting in-hospital heat-related mortality: a multi-city case-crossover analysis. J Epidemiol Commun Health 62:209-215.CrossRefPubMedGoogle Scholar
  60. Toloo G, FitzGerald G, Aitken P, Verrall K, Tong S. 2013. Evaluating the effectiveness of heat warning systems: systematic review of epidemiological evidence. Int J Pub Health 58(5): 667–681.CrossRefGoogle Scholar
  61. Toulemon L, Barbieri M. 2008. The mortality impact of the August 2003 heat wave in France: investigating the ‘harvesting’ effect and other long-term consequences. Popul Stud 62:39-53.CrossRefPubMedGoogle Scholar
  62. Uejio CK, Wilhelmi OV, Golden JS, Mills DM, Gulino SP, Samenow, JP. 2011. Intra-urban societal vulnerability to extreme heat: the role of heat exposure and the built environment, socioeconomics, and neighborhood stability. Health Place 17:498–507CrossRefPubMedGoogle Scholar

Copyright information

© International Association for Ecology and Health 2014

Authors and Affiliations

  1. 1.Department of GeographyKent State UniversityKentUSA
  2. 2.New York State Department of Health, AlbanyNew YorkUSA

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