Heat-related deaths--Chicago,Illinois, 1996-2001, and United States, 1979-1999

Heat waves (i.e., >/=3 consecutive days of air temperatures >/=90 degrees F [>/=32.2 degrees C]) are meteorologic events that contribute significantly to heat-related deaths. Exposure to excessive heat can cause illness, injury, and death. This report describes four cases of heat-related deaths, as reported by the Office of the Medical Examiner, Cook County, Chicago, that occurred during 1996-2001; summarizes total heat-related deaths in Chicago during 1996-2001; and compares the number of heat-related deaths during the 1995 and 1999 Chicago heat waves. This report also summarizes trends in the United States during 1979-1999, describes risk factors associated with heat-related deaths and symptoms, and outlines preventive measures for heat-related illness, injury, and death. Persons at risk for heat-related death should reduce strenuous outdoor activities, drink water or nonalcoholic beverages frequently, and seek air conditioning.     

Heat-related deaths--four states,July-August 2001, and United States, 1979-1999

Each year in the United States, approximately 400 deaths are attributed to excessive natural heat; these deaths are preventable. This report describes heat-related deaths in Missouri, New Mexico, Oklahoma, and Texas when elevated temperatures were recorded for several consecutive days during July-August 2001; summarizes heat-related deaths in the United States during 1979-1999; and presents risk factors and preventive measures associated with heat-related illness and death, especially in susceptible populations.     

Heat-related mortality--Arizona, 1993-2002, and United States, 1979-2002

Hyperthermia is the elevation of body temperature resulting from the body's inability to dissipate heat. Continued exposure to ambient heat close to body temperature (98.6 degrees F [37.0 degrees C]) contributes to a substantial number of deaths from hyperthermia, especially among elderly persons. To assess the health risk from hyperthermia, Arizona health practitioners and CDC researched cases of heat-related death and illness in Arizona, used U.S. death certificate data to summarize trends in heat-related deaths, and compared age-specific, heat-related death rates in Arizona with those in the United States overall. Findings indicated that, during 1979-2002, a total of 4,780 heat-related deaths in the United States were attributable to weather conditions and that, during 1993-2002, the incidence of such deaths was three to seven times greater in Arizona than in the United States overall. Public health agencies in communities affected by periods of extreme heat should educate populations at risk (e.g., persons aged > or = 65 years) and consider designing and implementing location-specific heat response plans (HRPs).     

Heat-related deaths among crop workers--United States, 1992--2006

Workers employed in outdoor occupations such as farming are exposed to hot and humid environments that put them at risk for heat-related illness or death. This report describes one such death and summarizes heat-related fatalities among crop production workers in the United States during 1992--2006. During this 15-year period, 423 workers in agricultural and nonagricultural industries were reported to have died from exposure to environmental heat; 68 (16%) of these workers were engaged in crop production or support activities for crop production. The heat-related average annual death rate for these crop workers was 0.39 per 100,000 workers, compared with 0.02 for all U.S. civilian workers. Data aggregated into 5-year periods indicated that heat-related death rates among crop workers might be increasing; however, trend analysis did not indicate a statistically significant increase. Prevention of heat-related deaths among crop workers requires educating employers and workers on the hazards of working in hot environments, including recognition of heat-related illness symptoms, and implementing appropriate heat stress management measures.     

Influenza and pneumococcal vaccination levels among persons aged > or = 65 years--United States, 2001

Two vaccine-preventable diseases, influenza and pneumococcal disease, contribute to the mortality of older persons in the United States. Influenza caused an average of 20,000 deaths per year during influenza epidemics in the United States from 1969 to 1996; persons aged > or = 65 years accounted for approximately 90% of these deaths. Pneumococcal disease caused approximately 3,400 deaths among persons aged > or = 65 years in the United States in 1998. National health objectives for 2010 include increasing influenza and pneumococcal vaccination levels to > or = 90% among persons aged > or = 65 years (objective nos. 14.29a and 14.29b, respectively). To assess progress toward achieving these objectives, CDC analyzed data from the 2001 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results, which indicate that the estimated point prevalences of influenza and pneumococcal vaccination were <80% among persons aged > or = 65 years in all reporting areas. Influenza vaccination levels during 2000-2001 decreased from 1998-1999 levels in 27 of 52 reporting areas; pneumococcal vaccination prevalence increased a median of 7 percentage points from 1999 to 2001. Continued efforts are needed to increase the proportion of older adults who receive influenza and pneumococcal vaccines; health-care providers should offer pneumococcal vaccine all year and should continue to offer influenza vaccine during December and throughout the influenza season, even after influenza activity has been documented in the community.     

Measles--United States, 1999

State and local health departments reported a provisional total of 100 confirmed measles cases to CDC in 1999. This total equals the record low number of cases reported in 1998 (1). Since 1997, measles incidence in the United States has remained < or = 0.5 cases per 1,000,000 population. This report describes the epidemiology of measles during 1999, which indicates that measles is not endemic in the United States.     

