Final Report: Heat-related Hospital Admissions Among the Elderly: Community, Socio-economic and Medical Determinants of Vulnerability and Economic Impacts

EPA Grant Number: R832752
Title: Heat-related Hospital Admissions Among the Elderly: Community, Socio-economic and Medical Determinants of Vulnerability and Economic Impacts
Investigators: O'Neill, Marie , Brown, Daniel , Diez Roux, Ana V. , Levy, Helen , Schrag, Daniel , Schwartz, Joel , Stults, Melissa , Williams, Roger , Zanobetti, Antonella
Institution: University of Michigan , Harvard University , ICLEI Local Governments for Sustainability/Cities for Climate Protection Campaign , University of Michigan
EPA Project Officer: Chung, Serena
Project Period: January 1, 2006 through December 1, 2009 (Extended to December 31, 2010)
Project Amount: $576,091
RFA: The Impact of Climate Change & Variability on Human Health (2005) RFA Text |  Recipients Lists
Research Category: Global Climate Change , Health Effects , Health , Climate Change

Objective:

  1.  
    1. Determine whether excess hospital admissions occur among elderly people during hot weather in 34 U.S. cities from cardiovascular, respiratory, diabetes and heat-related causes.
    2. Assess whether vulnerability to heat-associated hospital admission differs according to:
      • co-morbid conditions (diabetes; cardiovascular, respiratory, renal disease; overall frailty).
      • individual characteristics (race, gender, age, use of public vs. private hospital).
      • city-wide characteristics (percent poverty, percent with college education, percent non-white population, air conditioning [AC] prevalence, percent green space, housing characteristics, air pollution concentrations, weather variability, city preventive programs).
  2. Quantify the economic impact of these admissions under different climate change scenarios and adaptive/mitigative strategies, addressing equity concerns.
  3. Disseminate results to city officials in order to foster and inform preventive actions and policies.

Summary/Accomplishments (Outputs/Outcomes):

Although the period of performance of this grant has ended, we continue to conduct analyses on the epidemiological data. We plan to publish these data in peer-reviewed journals and submit them to the Project Officer, citing the EPA grant. Our priority has been to ensure the integrity of the analyses and that the publications reflect a rigorous and thorough approach. The papers (from Objective 1) are not finalized, nor are the economic analyses in Objective 2 that build on them, due in part to several factors.

We increased the size of our analytic dataset. We added three years of Medicare data to the analytic datasets originally anticipated in the grant proposal (so the time series now runs from 1985-2006) and added 101 new cities, so the new number of cities in our analyses is 135. This enhances the statistical power of the study and provides data relevant for many more local communities. We revised our definition of the "cities" for the analysis so that they include counties closest to the temperature monitor we are using.

We explored some key methodological questions about autocorrelation in the exposure series (temperature) and how to handle seasonal smoothing in discontinuous time series. Some of these explorations were inspired by the fact that initial results of the temperature/hospital admission associations were null or even negative when we looked at lags of temperature up to five days prior to the dates of hospital admissions, a result that contradicted previous research looking at temperature and mortality. We did see positive associations with heat on the day of hospital admissions. Although we did present some of the findings from the initial analyses in abstract and poster form (at ISEE 2007), we wanted to further scrutinize them before completing a full-length publication.

We have engaged in the dissemination part (Objective 3) in terms of preliminary findings and better understanding the information needs for preventive actions and policies by interacting with our partners and collaborators. Along with these activities, the dataset compilation and analyses have set the stage for ongoing work in collaboration with academic, government, and non-profit partners.

Conclusions:

The research conducted to date provides a firm foundation for understanding how community and individual factors may play into vulnerability to heat exposure in the United States, and how science can be used by local decision-makers to improve the environment and public health. Specifically, we learned that vulnerability to heat-related health impacts may vary spatially and that inner city areas and northern regions of the United States may be at greater risk. The findings on heat vulnerability of Reid, et al. (2009), funded by this study, have inspired multiple inquiries and at least one California-based follow-up project, which attempts to validate the heat vulnerability index with locally acquired health data. In other words in a particular city (like Seattle), the index suggests that certain census tracts where fewer households have air conditioning and/or have lower incomes may be at greater risk for heat-related health problems during a heat wave. If indeed it is seen that higher mortality or hospital admissions occur in such census tracts during hot weather, this suggests that local Seattle officials may wish to target programs to prevent these adverse impacts for those areas. Prevention programs might include tree planting, opening cooling centers, weatherizing homes, and/or supplying energy efficient cooling devices in certain zones so residents can stay cool and healthy. The validation findings, once published, are likely to inform solutions at a local level to the challenge of adapting to a changing climate.

