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Missouri Hyperthermia: Cases, Deaths, and Risk Factors, 1980-2016, Lecture notes of Epidemiology

Johnson UniversityEpidemiology

Data on hyperthermia cases and deaths in Missouri from 1980 to 2016. It includes information on the number of deaths and non-fatal cases, age and sex distribution, and locations of deaths. The document also discusses risk factors for hyperthermia, such as underlying medical conditions, occupations, and locations. The data is presented in tables and charts.

What you will learn

  • Which age groups are most at risk for non-fatal heat-related illnesses?
  • What are the leading risk factors for hyperthermia deaths in Missouri?
  • What are the most common occupations for hyperthermia deaths in Missouri?
  • What percentage of hyperthermia deaths occurred in urban areas versus rural areas?
  • What is the number of hyperthermia deaths in Missouri from 1980 to 2016?

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Hyperthermia
Each year many Missourians suffer from heat-related illnesses, with some cases resulting in
death. During prolonged periods of high temperatures, using air conditioning–either at home or
by seeking shelter in a local cooling center–is the best preventive measure.
The Missouri Department of Health and Senior Services’ (DHSS) Bureau of Environmental
Epidemiology (BEE) monitors high temperatures and humidity across the state in an effort to
help prevent heat-related illness and death. Very young children, senior citizens, and the
chronically ill are more vulnerable to the effects of high temperatures. They perspire less and are
more likely to have health problems requiring medications that can impair the body's response to
heat. Many prescription medications make individuals more sensitive to the heat. Some of these
medications include heart drugs, some anti-Parkinsonian agents, antihistamines, over-the-counter
sleeping pills, antidepressants, anti-psychotics, and major tranquilizers.
The former Missouri Division of Health initiated statewide hyperthermia death surveillance in
1980 in response to a heat wave that resulted in an unprecedented 389 deaths due to Missouri’s
extreme temperatures during July of that summer. Under the Missouri Code of State Regulations,
19 CSR 20.20-020, health care providers have been required to report cases of hyperthermia to
DHSS since 1993. The department conducts on-going statewide surveillance for hot weather-
related illnesses and deaths.
The BEE hyperthermia surveillance program defines hyperthermia as a physician-diagnosed case
of weather-related heat exhaustion, heat stroke, or a death certificate that includes hot weather
exposure as the underlying cause or a contributing cause. Cases are reported by hospital
emergency departments, urgent care centers, and other health care providers. Information on
deaths is received from the DHSS Bureau of Vital Statistics (BVS), medical examiners, and
coroners. The number of deaths reported in this report differs from information published by
BVS, as this report includes deaths that list hot weather exposure as either an underlying or
contributing cause. Data published by BVS and BEE are not directly comparable due to
differences in case ascertainment and classification.
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Download Missouri Hyperthermia: Cases, Deaths, and Risk Factors, 1980-2016 and more Lecture notes Epidemiology in PDF only on Docsity!

Hyperthermia

Each year many Missourians suffer from heat-related illnesses, with some cases resulting in

death. During prolonged periods of high temperatures, using air conditioning–either at home or

by seeking shelter in a local cooling center–is the best preventive measure.

The Missouri Department of Health and Senior Services’ (DHSS) Bureau of Environmental

Epidemiology (BEE) monitors high temperatures and humidity across the state in an effort to

help prevent heat-related illness and death. Very young children, senior citizens, and the

chronically ill are more vulnerable to the effects of high temperatures. They perspire less and are

more likely to have health problems requiring medications that can impair the body's response to

heat. Many prescription medications make individuals more sensitive to the heat. Some of these

medications include heart drugs, some anti-Parkinsonian agents, antihistamines, over-the-counter

sleeping pills, antidepressants, anti-psychotics, and major tranquilizers.

The former Missouri Division of Health initiated statewide hyperthermia death surveillance in

1980 in response to a heat wave that resulted in an unprecedented 389 deaths due to Missouri’s

extreme temperatures during July of that summer. Under the Missouri Code of State Regulations,

19 CSR 20.20-020, health care providers have been required to report cases of hyperthermia to

DHSS since 1993. The department conducts on-going statewide surveillance for hot weather-

related illnesses and deaths.

