Extreme heat increases visits to the emergency department

Studies have long shown people over the age of 65 face an increased risk of hospital admission and death during extreme heat days, but US and Canadian researchers have now found young and middle-aged people are at risk, too.

"By looking at emergency department visits for different causes and for several age groups, we were able to characterise with accuracy the varying impact on health on different populations," says study co-author Francesca Dominici, from the Harvard T.H. Chan School of Public Health.

A goal of the study was to provide actionable information to clinicians and public health experts regarding how to prevent these emergency department (ED) visits, especially considering extreme heat events can be predicted.

Published in the BMJ, the study found extremely hot days - with an average temperature of 34.4°C - are associated with a higher risk of ED presentation for adults of all ages.

The strongest association was for adults between the ages of 18 and 64.

The study looked at more than 74 million adults and 22 million ED visits across 2939 US counties from May to September, 2010 to 2019. It used medical insurance claims data to investigate links between hot days and rates of ED visits for any cause as well as specific causes.

Extreme heat days increased people's risk of an ED visit by 66 per cent for a heat-related illness, as well as by 30 per cent for renal disease.

But the risk varied with age - there was a 10.3 per cent higher risk of ED visits in people ages 45 to 54 years old, compared to a 3.6 per cent higher risk in those older than 75.

"Younger adults may be at greater risk of exposure to extreme heat, particularly among workers that spend substantial time outdoors," says lead author Shengzhi Sun, from the Department of Environmental Health at Boston University School of Public Health (BUSPH).

Gregory Wellenius, professor of environmental health at BUSPH, says many illnesses that lead to utilisation of the ED do not lead to hospitalisation, particularly among younger adults.

"By looking at emergency room visits, we aimed to obtain a more comprehensive picture of the true burden of disease that might be attributed to the days of high heat."

The study also found differences in risk across regions - there was a higher risk of ED visits on extreme heat days in the US' northwest, midwest and northwest, as opposed to the hotter southeast. The researchers say this shows heat is especially dangerous in cooler climates, where people may be less adapted to, or less aware of, heat. This is crucial to recognise as global temperatures rise, particularly as countries decide how to adapt.

Extreme heat is a particular problem in cities. Exposure to deadly urban heat has tripled since the 1980s, and with more than 50 per cent of the world's population living in urban areas, this signals an urgent need to redesign our future cities.