Abstract
BACKGROUND AND AIM: Days of extreme heat are associated with increased risk of death and hospitalization among older adults. However, the impacts of heat on young and middle-aged adults remain poorly documented. We aimed to quantify the association between heat and all-cause and cause-specific emergency department (ED) visits in the conterminous US among adults aged 18 years and older. METHODS: We analyzed de-identified data from ~22 million ED visits between 2010 and 2019 among adults aged 18 years and older with health insurance living in 2,939 US counties using the OptumLabs® Data Warehouse. We estimated daily population-weighted county average maximum ambient temperature and defined days of extreme heat as those with daily maximum temperature exceeding the 95th percentile of county-specific daily warm-season (May to September) maximum temperature. We used hypothesis-driven and data-driven approaches to evaluate the association between warm-season ambient temperature and all-cause and cause-specific ED visits using a case-crossover study design with a distributed lag nonlinear model. RESULTS:Days of extreme heat over the subsequent five days were associated with a relative risk of 1.08 (95% CI: 1.07, 1.08) for all-cause ED visits, 1.61 (95% CI: 1.58, 1.65) for heat-related illness, and 1.28 (95% CI: 1.24, 1.33) for renal disease, compared to the temperature of minimum morbidity. The association for extreme heat was more pronounced among males and in counties in the US Northern Great Plains. In the data-driven analysis, we identified several previously unrecognized conditions that were statistically significantly associated with extreme heat, including allergic reactions, anxiety disorders, open wounds of extremities, urinary tract infections, and skin infections. CONCLUSIONS:These results suggest that in this large population of adults with commercial health insurance, the adverse health effects of extreme heat are not limited to the older adults or to disorders previously recognized as associated with heat. KEYWORDS: Temperature, Temperature extremes, Climate, Epidemiology
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