Heatwaves and hospitalizations due to hyperthermia in defined climate regions in the conterminous USA

  • Alexander Liss
  • Elena N. NaumovaEmail author
Part of the following topical collections:
  1. Topical Collection on Geospatial Technology in Environmental Health Applications


Heatwaves are one of the deadliest natural disasters that occur annually with thousands of people seeking medical attention. The spatio-temporal synchronization between peaks in disease manifestation and high temperature provides important insights into the seasonal timing of the heatwave and the response it may cause with respect to emergence, severity, and duration. The objectives of this study are to examine the association between hospitalizations due to heat stroke in older adults and heat in the United States (US) and explore synchronization with respect to heatwave sequence, time of arrival, and regional climate. Three large data sets were utilized: daily hospitalization records of the US elderly between 1991 and 2006, annual demographic summaries on Medicare beneficiaries maintained by the Centers for Medicare and Medicaid Services (CMS), and nationwide daily meteorological observations. We modeled seasonal fluctuations in health outcomes, such as the timing and intensity of the seasonal peak in hospitalizations using refined harmonic GLM for eight climatically similar regions. During the 16-year study period, there were 40,019 heat-related hospitalizations (HRH) in the conterminous  US. The rates of HRH varied substantially across eight climatic regions: with the highest rate of 7.05 cases per million residents observed in areas with temperate arid summers and winters (TaTa) and the lowest rate of 0.67—in areas with cold moderately dry summers and arid winters (CdCa), where summer temperatures are about  18.3 °C and 12.1 °C, respectively. We detected 400 heatwaves defined as any day when the night time temperature is above its 90th percentile for the current and previous nights. The first seasonal heatwave in a season resulted in 4274 hospitalizations over 342 heatwave-days: 34.3% of 12,442 hospitalizations occurred in 26% of 1308 heatwave-days. The relative risks of increased HRH associated with the first and second heatwaves were 10.4 (95%CI: 8.5; 12.3) and 11.4 (95%CI: 9.6; 13.3), respectively, indicating the disproportional effects of early heatwave arrivals. The seasonal spike in heat stroke hospitalizations in regions with relatively similar annual temperatures, e.g. in areas with temperate moderately dry summers and winters (TdTa: 12.8 °C) and (TaTa: 11.1 °C) ranged between 4.5 (95%CI: 3.3; 5.5) and 11.0 (95%CI: 8.2; 14.9) cases per million residents, respectively, indicating substantial regional differences. The differences in heat-related hospitalizations and response to heatwaves are substantial among older adults residing in different climate regions of the conterminous US. The disproportionally high response to the early seasonal heatwave deserves special attention, especially in the context of prevention and decision support frameworks.


Heatwave Climate Extreme weather Elderly Health Seasonality Statistical model Decision support Data science 



Authors are thankful to three reviewers for thoughtful comments and suggestions and editorial help provided by Tania M. Alarcon-Falconi and Yuri N. Naumov. All statements of fact, opinion, or analysis expressed are those of the authors and do not reflect the official positions or views of the Intelligence Community or any other U.S. Government agency. Nothing in the contents should be construed as asserting or implying U.S. Government authentication of information or Intelligence Community endorsement of the author’s views.

Funding information

The hospitalization records were acquired from the Centers for Medicare and Medicaid Services (CMS) in part through the project “Gastroenteritis and Extreme Weather Events in Elderly-GEWEL” (NIEHS-R01ES013171) funded by the National Institute of Environmental Health Sciences. This study was in part supported by a grant from the Intelligence Community Research Fellowship Program.

Supplementary material

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Supplementary Table 6 (DOCX 38 kb)
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Figure S1

Daily time series of heat-related hospitalization counts (black lines) and fitted model curves (yellow empty circle) in older adults for each of the eight LKN climate regions: CdCa (a), CwCd (b), HwHd (c), HwHw (d), TaTa (e), TdTa (f), TwCd (g), TwTw (h). (PNG 2327 kb)

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High resolution image (EPS 8619 kb)
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ESM 1 (DOCX 23 kb)


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Civil and Environmental EngineeringTufts University, School of EngineeringMedfordUSA
  2. 2.Friedman School of Nutrition Science and PolicyTufts UniversityBostonUSA
  3. 3.Initiative for the Forecasting and Modeling of Infectious DiseasesTufts UniversityMedfordUSA

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