The BEE hyperthermia surveillance program defines hyperthermia as a physician-diagnosed case

of weather-related heat exhaustion, heat stroke, or a death certificate that includes hot weather

exposure as the underlying cause or a contributing cause. Cases are reported by hospital

emergency departments, urgent care centers, and other health care providers. Information on

deaths is received from the DHSS Bureau of Vital Statistics (BVS), medical examiners, and

coroners. The number of deaths reported in this report differs from information published by

BVS, as this report includes deaths that list hot weather exposure as either an underlying or

contributing cause. Data published by BVS and BEE are not directly comparable due to

differences in case ascertainment and classification.

From 1980 through 2016, there have been 4,377 cases of hyperthermia reported, including 1,

deaths caused by Missouri’s hot weather and high humidity.

Hyperthermia Mortality, Missouri 1980-

Deaths

n=1,

In Missouri, the greatest numbers of heat-related deaths have occurred in the urban, more

densely populated areas of St. Louis City, St Louis County, and Jackson County (Kansas City).

Of the 1,254 Missouri residents who died from hot weather as an underlying or contributing

cause from 1980 through 2016, there were 826 (65.9%) deaths in these metropolitan areas.

Deaths in the less populated counties accounted for 428 (34.1%) of the deaths. Non-Missouri

residents who succumb to heat while visiting our state are also considered cases, accounting for

18 deaths.

Jackson County

St. Louis County

St. Louis City

All Other Counties

Hyperthermia Mortality by County of Residence,

Missouri 1980-

n=1,254 – does not include 18 deaths of non-Missouri residents

Jackson County

St. Louis County

St. Louis City

All Other Counties

Hyperthermia Mortality by County of Death,

Missouri 1980-

n=1,272 - includes 18 deaths of non-Missouri residents

Jackson County

St. Louis City

All Other Counties

n=

Hyperthermia Mortality by County of Residence,

Missouri 1980

In 1980, however, the opposite was seen. In that summer heat wave, there were 179 male deaths

(46%) and 210 (54%) deaths in females.

A more significant difference is shown in the number of non-fatal cases of hyperthermia. Males

are clearly the most frequent victims of non-fatal heat-related illness. Non-fatal cases are very

underreported. Data reported from 2010 through 2016 show 73.2% of the non-fatal cases were

men.

Deaths Non-Fatal Cases

Female

Male

n=4, *Data for non-fatal cases prior to 2010 is unavailable

Hyperthermia Morbidity and Mortality by Sex, Missouri 1980- 2016*

People ages 15 through 64 years are much more likely than senior citizens to become ill with a

non-fatal heat-related illness. Although non-fatal cases are very underreported and data prior to

2010 is unavailable, from 2010 through 2016 there have been 2,665 illnesses reported in people

ages 15 through 64 years, which is 85.8% of the total of 3,105 reported.

Death is much more likely in the <5 years age group as well as in those who are age 65 and

older.

Heat-related illnesses and deaths in the younger population often have contributing causes such

as physical activity (sports or work), complicating medical conditions, or substance abuse.

There have been 189 heat-related illnesses reported, including four deaths, of people

participating in or watching sporting events.

  • A 31-year-old woman died in 2016 after having played five games of softball in the July

heat.

  • A 52-year-old man was admitted to the hospital and died of a heart condition exacerbated by

hot weather after watching an all-terrain vehicle competition at the end of July 2011. The

high outdoor temperature on that day was 99°F. During the prior week, high temperatures

ranged between the upper 90s to 102°F and overnight low temperatures did not drop below

75°F.

Non-Fatal Cases Deaths

Hyperthermia Morbidity and Mortality by Age, Missouri 1980- 2016*

n=4, *Data for non-fatal cases prior to 2010 is unavailable

People who work in extreme heat are at risk for heat-related illness. Stress from exposure to hot

weather can cause heat exhaustion, heat stroke, and even death. Workers at risk of heat stress

include outdoor workers such as farmers, construction workers, landscapers, factory workers,

and others who do not have air conditioning available. Those at even greater risk include those

workers who are age 65 years and older, are overweight, have heart disease or high blood

pressure, or who take medications that make them more susceptible to heat-related illness. Of the

4,377 hyperthermia fatal and non-fatal cases reported from 1980 through 2016, 1,176 (26.9%)

included work as a contributing cause. Males comprised 86.8% of these occupational cases.