Estimating the Incidence of Heat-Related Deaths Among Immigrants in Pima County, Arizona

Widespread media reports have described an increase in heat-related deaths among illegal immigrant border crossers in Southern Arizona in recent years. We conducted a retrospective case series review of heat-related deaths reported by a large border county medical examiner office in an attempt to estimate the occurrence and distribution of these deaths for the years 1998–2003. United States Border Patrol apprehension data were also collected and used in the analysis to estimate the size of the population of border crossers. An increase in the total heat-related deaths has occurred since 1999 in Pima County Arizona and has continued to date. Precise estimates of rates are not possible but appear to have increased as well. Implications for understanding the complexity of researching this public health issue including the definition of cases and population at risk are discussed.     

Probable locally acquired mosquito-transmitted Plasmodium vivax infection--Suffolk County, New York, 1999

In the United States, malaria transmission was eliminated in the 1940s, and malaria eradication was certified in 1970 (1). Since then, 60 small localized outbreaks of probable mosquito-transmitted malaria have been reported to CDC (2-6). Before 1995, the number of imported malaria cases reported to the Suffolk County (New York) Department of Health Services ranged from zero to eight per year. Since 1995, seven to 17 cases per year have been reported. In all of these cases, a history of residing in or traveling to an area with endemic malaria outside the United States was confirmed. This report describes the investigation of two cases of Plasmodium vivax malaria that occurred in Suffolk County in August 1999; the patients had no history of travel outside of the United States.     

Hypothermia-related deaths--United States, 1999-2002 and 2005

Hypothermia, defined as a core body temperature of <95 degrees F (<35 degrees C), is preventable. Excessive exposure to cold temperatures leads to potentially fatal central nervous system depression, arrhythmias, and renal failure. Advanced age, chronic medical conditions, substance abuse, and homelessness are among risk factors for hypothermia-related death. This report describes three hypothermia-related deaths that occurred during 2005 and reviews CDC data on hypothermia-related deaths during 1999-2002 in the United States. Public health strategies should target U.S. populations at increased risk for exposure to excessive cold and recommend behavior modification (e.g., dressing warmly, modifying activity levels, or avoiding alcohol) to help reduce mortality and morbidity from hypothermia.     

Delayed supply of influenza vaccine and adjunct ACIP influenza vaccine recommendations for the 2000-01 influenza season. Advisory Committee on Immunization Practices

Annual vaccination against influenza is the primary means for minimizing serious adverse outcomes from influenza virus infections. These infections result in approximately 20,000 deaths and 110,000 hospitalizations per year in the United States (1). The amount of trivalent inactivated influenza vaccine produced for distribution in the United States has increased substantially; in 1999, four manufacturers produced a combined total of 80 to 85 million doses.     

Vital Signs: Alcohol Poisoning Deaths — United States, 2010–2012

Background

Alcohol poisoning is typically caused by binge drinking at high intensity (i.e., consuming a very large amount of alcohol during an episode of binge drinking). Approximately 38 million U.S. adults report binge drinking an average of four times per month and consuming an average of eight drinks per episode.

Methods

CDC analyzed data for 2010–2012 from the National Vital Statistics System to assess average annual alcohol poisoning deaths and death rates (ICD-10 codes X45 and Y15; underlying cause of death) in the United States among persons aged ≥15 years, by sex, age group, race/ethnicity, and state.

Results

During 2010–2012, an annual average of 2,221 alcohol poisoning deaths (8.8 deaths per 1 million population) occurred among persons aged ≥15 years in the United States. Of those deaths, 1,681 (75.7%) involved adults aged 35–64 years, and 1,696 (76.4%) involved men. Although non-Hispanic whites accounted for the majority of alcohol poisoning deaths (67.5%; 1,500 deaths), the highest age-adjusted death rate was among American Indians/Alaska Natives (49.1 per 1 million). The age-adjusted rate of alcohol poisoning deaths in states ranged from 5.3 per 1 million in Alabama to 46.5 per 1 million in Alaska.

Conclusions

On average, six persons, mostly adult men, die from alcohol poisoning each day in the United States. Alcohol poisoning death rates vary substantially by state.

Implications for Public Health Practice

Evidence-based strategies for preventing excessive drinking (e.g., regulating alcohol outlet density and preventing illegal alcohol sales in retail settings) could reduce alcohol poisoning deaths by reducing the prevalence, frequency, and intensity of binge drinking.     

