Real-time surveillance of heat-related morbidity: Relation to excess mortality associated with extreme heat

• Published in: PloS one Vol. 12; no. 9; p. e0184364
• Main Authors: Mathes, Robert W, Ito, Kazuhiko, Lane, Kathryn, Matte, Thomas D
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 06.09.2017; Public Library of Science (PLoS)
• Subjects: Algorithms; Analysis; Cities; Confidence intervals; Daily weather; Data analysis; Data collection; Dispatchers (Transportation); Earth Sciences; Emergencies; Emergency medical services; Emergency Medical Services - statistics & numerical data; Emergency Medicine - statistics & numerical data; Emergency Service, Hospital - statistics & numerical data; Emergency services; Epidemiology; Extreme Heat; Extreme high temperatures; Fatalities; Fever; Health aspects; Health surveillance; Heat; Heat Stress Disorders - therapy; Hot weather; Humans; Hygiene; Illnesses; Linear Models; Medicine and Health Sciences; Morbidity; Mortality; New York; New York City; Parameter estimation; People and Places; Public health; Real time; Risk factors; Seasons; Surveillance; Time Factors; Trends; Weather; Weather conditions; New York; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0184364

The impact of heat on mortality is well documented but deaths tend to occur after (or lag) extreme heat events, and mortality data is generally not available for timely surveillance during extreme heat events. Recently, systems for near-real time surveillance of heat illness have been reported but have not been validated as predictors of non-external cause of deaths associated with extreme heat events. We analyzed associations between daily weather conditions, emergency medical system (EMS) calls flagged as heat-related by EMS dispatchers, emergency department (ED) visits classified as heat-related based on chief complaint text, and excess non-external cause mortality in New York City. EMS and ED data were obtained from data reported daily to the city health department for syndromic surveillance. We fit generalized linear models to assess the relationships of daily counts of heat related EMS and ED visits to non-external cause deaths after adjustment for weather conditions during the months of May-September between 1999 and 2013. Controlling for temporal trends, a 7% (95% confidence interval (CI): 2-12) and 6% (95% CI: 3-10) increase in non-external cause mortality was associated with an increase from the 50th percentile to 99th percentile of same-day and one-day lagged heat-related EMS calls and ED visits, respectively. After controlling for both temporal trends and weather, we observed a 7% (95% CI: 3-12) increase in non-external cause mortality associated with one-day lagged heat-related EMS calls and a 5% mortality increase with one-day lagged ED visits (95% CI: 2-8). Heat-related illness can be tracked during extreme heat events using EMS and ED data which are indicators of heat associated excess non-external cause mortality during the warm weather season.