Female

Male

Occupational Hyperthermia Cases by Age and Sex, Missouri 1980-2016*

n=1, *Data for non-fatal cases prior to 2010 is unavailable

There have been 37 occupational heat deaths reported from 1980-2016. Ten (27.0%) of these

were farmers or other agricultural workers; eight (21.6%) were carpenters, five (13.5%) were

landscaping workers, two (5.4%) were postal mail carriers, and two (5.4%) were active military.

Other occupations with one death each were fire fighter, real estate agent, logger, brick mason,

roofer, meat processor, welder, truck driver, and freight mover. The occupation was unknown for

one work-related hyperthermia death in 1980.

Farmers/Other Agricultureal Workers

Carpenters/Construction Laborers

Landscaping, Lawn Service, Groundskeeping Workers

Postal Service Mail Carriers

Active Military

All Other Occupations

Unknown Occupation

Hyperthermia Mortality by Occupation, Missouri 1980- 2016

n=

In the 1980 heat wave, an even higher proportion of deaths were people age 65 years and older,

with a total of 279 (71.7%) of the 389 total deaths that summer. There were no deaths in the 5-

or 15-24 year age groups reported for 1980.

In addition to medical conditions such as heart disease, athletics, occupation, substance abuse,

and age, there are many risk factors and contributing causes for hyperthermia. These include

living alone, mental impairment, being in a vehicle, medication use, homelessness, and power

outages. People with one or more of these factors are even more at risk for heat-related illness

and death.

No Risk Factor Reported

Sports/Outdoor Activity

Power Outage

Homeless

Rx/OTC Drug Use

Illicit/Unk Drug/Alcohol Use

Occupational

In Vehicle

Dementia/Mental Impairment

Lived Alone

Heart Disease

Physical Handicap/Obesity/ Underlying Medical Condition

Hyperthermia Mortality by Risk Factor, Missouri 1980-

n=1,616 factors - there may be >1 factor per case n=1,272 cases

The most common location where people become ill and die from hot weather is in their own

home. Over half (50.8%) of the 264 hyperthermia deaths from 2007 through 2016 were of people

who were found deceased inside their residence. People who died outside comprised 17.4% (46)

of deaths. Automobiles were the location in 8.3% (22) of deaths. Other structures such as storage

or abandoned buildings were much less common, being the location of only 6 (2.3%) deaths.

There were 48 people (18.2%) who were transported to a hospital and died either in the

emergency department or as an inpatient due to exposure to hot weather.

Died in Residence Died in Vehicle Other Building Hospital Outside Unknown

Hyperthermia Mortality by Location of Death, Missouri 2007-

n=

Missouri’s highest temperatures generally occur in June, July, and August each summer. Thus,

the majority of hot-weather-related cases also occur during these months. Of the 1,272 deaths

reported from 1980 through 2016 and the 3,105 non-fatal heat-related illnesses from 2010

through 2016, 860 (19.6%) were during the month of June; 2,261 (51.7%) were in July; and 965

(22%) were in August.

APRIL MAY JUNE JULY AUGUST SEPTEMBER OCTOBER

n=4,

Missouri’s variable Midwest weather can cause illness and even deaths in spring and autumn as

well.

  • Four women ages 66, 70, 85, and 88 years of age died within two days when the air

conditioning system of a skilled nursing facility either failed or had not been turned on. The

daytime high temperatures had been between 82°F and 91°F for only a few days in early

April 2001, but the room temperature on the top floor of the three-story brick facility was

reported to be between 95°F and 98°F.

Even in September when night-time temperatures typically cool off, there have been 29 deaths,

13 of which were in people with a known heart or cardiovascular condition.

During heat waves, varying public and private emergency response plans are implemented across

the state. These responses include opening cooling centers, distributing ice and water, and people

checking door-to-door for persons in danger from the heat. Without these local response actions,

public health officials believe mortality from hot weather would be much greater.

Note: Percentages have been rounded and may not total 100%