Though not yet published, our preliminary epidemiologic results to date suggest that the "signal" of heat-associated morbidity may be less strong than that of heat-associated mortality. Given that the instigation of many current public health interventions related to heat (through "heat health warning systems") are mainly informed by heat-mortality associations, this finding sets us at ease that those mortality-based systems may be the most appropriate ones for that particular purpose. However, down the road, we hope to analyze both mortality and morbidity data using consistent methods to assess comparability of those signals. We will then be able to evaluate the economic impacts of these health impacts in a comprehensive and compelling way that will be transparent and useful to local partners. Our efforts to compile a well documented and comprehensive national dataset should benefit ours and others' future efforts to produce high quality scientific analyses to inform public policy and action.

A final potential benefit of the work funded under the grant is the partnerships and contacts that have been developed between the various participants from the academic and public sectors. Through ICLEI, we have reached out to local officials in the environmental management, public health, and social services domains and continue to maintain contact with many of them as we continue with analyses funded by EPA under this STAR grant, as well as projects funded by the Centers for Disease Control and Prevention, the National Aeronautic and Space Administration, and the Graham Environmental Sustainability Institute at the University of Michigan. These new partnerships have added to the understanding by academics of the science needs and challenges of local officials tasked with protecting the environment and public health, and increased the opportunities for the science to be better informed by local priorities and realities.

The key findings, conclusions and results of the published papers to date can be summarized as follows (see abstracts for more details):

O'Neill MS, Jackman DK, Wyman M, Manarolla X, Gronlund CJ, Brown DG, Brines SJ, Schwartz J, Diez-Roux AV. (2010) U.S. local action on heat and health: are we prepared for climate change? International Journal of Public Health 2010;55(2):105-112.

The key message of this paper was that relatively few of our surveyed cities reported active and comprehensive programs addressing heat and health; components of these programs were defined based on EPA guidance. Local government respondents were eager to see examples of case studies of successful programs in other cities.

White-Newsome, JL, O’Neill MS, Gronlund, CJ, Sunbury, TM, Rood, RB, Parker, EA, Brown, DG, Brines, SJ, Rivera, Z. (2009) Climate change, heat waves and environmental justice: advancing knowledge and action. Environmental Justice 2009;2(4):197-205.

This paper presented a framework for examining vulnerability to heat with a focus on environmental justice issues using data and examples from Detroit, Michigan.

Reid, CE, O’Neill MS, Gronlund, CJ, Brines, SJ, Brown, DG, Diez Roux, AV, Schwartz, J. (2009) Mapping community determinants of heat vulnerability. Environmental Health Perspectives 2009;117(11):1730-1736.

This paper created a census tract-level map using an index of heat-related morbidity/mortality derived from six U.S. Census demographic characteristics and two household air conditioning variables, satellite images of vegetation, and diabetes prevalence from a national survey.

Substantial variability in vulnerability was seen across the U.S., and this work has set the stage for several follow-on analyses to validate the work with actual health data.

O'Neill MS, Carter R, Kish JK, Gronlund CJ, White-Newsome JL, Manarolla X, Zanobetti A, Schwartz JD. (2009) Preventing heat-related morbidity and mortality: new approaches in a changing climate. Maturitas 2009;64(2):98-103.

This publication presented a framework for translating epidemiological and other evidence on health effects from heat into decision tools for use by local actors interested in prevention and sustainability. The approach has garnered substantial interest and follow-on work is underway.

Conlon, KC, Rajkovich, NB White-Newsome, JL, Larsen, L, O'Neill, MS. (2011) Preventing cold-related morbidity and mortality in a changing climate. Accepted for publication in Maturitas.

This is a companion review to the heat-related article that was invited by the editor of the same journal, focusing on cold-related health issues, and how climate change may influence them.

