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Heat-Associated Mortality -- New York City

The estimated annual death rate in New York City based on data collected during the week ending Friday, June 15, 1984, was 1,343 per 100,000 population, a 35% increase over the average rate for the preceding 4 weeks (Figure 7). This was the highest mortality rate recorded in New York City since January 1981 and was associated with a sudden and severe heat wave--mean daily temperatures* rose from 21.1 C (70 F) in the preceding week to 28.9 C (84 F). The greatest increase was for persons aged 75 years and over, among whom the death rate increased 47%. The death rate for elderly women increased more than for elderly men (Figure 8). Among those aged 75-84 years, death rates rose 39% for men, compared with 66% for women; among those over 85 years old, increases were 13% for men and 55% for women.

The increased number of deaths was almost exclusively among nonhospitalized persons living at home (Table 4). Among persons 65 years or older, there was a 150% increase in the number of deaths occurring at home. There were only small changes in the number of deaths occurring in hospitals or nursing homes.

These data suggest that the noninstitutionalized elderly, particularly women, are at highest risk of heat-associated death. Programs are needed to protect this relatively small but sensitive group during prolonged or severe heat. Reported by AR Kristal, DrPH, S Schultz, MD, DJ Sencer, MD, New York City Dept of Health; Special Studies Br, Chronic Diseases Div, Center for Environmental Health, CDC.

Editorial Note

Editorial Note: This report is consistent with previous descriptions of the dramatic increases in total mortality that may accompany severe heat. Health effects of heat are particularly prominent in urban areas (1-6).

In previous episodes of this sort, physicians have attributed only 10%-60% of the excess deaths directly to the heat, e.g., by a diagnosis of heat stroke. Increases in deaths attributed to cerebrovascular disease and ischemic heart disease have accounted for a large part of the remainder of the excess (1,4-6). Although heat stress may aggravate underlying vascular disease, some deaths attributed to these two causes may be misclassified heatstroke deaths. The predominance of excess deaths among females described in this report was not seen on at least one other occasion when a similar analysis was done (7).

Prevention of heat-related illness in the general population and in persons occupationally exposed to high temperatures has been recently discussed (8,9).

References

  1. Jones TS, Liang AP, Kilbourne EM, et al. Morbidity and mortality associated with the July 1980 heat wave in St. Louis and Kansas City, Missouri. J Am Med Assoc 1982;247:3327-31.

  2. Applegate WB, Runyan JW Jr, Brasfield L, et al. Analysis of the 1980 heat wave in Memphis. Journal of the American Geriatrics Society 1981;29:337-42.

  3. McFarlane A, Waller RE. Short term increases in mortality during heatwaves. Nature 1976;264:434-6.

  4. Ellis FP. Mortality from heat illness and heat-aggravated illness in the United States. Env Res 1972;5:1-58.

  5. Schuman SH, Anderson CP, Oliver JT. Epidemiology of successive heat waves in Michigan in 1962 and 1963. J Am Med Assoc 1964;189:733-8.

  6. Schuman SH. Patterns of urban heat-wave deaths and implications for prevention. Data from New York and St. Louis during July 1966.

  7. Bridger CA, Ellis FP, Taylor HL. Mortality in St. Louis, Missouri, during heat waves in 1936, 1953, 1954, 1955, and 1966. Env Res 1976;12:38-48.

  8. CDC. Illness and death due to environmental heat--Georgia and St. Louis, Missouri, 1983. MMWR 1984;33:325-6.

  9. CDC. Fatalities from occupational heat exposure. MMWR 1984;33:410-2. *The arithmetic mean of the highest and lowest recorded temperatures.

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