International Journal of Biometeorology

, Volume 61, Issue 8, pp 1359–1370 | Cite as

Extreme climatic conditions and health service utilisation across rural and metropolitan New South Wales

  • Edward Jegasothy
  • Rhydwyn McGuire
  • John Nairn
  • Robert Fawcett
  • Benjamin Scalley
Original Paper


Periods of successive extreme heat and cold temperature have major effects on human health and increase rates of health service utilisation. The severity of these events varies between geographic locations and populations. This study aimed to estimate the effects of heat waves and cold waves on health service utilisation across urban, regional and remote areas in New South Wales (NSW), Australia, during the 10-year study period 2005–2015. We divided the state into three regions and used 24 over-dispersed or zero-inflated Poisson time-series regression models to estimate the effect of heat waves and cold waves, of three levels of severity, on the rates of ambulance call-outs, emergency department (ED) presentations and mortality. We defined heat waves and cold waves using excess heat factor (EHF) and excess cold factor (ECF) metrics, respectively. Heat waves generally resulted in increased rates of ambulance call-outs, ED presentations and mortality across the three regions and the entire state. For all of NSW, very intense heat waves resulted in an increase of 10.8% (95% confidence interval (CI) 4.5, 17.4%) in mortality, 3.4% (95% CI 0.8, 7.8%) in ED presentations and 10.9% (95% CI 7.7, 14.2%) in ambulance call-outs. Cold waves were shown to have significant effects on ED presentations (9.3% increase for intense events, 95% CI 8.0–10.6%) and mortality (8.8% increase for intense events, 95% CI 2.1–15.9%) in outer regional and remote areas. There was little evidence for an effect from cold waves on health service utilisation in major cities and inner regional areas. Heat waves have a large impact on health service utilisation in NSW in both urban and rural settings. Cold waves also have significant effects in outer regional and remote areas. EHF is a good predictor of health service utilisation for heat waves, although service needs may differ between urban and rural areas.


Heat Wave Health Service Utilisation World Meteorological Organization Cold Wave Emergency Department Presentation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors gratefully acknowledge Dr. Nectarios Rose for assistance with study design and statistical analysis and Dr. Tara Smith for assistance in drafting the manuscript. We also thank NSW Ambulance, the Centre for Epidemiology and Evidence at the NSW Ministry of Health and the Australian Bureau of Meteorology for provision of data. This work was completed while Edward Jegasothy was employed as a trainee on the Biostatistics Training Program funded by the NSW Ministry of Health. He undertook this work while based at the Environmental Health Branch, Health Protection NSW.

Compliance with ethical standard

Competing interests

The authors declare that they have no competing interests.

Ethical Approval

This study did not require ethics committee approval.


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Copyright information

© UK Crown 2017

Authors and Affiliations

  • Edward Jegasothy
    • 1
    • 2
  • Rhydwyn McGuire
    • 3
  • John Nairn
    • 4
    • 5
  • Robert Fawcett
    • 6
  • Benjamin Scalley
    • 7
  1. 1.NSW Biostatistics Training ProgramNSW Ministry of HealthSydneyAustralia
  2. 2.Sydney School of Public HealthUniversity of SydneyCamperdownAustralia
  3. 3.Centre for Epidemiology and EvidenceNSW Ministry of HealthSydneyAustralia
  4. 4.Australian Bureau of MeteorologyAdelaideAustralia
  5. 5.University of AdelaideAdelaideAustralia
  6. 6.Australian Bureau of MeteorologyMelbourneAustralia
  7. 7.Health Protection NSWNSW HealthSydneyAustralia

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