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Abstract
Current syndromic surveillance systems can track changes in heat-related illness (HRI) and overall healthcare utilization in real time to provide situational awareness. Retrospective analyses of emergency department and urgent care visits collected via syndromic surveillance data can be used to assess overall contributions of ambient conditions on healthcare utilization. Using distributed lag nonlinear models, syndromic surveillance data from participating facilities in Virginia were analyzed to determine exposure-response relationships using four different meteorological metrics for assessing heat stress. All-cause healthcare visits start to increase at 26 °C (79 °F) maximum daily heat index, whereas HRI visits start to increase at 30 °C (86 °F), with an estimated 6% of healthcare visits attributable to ambient heat during the summer months in Virginia. Results from this study can be used to develop targeted public health messaging when ambient conditions are expected to increase healthcare visits.
Introduction
Each year there are more than 65,000 emergency department visits and 9,235 hospitalizations identified as heat-related illnesses (HRIs) in the U.S. (Centers for Disease Control and Prevention, 2022). HRIs range from rashes and cramps to heat exhaustion and heat stroke (World Health Organization, 2011). During the 2021 record-breaking heat in Oregon and Washington, heat-related emergency department visits were 69 times higher than during the same period in 2019 (Schramm et al., 2021).
Beyond HRI, evidence shows there are associations between high outdoor temperatures and other adverse health outcomes, resulting in increased hospital admissions, emergency department visits, and ambulance requests (Gronlund, 2014). Additionally, Gronlund et al. (2014) found that extreme heat is associated with increased hospital admissions, especially for renal diseases (15%, 95% confidence interval [CI] [9, 21]) and respiratory diseases (4%; 95% CI [2, 7]) among older adults in the U.S. Moreover, Anderson et al. (2013) found that for every 10 °F increase in temperature on the same day, the hospital admission rate for respiratory issues increases on average by 4% over 213 counties in the U.S.
While infrastructure improvements and higher prevalence of air conditioning mitigated HRI in the latter part of the 20th century, evidence suggests that risk of heat-related morbidity and mortality is now increasing due to climate change (Bobb et al., 2014; Davis et al., 2003; Lay et al., 2018). An estimated 37% of the burden...