Abstract
Exposure to cold weather can cause cold-related illness and death, which are preventable. To understand the current burden, risk factors, and circumstances of exposure for illness and death directly attributed to cold, we examined hospital discharge, death certificate, and medical examiner data during the cold season from 2005 to 2014 in New York City (NYC), the largest city in the United States. On average each year, there were 180 treat-and-release emergency department visits (average annual rate of 21.6 per million) and 240 hospital admissions (29.6 per million) for cold-related illness, and 15 cold-related deaths (1.8 per million). Seventy-five percent of decedents were exposed outdoors. About half of those exposed outdoors were homeless or suspected to be homeless. Of the 25% of decedents exposed indoors, none had home heat and nearly all were living in single-family or row homes. The majority of deaths and illnesses occurred outside of periods of extreme cold. Unsheltered homeless individuals, people who use substances and become incapacitated outdoors, and older adults with medical and psychiatric conditions without home heat are most at risk. This information can inform public health prevention strategies and interventions.
Highlights
Environmental cold causes illness and death in many regions of the world [1,2,3,4,5]
We examine cold-related illness and death, defined in this analysis as hypothermia and tissue damage due to environmental cold exposure, including a detailed investigation of medical examiner records for hypothermia deaths
In New York City (NYC), unsheltered homeless individuals, adults using substances who become incapacitated outdoors, and older adults with mental health conditions living in detached single-family homes without heat are at risk of cold-related death and illness
Summary
Environmental cold causes illness and death in many regions of the world [1,2,3,4,5]. Cold-related illness includes hypothermia, which occurs when the body’s temperature drops below 35 ◦ C (95 ◦ F), and less serious injuries, such as frostbite of the extremities [6]. Cold temperatures can result in illness and death by exacerbating chronic conditions, including respiratory and cardiovascular disease. Some studies have found that mortality has a linear relationship with cold, with deaths occurring over a wide range of temperatures throughout the winter [1]. Other researchers have found no difference in excess mortality burden by seasonal temperature range, theorizing that any differences detected are due to inadequate control for seasonal confounders [8]
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