Summer Heat, Hospital Admissions and Mortality among the Elderly in Michigan and the United States.

Background: With climate change and population aging, the health burden of extreme heat (EH) is a present and future concern. However, characteristics of vulnerability to EH and associations between EH and morbidity vs. mortality are not well understood, and previous studies have focused on small numbers of cities and/or used sociodemographic and land cover information at a course geographic resolution (e.g., city-level). Objectives: For ages 65 and over, we examined 1) vulnerability to EH-associated mortality in 8 Michigan cities by individual and neighborhood socio-demographic characteristics and green space, 2) associations between heat and HAs in over 100 U.S. cities and 3) vulnerability to EH-associated HAs by individual and neighborhood characteristics and citywide air-conditioning prevalence in over 100 U.S. cities. Methods: In time-stratified case-crossover designs, we regressed natural-cause mortality or HAs against moderate heat and EH, or an indicator for maximum or apparent temperature above a city-specific threshold, over multiple lag days. We examined vulnerability by personal and ZIP-code (neighborhood) characteristics using multiple interaction terms between each of the characteristics and EH terms and by citywide air-conditioning prevalence in meta-analyses. Results: In Michigan, we observed increased vulnerability to heat-associated mortality among men, blacks and the very old (78 years or older). Nationally, EH was associated with higher HAs for cardiovascular, renal and respiratory diseases, with rates increasing by 43% (95% CI: 37%, 50%) for renal diseases, though over longer lags, substantial displacement of the initial effect was observed for cardiovascular and respiratory HAs. We observed increased vulnerability to EH-associated HAs among men and the very old, in neighborhoods with more residents of nonwhite race and lower education and in cities with lower air-conditioning prevalence. Significant heterogeneity existed between cities for many of the vulnerability characteristics. Results were suggestive of increased vulnerability to heat-associated mortality and HAs in neighborhoods with less green space. Conclusions: Individuals with respiratory and renal conditions may benefit from heat adaptation interventions, and heat health warning systems and vulnerability maps may benefit from incorporating information on heat-associated HAs. Socio-demographic characteristics and possibly green space modify the association between EH and HAs and mortality, though effects vary by city.PhDEnvironmental Health SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/99973/1/gronlund_1.pd

Heat, Heat Waves, and Hospital Admissions among the Elderly in the United States, 1992–2006

Background: Heat-wave frequency, intensity, and duration are increasing with global climate change. The association between heat and mortality in the elderly is well documented, but less is known regarding associations with hospital admissions. Objectives: Our goal was to determine associations between moderate and extreme heat, heat waves, and hospital admissions for nonaccidental causes among Medicare beneficiaries ≥ 65 years of age in 114 cities across five U.S. climate zones. Methods: We used Medicare inpatient billing records and city-specific data on temperature, humidity, and ozone from 1992 through 2006 in a time-stratified case-crossover design to estimate the association between hospitalization and moderate [90th percentile of apparent temperature (AT)] and extreme (99th percentile of AT) heat and heat waves (AT above the 95th percentile over 2–8 days). In sensitivity analyses, we additionally considered confounding by ozone and holidays, different temperature metrics, and alternate models of the exposure–response relationship. Results: Associations between moderate heat and hospital admissions were minimal, but extreme heat was associated with a 3% (95% CI: 2%, 4%) increase in all-cause hospital admissions over the subsequent 8 days. In cause-specific analyses, extreme heat was associated with increased hospitalizations for renal (15%; 95% CI: 9%, 21%) and respiratory (4%; 95% CI: 2%, 7%) diseases, but not for cardiovascular diseases. An added heat-wave effect was observed for renal and respiratory admissions. Conclusion: Extreme heat is associated with increased hospital admissions, particularly for renal causes, among the elderly in the United States. Citation: Gronlund CJ, Zanobetti A, Schwartz JD, Wellenius GA, O’Neill MS. 2014. Heat, heat waves, and hospital admissions among the elderly in the United States, 1992–2006. Environ Health Perspect 122:1187–1192; http://dx.doi.org/10.1289/ehp.120613

Assessing the magnitude and uncertainties of the burden of selected diseases attributable to extreme heat and extreme precipitation under a climate change scenario in Michigan for the period 2041–2070

Abstract Background Extreme heat (EH) and extreme precipitation (EP) events are expected to increase with climate change in many parts of the world. Characterizing the potential future morbidity and mortality burden of EH and EP and associated costs, as well as uncertainties in the estimates, can identify areas for public health intervention and inform adaptation strategies. We demonstrate a burden of disease and uncertainty assessment using data from Michigan, USA, and provide approaches for deriving these estimates for locations lacking certain data inputs. Methods Case-crossover analysis adapted from previous Michigan-specific modeling was used to characterize the historical EH-mortality relationship by county poverty rate and age group. Historical EH-associated hospitalization and emergency room visit risks from the literature were adapted to Michigan. In the U.S. Environmental Protection Agency’s BenMAP software, we used a novel approach, with multiple spatially-varying exposures, to estimate all non-accidental mortality and morbidity occurring on EH days (EH days; days where maximum temperature 32.2–35 C or > 35 C) and EP days. We did so for two time periods: the “historical” period (1971–2000), and the “projected” period (2041–2070), by county. Results The rate of all non-accidental mortality associated with EH days increased from 0.46/100,000 persons historically to 2.9/100,000 in the projected period, for 240 EH-attributable deaths annually. EH-associated ED visits increased from 12/100,000 persons to 68/100,000 persons, for 7800 EH-attributable emergency department visits. EP-associated ED visits increased minimally from 1.7 to 1.9/100,000 persons. Mortality and morbidity were highest among those aged 65+ (91% of all deaths). Projected health costs are dominated by EH-associated mortality ($280 million) and EH-associated emergency department visits ($14 million). A variety of sources contribute to a moderate-to-high degree of uncertainty around the point estimates, including uncertainty in the magnitude of climate change, population composition, baseline health rates, and exposure-response estimates. Conclusions The approach applied here showed that health burden due to climate may significantly rise for all Michigan counties by midcentury. The costs to health care and uncertainties in the estimates, given the potential for substantial attributable burden, provide additional information to guide adaptation measures for EH and EP.https://deepblue.lib.umich.edu/bitstream/2027.42/148825/1/12940_2019_Article_483.pd