The quality assurance procedures and checks led to modification of the final datasets which have been analyzed for the published works and those works in progress.

Workshops

We held two workshops to share results and ideas as planned in the grant. The first one was held as part of the ICLEI Local Action Summit 2010 in Washington, DC, September 24–26, 2010. It was entitled Building Resilience to Climate Change: Adaptation Planning 101 – Conducting a Vulnerability and Risk Assessment and was attended by a number of local officials. The workshop goal was to "provide community decision-makers with the information and tools they need to increase community resilience towards heat-health impacts." The target audience was community decision-makers: elected officials, municipal public health staff, state public health representatives; medical professionals; emergency management personnel; sustainability or climate representatives; and public health clinics. The second workshop was held in Detroit, Michigan, on December 15, 2010. It was entitled Preparing for Increased Heat-Health Events: A Workshop for Community Decision-Makers. We had a similar target audience and the event was well received and attended.


Journal Articles on this Report : 21 Displayed | Download in RIS Format

Other project views: All 38 publications 21 publications in selected types All 21 journal articles
Type Citation Project Document Sources
Journal Article Bell ML, O'Neill MS, Ranjit N, Borja-Aburto VH, Cifuentes LA, Gouveia NC. Vulnerability to heat-related mortality in Latin America: a case-crossover study in Sao Paulo, Brazil, Santiago, Chile and Mexico City, Mexico. International Journal of Epidemiology 2008;37(4):796-804. R832752 (Final)
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  • Journal Article Conlon KC, Rajkovich NB, White-Newsome JL, Larsen L, O'Neill MS. Preventing cold-related morbidity and mortality in a changing climate. Maturitas 2011;69(3):197-202. R832752 (Final)
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  • Journal Article Gronlund CJ, Zanobetti A, Schwartz JD, Wellenius GA, O'Neill MS. Heat, heat waves, and hospital admissions among the elderly in the United States, 1992-2006. Environ Health Perspectives 2014;122(11):1187-1192. R832752 (Final)
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  • Journal Article Li B, Sain S, Mearns LO, Anderson HA, Kovats S, Ebi KL, Bekkedal MYV, Kanarek MS, Patz JA. The impact of extreme heat on morbidity in Milwaukee, Wisconsin. Climatic Change 2012;110(3-4):959-976. R832752 (Final)
    R832750 (2007)
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  • Journal Article O'Neill MS, Bell ML, Ranjit N, Cifuentes LA, Loomis D, Gouveia N, Borja-Aburto VH. Air pollution and mortality in Latin America: the role of education. Epidemiology 2008;19(6):810-819. R832752 (Final)
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  • Journal Article O'Neill MS, Ebi KL. Temperature extremes and health: impacts of climate variability and change in the United States. Journal of Occupational and Environmental Medicine 2009;51(1):13-25. R832752 (Final)
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  • Journal Article O'Neill MS, Carter R, Kish JK, Gronlund CJ, White-Newsome JL, Manarolla X, Zanobetti A, Schwartz JD. Preventing heat-related morbidity and mortality: new approaches in a changing climate. Maturitas 2009;64(2):98-103. R832752 (2009)
    R832752 (Final)
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  • Journal Article O'Neill MS, Jackman DK, Wyman M, Manarolla X, Gronlund CJ, Brown DG, Brines SJ, Schwartz J, Diez-Roux AV. US local action on heat and health: are we prepared for climate change? International Journal of Public Health 2010;55(2):105-112. R832752 (2009)
    R832752 (Final)
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  • Journal Article Oswald EM, Rood RB, Zhang K, Gronlund CJ, O'Neill MS, White-Newsome JL, Brines SJ, Brown DG. An investigation into the spatial variability of near-surface air temperatures in the Detroit, Michigan, metropolitan region. Journal of Applied Meteorology and Climatology 2012;51(7):1290-1304. R832752 (Final)
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  • Journal Article Reid CE, O’Neill MS, Gronlund CJ, Brines SJ, Brown DG, Diez-Roux AV, Schwartz J. Mapping community determinants of heat vulnerability. Environmental Health Perspectives 2009;117(11):1730-1736. R832752 (2009)
    R832752 (Final)
