Heat-related emergency hospitalizations for respiratory diseases in the Medicare population.

RATIONALE The heat-related risk of hospitalization for respiratory diseases among the elderly has not been quantified in the United States on a national scale. With climate change predictions of more frequent and more intense heat waves, it is of paramount importance to quantify the health risks related to heat, especially for the most vulnerable. OBJECTIVES To estimate the risk of hospitalization for respiratory diseases associated with outdoor heat in the U.S. elderly. METHODS An observational study of approximately 12.5 million Medicare beneficiaries in 213 United States counties, January 1, 1999 to December 31, 2008. We estimate a national average relative risk of hospitalization for each 10°F (5.6°C) increase in daily outdoor temperature using Bayesian hierarchical models. MEASUREMENTS AND MAIN RESULTS We obtained daily county-level rates of Medicare emergency respiratory hospitalizations (International Classification of Diseases, Ninth Revision, 464-466, 480-487, 490-492) in 213 U.S. counties from 1999 through 2008. Overall, each 10°F increase in daily temperature was associated with a 4.3% increase in same-day emergency hospitalizations for respiratory diseases (95% posterior interval, 3.8, 4.8%). Counties' relative risks were significantly higher in counties with cooler average summer temperatures. CONCLUSIONS We found strong evidence of an association between outdoor heat and respiratory hospitalizations in the largest population of elderly studied to date. Given projections of increasing temperatures from climate change and the increasing global prevalence of chronic pulmonary disease, the relationship between heat and respiratory morbidity is a growing concern.

[1]  J. Marini,et al.  Effect of heat delivery and extraction on airway conductance in normal and in asthmatic subjects. , 1985, The American review of respiratory disease.

[2]  G. Davey Smith,et al.  The natural history of chronic obstructive pulmonary disease , 2006, European Respiratory Journal.

[3]  Daniel Oudin Åström,et al.  Heat wave impact on morbidity and mortality in the elderly population: a review of recent studies. , 2011, Maturitas.

[4]  Rupa Basu,et al.  The Effect of High Ambient Temperature on Emergency Room Visits , 2012, Epidemiology.

[5]  James M. Calm,et al.  Emissions and environmental impacts from air-conditioning and refrigeration systems , 2002 .

[6]  Paul Wilkinson,et al.  Declining vulnerability to temperature-related mortality in London over the 20th century. , 2006, American journal of epidemiology.

[7]  George Havenith,et al.  Temperature regulation, heat balance and climatic stress , 2005 .

[8]  John M. Johnson,et al.  Cardiovascular Adjustments to Heat Stress , 2011 .

[9]  R. Basu,et al.  The effect of temperature on hospital admissions in nine California counties , 2010, International Journal of Public Health.

[10]  Richard H. Jones,et al.  Atmospheric mold spore counts in relation to meteorological parameters , 1997, International journal of biometeorology.

[11]  Sabit Cakmak,et al.  Influence of outdoor aeroallergens on hospitalization for asthma in Canada. , 2004, The Journal of allergy and clinical immunology.

[12]  Glen P. Kenny,et al.  Heat stress in older individuals and patients with common chronic diseases , 2010, Canadian Medical Association Journal.

[13]  M. White.  Components and mechanisms of thermal hyperpnea. , 2006, Journal of applied physiology.

[14]  S B Thacker,et al.  Morbidity and mortality associated with the July 1980 heat wave in St Louis and Kansas City, Mo. , 1982, JAMA.

[15]  Mark J. Mendell,et al.  Respiratory and Allergic Health Effects of Dampness, Mold, and Dampness-Related Agents: A Review of the Epidemiologic Evidence , 2011, Environmental health perspectives.

[16]  F. Dominici,et al.  Ozone and short-term mortality in 95 US urban communities, 1987-2000. , 2004, JAMA.

[17]  P. Nastos.  Weather, Ambient Air Pollution and Bronchial Asthma in Athens, Greece , 2008 .

[18]  Lu-Yuan Lee,et al.  TRPV1 as a cough sensor and its temperature-sensitive properties. , 2011, Pulmonary pharmacology & therapeutics.

[19]  C. Morris,et al.  Inference for multivariate normal hierarchical models , 2000 .

[20]  Don D. Sin,et al.  Why Are Patients With Chronic Obstructive Pulmonary Disease at Increased Risk of Cardiovascular Diseases?: The Potential Role of Systemic Inflammation in Chronic Obstructive Pulmonary Disease , 2003 .