Strategies to Reduce the Harmful Effects of Extreme Heat Events: A Four-City Study

Extreme heat events (EHEs) are becoming more intense, more frequent and longer lasting in the 21st century. These events can disproportionately impact the health of low-income, minority, and urban populations. To better understand heat-related intervention strategies used by four U.S. cities, we conducted 73 semi-structured interviews with government and non-governmental organization leaders representing public health, general social services, emergency management, meteorology, and the environmental planning sectors in Detroit, MI; New York City, NY; Philadelphia, PA and Phoenix, AZ—cities selected for their diverse demographics, climates, and climate adaptation strategies. We identified activities these leaders used to reduce the harmful effects of heat for residents in their city, as well as the obstacles they faced and the approaches they used to evaluate these efforts. Local leaders provided a description of how local context (e.g., climate, governance and city structure) impacted heat preparedness. Despite the differences among study cities, political will and resource access were critical to driving heat-health related programming. Upon completion of our interviews, we convened leaders in each city to discuss these findings and their ongoing efforts through day-long workshops. Our findings and the recommendations that emerged from these workshops could inform other local or national efforts towards preventing heat-related morbidity and mortality

Strategies to reduce the harmful effects of extreme heat events: A four-city study

Extreme heat events (EHEs) are becoming more intense, more frequent and longer lasting in the 21st century. These events can disproportionately impact the health of low-income, minority, and urban populations. To better understand heat-related intervention strategies used by four U.S. cities, we conducted 73 semi-structured interviews with government and non-governmental organization leaders representing public health, general social services, emergency management, meteorology, and the environmental planning sectors in Detroit, MI; New York City, NY; Philadelphia, PA and Phoenix, AZ—cities selected for their diverse demographics, climates, and climate adaptation strategies. We identified activities these leaders used to reduce the harmful effects of heat for residents in their city, as well as the obstacles they faced and the approaches they used to evaluate these efforts. Local leaders provided a description of how local context (e.g., climate, governance and city structure) impacted heat preparedness. Despite the differences among study cities, political will and resource access were critical to driving heat-health related programming. Upon completion of our interviews, we convened leaders in each city to discuss these findings and their ongoing efforts through day-long workshops. Our findings and the recommendations that emerged from these workshops could inform other local or national efforts towards preventing heat-related morbidity and mortality

Extreme precipitation and beach closures in the great lakes region: Evaluating risk among the elderly

Abstract: As a result of climate change, extreme precipitation events are expected to increase in frequency and intensity. Runoff from these extreme events poses threats to water quality and human health. We investigated the impact of extreme precipitation and beach closings on the risk of gastrointestinal illness (GI)-related hospital admissions among individuals 65 and older in 12 Great Lakes cities from 2000 to 2006. Poisson regression models were fit in each city, controlling for temperature and long-term time trends. City-specific estimates were combined to form an overall regional risk estimate. Approximately 40,000 GI-related hospital admissions and over 100 beach closure days were recorded from May through September during the study period. Extreme precipitation (≥90th percentile) occurring the previous day (lag 1) is significantly associated with beach closures in 8 of the 12 cities (p < 0.05). However, no association was observed between OPEN ACCESS Int. J. Environ. Res. Public Health 2014, 11 2015 beach closures and GI-related hospital admissions. These results support previous work linking extreme precipitation to compromised recreational water quality

Modeling and comparing central and room air conditioning ownership and cold-season in-home thermal comfort using the American Housing Survey

Household-level information on central air conditioning (cenAC) and room air conditioning (rmAC) air conditioning and cold-weather thermal comfort are often missing from publicly available housing databases hindering research and action on climate adaptation and air pollution exposure reduction. We modeled these using information from the American Housing Survey for 2003-2013 and 140 US core-based statistical areas employing variables that would be present in publicly available parcel records. We present random-intercept logistic regression models with either cenAC, rmAC or "home was uncomfortably cold for 24 h or more" (tooCold) as outcome variables and housing value, rented vs. owned, age, and multi- vs. single-family, each interacted with cooling- or heating-degree days as predictors. The out-of-sample predicted probabilities for years 2015-2017 were compared with corresponding American Housing Survey values (0 or 1). Using a 0.5 probability threshold, the model had 63% specificity (true negative rate), and 91% sensitivity (true positive rate) for cenAC, while specificity and sensitivity for rmAC were 94% and 34%, respectively. Area-specific sensitivities and specificities varied widely. For tooCold, the overall sensitivity was effectively 0%. Future epidemiologic studies, heat vulnerability maps, and intervention screenings may reliably use these or similar AC models with parcel-level data to improve understanding of health risk and the spatial patterning of homes without AC