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  • Journal Article Reid CE, Mann JK, Alfasso R, English PB, King GC, Lincoln RA, Margolis HG, Rubado DJ, Sabato JE, West NL, Woods B, Navarro KM, Balmes JR. Evaluation of a heat vulnerability index on abnormally hot days: an environmental public health tracking study. Environmental Health Perspectives 2012;120(5):715-720. R832752 (Final)
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  • Journal Article White-Newsome JL, Sánchez BN, Parker EA, Dvonch JT, Zhang Z, O'Neill MS. Assessing heat-adaptive behaviors among older, urban-dwelling adults. Maturitas 2011;70(1):85-91. R832752 (Final)
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  • Journal Article White-Newsome JL, Sánchez BN, Jolliet O, Zhang Z, Parker EA, Dvonch JT, O'Neill MS. Climate change and health: indoor heat exposure in vulnerable populations. Environmental Research 2012;112:20-27. R832752 (Final)
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  • Journal Article White-Newsome JL, Brines SJ, Brown DG, Dvonch JT, Gronlund CJ, Zhang K, Oswald EM, O'Neill MS. Validating Satellite-derived land surface temperature with in situ measurements:a public health perspective. Environmental Health Perspectives 2013;121(8):925-931. R832752 (Final)
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  • Journal Article White-Newsome J, O’Neill MS, Gronlund C, Sunbury TM, Brines SJ, Parker E, Brown DG, Rood RB, Rivera Z. Climate change, heat waves, and environmental justice: advancing knowledge and action. Environmental Justice 2009;2(4):197-205. R832752 (2009)
    R832752 (Final)
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  • Journal Article Zanobetti A, O'Neill MS, Gronlund CJ, Schwartz JD. Summer temperature variability and long-term survival among elderly people with chronic disease. Proceedings of the National Academy of Sciences of the United States of America 2012;109(17):6608-6613. R832752 (Final)
    R832416 (Final)
    R834798 (2012)
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    R834798 (2014)
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    R834798C002 (2012)
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  • Journal Article Zanobetti A, O'Neill MS, Gronlund CJ, Schwartz JD. Susceptibility to mortality in weather extremes: effect modification by personal and small-area characteristics. Epidemiology 2013;24(6):809-819. R832752 (Final)
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  • Journal Article Zhang K, Oswald EM, Brown DG, Brines SJ, Gronlund CJ, White-Newsome JL, Rood RB, O'Neill MS. Geostatistical exploration of spatial variation of summertime temperatures in the Detroit metropolitan region. Environmental Research 2011;111(8):1046-1053. R832752 (Final)
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  • Journal Article Zhang K, Rood RB, Michailidis G, Oswald EM, Schwartz JD, Zanobetti A, Ebi KL, O'Neill MS. Comparing exposure metrics for classifying 'dangerous heat' in heat wave and health warning systems. Environment International 2012;46:23-29. R832752 (Final)
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  • Journal Article Zhang K, Li Y, Schwartz JD, O'Neill MS. What weather variables are important in predicting heat-related mortality? A new application of statistical learning methods. Environmental Research 2014;132:350-359. R832752 (Final)
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  • Journal Article Zhang K, Chen YH, Schwartz JD, Rood RB, O'Neill MS. Using Forecast and observed weather data to assess performance of forecast products in identifying heat waves and estimating heat wave effects on mortality. Environmental Health Perspectives 2014;122(9):912-918. R832752 (Final)
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  • Supplemental Keywords:

    RFA, Health, Scientific Discipline, Air, ENVIRONMENTAL MANAGEMENT, Health Risk Assessment, climate change, Air Pollution Effects, Risk Assessments, Environmental Monitoring, Ecological Risk Assessment, Atmosphere, Risk Assessment, air quality modeling, ecosystem models, elderly adults, climatic influence, heat related health effects, hormone degradation, modeling, human exposure, climate models, demographics, heart attacks, regional climate model, cardiotoxicity, cardiovascular disease, exposure assessment, Global Climate Change, human health risk, ambient air pollution

    Progress and Final Reports:

    Original Abstract
  • 2006 Progress Report
  • 2007 Progress Report
  • 2008 Progress Report
  • 2009 Progress Report