[21]  K. R. Chapman,et al.  Epidemiology and costs of chronic obstructive pulmonary disease , 2006, European Respiratory Journal.

[22]  Francesca Dominici,et al.  Hospital admissions and chemical composition of fine particle air pollution. , 2009, American journal of respiratory and critical care medicine.

[23]  Carrie A. Werner,et al.  The Older Population: 2010 , 2010 .

[24]  M. Bell,et al.  Spatial and temporal modeling of daily pollen concentrations , 2011, International Journal of Biometeorology.

[25]  Don Hayes,et al.  Bronchoconstriction triggered by breathing hot humid air in patients with asthma: role of cholinergic reflex. , 2012, American journal of respiratory and critical care medicine.

[26]  F. Dominici,et al.  Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases. , 2006, JAMA.

[27]  Gail M. Williams,et al.  Does Particulate Matter Modify the Association between Temperature and Cardiorespiratory Diseases? , 2006, Environmental health perspectives.

[28]  Lu-Yuan Lee,et al.  Bronchoconstriction induced by hyperventilation with humidified hot air: role of TRPV1-expressing airway afferents. , 2009, Journal of applied physiology.

[29]  Julia M. Gohlke,et al.  A human health perspective on climate change: a report outlining the research needs on the human health effects of climate change , 2010 .

[30]  M. Cabanac,et al.  Core temperature thresholds for hyperpnea during passive hyperthermia in humans , 2004, European Journal of Applied Physiology and Occupational Physiology.

[31]  L. Leon,et al.  Heat stroke: role of the systemic inflammatory response. , 2010, Journal of applied physiology.

[32]  Gina Solomon,et al.  The 2006 California Heat Wave: Impacts on Hospitalizations and Emergency Department Visits , 2008, Environmental health perspectives.

[33]  Shilu Tong,et al.  Temperature modifies the health effects of particulate matter in Brisbane, Australia , 2006, International journal of biometeorology.

[34]  M. Mcgeehin,et al.  Excess hospital admissions during the July 1995 heat wave in Chicago. , 1999, American journal of preventive medicine.

[35]  Wendy M Novicoff,et al.  Changing heat-related mortality in the United States. , 2003, Environmental health perspectives.

[36]  L. P. Smith,et al.  Weather and the grass pollen content of the air , 1974, Clinical allergy.

[37]  Wilhelm Kirch,et al.  Extreme weather events and public health responses , 2005 .

[38]  Michelle L. Bell,et al.  Weather-Related Mortality: How Heat, Cold, and Heat Waves Affect Mortality in the United States , 2009, Epidemiology.

[39]  Shilu Tong,et al.  Ambient Temperature and Morbidity: A Review of Epidemiological Evidence , 2011, Environmental health perspectives.

[40]  Michelle L Bell,et al.  Lights Out: Impact of the August 2003 Power Outage on Mortality in New York, NY , 2011, Epidemiology.

[41]  R. Basu,et al.  The effects of temperature and use of air conditioning on hospitalizations. , 2010, American journal of epidemiology.

[42]  E. Lofgren,et al.  Influenza Seasonality: Underlying Causes and Modeling Theories , 2006, Journal of Virology.

[43]  Annibale Biggeri,et al.  Impact of High Temperatures on Mortality: Is There an Added Heat Wave Effect? , 2006, Epidemiology.

[44]  Chandler Brooks.  THE REGULATION OF BODY TEMPERATURE , 1948, Medical Journal of Australia.

[45]  H. R. Anderson,et al.  High temperature and hospitalizations for cardiovascular and respiratory causes in 12 European cities. , 2009, American journal of respiratory and critical care medicine.

[46]  S. Sain,et al.  The impact of extreme heat on morbidity in Milwaukee, Wisconsin , 2012, Climatic Change.

[47]  Shubhayu Saha,et al.  Excessive Heat and Respiratory Hospitalizations in New York State: Estimating Current and Future Public Health Burden Related to Climate Change , 2012, Environmental health perspectives.

[48]  Shao Lin,et al.  Extreme High Temperatures and Hospital Admissions for Respiratory and Cardiovascular Diseases , 2009, Epidemiology.

[49]  D. Newby,et al.  Heat and haze: a forecast for myocardial infarction? , 2009, Heart.

[50]  S. Tong,et al.  Ambient Temperature and Cardiorespiratory Morbidity: A Systematic Review and Meta-analysis , 2012, Epidemiology.