Journal of Community Health

, Volume 41, Issue 1, pp 57–69 | Cite as

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

  • Ethan D. Fechter-LeggettEmail author
  • Ambarish Vaidyanathan
  • Ekta Choudhary
Original Paper


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.


Heat illness Emergency department Urbanization Metropolitan Nonmetropolitan Time trend 



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.

Compliance with Ethical Standards

Conflict of interest



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Copyright information

© Springer Science+Business Media New York (outside the USA) 2015

Authors and Affiliations

  • Ethan D. Fechter-Leggett
    • 1
    • 2
    • 3
    Email author
  • Ambarish Vaidyanathan
    • 1
  • Ekta Choudhary
    • 4
  1. 1.Environmental Health Tracking Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental HealthCenters for Disease Control and PreventionChambleeUSA
  2. 2.Field Studies Branch, Division of Respiratory Disease Studies, National Institute for Occupational Safety and HealthCenters for Disease Control and PreventionMorgantownUSA
  3. 3.Epidemic Intelligence Service Program, Center for Surveillance, Epidemiology, and Laboratory ServicesCenters for Disease Control and PreventionAtlantaUSA
  4. 4.Health Studies Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental HealthCenters for Disease Control and PreventionAtlantaUSA

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