Vulnerability to renal, heat and respiratory hospitalizations during extreme heat among U.S. elderly

Abstract

Background Extreme heat (EH) is a growing concern with climate change, and protecting human health requires knowledge of vulnerability factors. We evaluated whether associations between EH (maximum temperature > 97th percentile) and hospitalization for renal, heat and respiratory diseases among people ≥ 65 years differed by individual and area-level characteristics. Methods We used Medicare billing records, airport weather data, U.S. Census data and satellite land cover imagery in 109 US cities, May-September, 1992–2006, in a time-stratified case-crossover design. Interaction terms between EH and individual (> 78 years, black race, sex) and home ZIP-code (percentages of non-green space, high school education, housing built before 1940) characteristics were incorporated in a single model. Next, we pooled city-specific effect estimates or regressed them on quartiles of air conditioning prevalence (ACP) in a multivariate random effects meta-analysis. Results EH and combined renal/heat/respiratory hospitalization associations were stronger among blacks, the very old, in ZIP codes with lower educational attainment or older housing and in cities with lower ACP. For example, for EH versus non-heat days, we found a 15% (95% CI 11%–19%) increase in renal/heat/respiratory hospitalizations among individuals in ZIP codes with higher percent of older homes in contrast to a 9% (95% CI 6%–12%) increase in hospitalizations in ZIP codes with lower percent older homes. Conclusion Vulnerability to EH-associated hospitalization may be influenced by age, educational attainment, housing age and ACP.

Vulnerability to extreme-heat-associated hospitalization in three counties in Michigan, USA, 2000–2009

“…Most studies suggest that the very old and the very young are most vulnerable (Basu 2002; Gronlund et al 2016; Isaksen et al 2015; Kravchenko et al 2013; Semenza et al 1999). During the heat waves in 1980 in St. Louis, Missouri and in 1995 in Chicago, mortality rates among people with chronic diseases, the very old or young, those of low socioeconomic status, and urban dwellers tended to be higher when compared to the general population (Jones et al 1982; Semenza et al 1999).…”

“…Vulnerability may vary according to sex; during the California heat wave of 2006, the mortality rate among women was higher than among men (Knowlton et al 2009). In addition, several studies in multiple U.S. locations found an increased risk for heat-associated mortality among African Americans as compared to whites (Gronlund et al 2016; Kravchenko et al 2013; McGeehin and Mirabelli 2001; Semenza et al 1999). However, other studies failed to find differences in vulnerability by race (Green et al 2010; Groulund 2014; Madrigano et al 2013; Pillai et al 2014).…”

Morbidität durch Hitze – eine Analyse der Krankenhauseinweisungen per Rettungseinsatz während einer Hitzewelle 2015 in Frankfurt/Main

“…Die Häufigkeit variierte in Abhängigkeit von dem jeweilig untersuchten Wohnort (Grünflächen in der Nachbarschaft, Anteil Wohnfläche mit Air-Conditioning, Alter der Immobilie usw.) [32].…”

Measuring temperature-related mortality using endogenously determined thresholds

“…A major issue with the V-shaped relationship developed in Martens (1998) andutilised in Tol (2002a) is that it has been found to be biased towards cold-related mortality and that this is likely to have led to bias towards finding a net reduction in mortality associated with climate change (Huber et al 2017). As previous studies have found different shapes for the temperature-mortality relationship depending upon the city/climate focused upon (Analitis et al 2008;Gasparrini et al 2015;Gasparrini et al 2017;Gosling et al 2009;Gronlund et al 2016;Guo et al 2014); it is likely that the application of a coldbiased temperature-mortality relationship to tropic, sub-tropic and temperate regions with warm summers will be problematic. The importance of assessing the nature of the temperature-mortality relationship using different techniques and data from a range of climatic regions is important as previous studies, which includes Guo et al…”