Changing heat-related mortality in the United States

Heat is the primary weather-related cause of death in the United States. Increasing heat and humidity, at least partially related to anthropogenic climate change, suggest that a long-term increase in heat-related mortality could occur. We calculated the annual excess mortality on days when apparent temperatures--an index that combines air temperature and humidity--exceeded a threshold value for 28 major metropolitan areas in the United States from 1964 through 1998. Heat-related mortality rates declined significantly over time in 19 of the 28 cities. For the 28-city average, there were 41.0 +/- 4.8 (mean +/- SE) excess heat-related deaths per year (per standard million) in the 1960s and 1970s, 17.3 +/- 2.7 in the 1980s, and 10.5 +/- 2.0 in the 1990s. In the 1960s and 1970s, almost all study cities exhibited mortality significantly above normal on days with high apparent temperatures. During the 1980s, many cities, particularly those in the typically hot and humid southern United States, experienced no excess mortality. In the 1990s, this effect spread northward across interior cities. This systematic desensitization of the metropolitan populace to high heat and humidity over time can be attributed to a suite of technologic, infrastructural, and biophysical adaptations, including increased availability of air conditioning.     

Silicosis mortality with respiratory tuberculosis in the United States, 1968-2006

The presence of tuberculosis (TB) in patients with silicosis increases mortality risk. To characterize silicosis-respiratory TB comortality in the United States, the authors used 1968-2006 National Center for Health Statistics multiple cause-of-death data for decedents aged ≥25 years. The authors calculated proportionate mortality ratios (PMRs) using available information on decedents' industries and occupations reported from 26 states from 1985 through 1999. Among 16,648 silicosis deaths, 2,278 (13.7%) had respiratory TB listed on the death certificate. Of silicosis-respiratory TB deaths, 1,666 decedents (73.1%) were aged ≥65 years, 2,255 (99.0%) were male, and 1,893 (83.1%) were white. Silicosis-respiratory TB deaths declined 99.5% during the study period (P < 0.001 for time-related trend), from 239.8 per year during 1968-1972 to 1.2 per year during 2002-2006, with no reported deaths in 2006. Silicosis-respiratory TB deaths reported from Pennsylvania (n = 525; 1.29 per million population), Ohio (n = 258; 0.81 per million), and West Virginia (n = 146; 2.35 per million) accounted for 40.8% of all such deaths in the United States. The highest PMR for silicosis-respiratory TB death was associated with the "miscellaneous nonmetallic mineral and stone products" industry (PMR = 73.7, 95% confidence interval: 33.8, 139.8). In the United States, 2006 marked the first year since 1968 with no silicosis-respiratory TB deaths. The substantial decline in silicosis-respiratory TB comortality probably reflects prevention and control measures for both diseases.     

Annual smoking-attributable mortality,years of potential life lost,and economic costs--United States, 1995-1999

Cigarette smoking is the leading cause of preventable death in the United States and produces substantial health-related economic costs to society. This report presents the annual estimates of the disease impact of smoking in the United States during 1995-1999. CDC calculated national estimates of annual smoking-attributable mortality (SAM), years of potential life lost (YPLL), smoking-attributable medical expenditures (SAEs) for adults and infants, and productivity costs for adults. Results show that during 1995-1999, smoking caused approximately 440,000 premature deaths in the United States annually and approximately $157 billion in annual health-related economic losses. Implementation of comprehensive tobacco-control programs as recommended by CDC could effectively reduce the prevalence, disease impact, and economic costs of smoking.     

State-specific unintentional-injury deaths--United States, 1999-2004

Deaths from unintentional injuries account for approximately two thirds of deaths from all injuries in the United States. Among persons aged 1-44 years, unintentional injuries are the leading cause of death and the leading cause of potential years of life lost before age 65 years. A Healthy People 2010 national objective calls for reducing the rate of deaths caused by unintentional injuries to 17.5 per 100,000 population from a baseline of 35.0 in 1998 (objective 15-13). A second objective calls for reducing the rate of deaths caused by unintentional injuries involving motor-vehicle traffic to 9.2 per 100,000 population from a 1998 baseline of 15.6 (objective 15-15). To determine the progress of states toward meeting these objectives, CDC analyzed vital statistics data for the period 1999-2004. This report summarizes the results of that analysis, which determined that, as of 2004, none of the states had achieved the first Healthy People 2010 objective, and four states and the District of Columbia (DC) had achieved the second. From 1999 to 2004, a total of 13 states reduced their unintentional-injury death rates, and 19 states reduced their motor-vehicle--traffic death rates. Overall in the United States, the rate of deaths caused by unintentional injuries increased 7%, from 35.3 per 100,000 population in 1999 to 37.7 in 2004. These findings underscore the need for states to continue to develop, implement, and evaluate injury-prevention programs and policies to reduce the number of deaths from unintentional injuries.     

Assessing capacity for surveillance, prevention, and control of West Nile virus infection--United States, 1999 and 2004

Indigenous human disease caused by West Nile virus (WNV) was first identified in the United States in August 1999 in the greater New York City area. By the end of 2004, human WNV disease had been reported in all states except Washington, Hawaii, and Alaska, and WNV transmission to humans had been documented by five routes: mosquito bites (principally from Culex spp.), blood transfusions, organ transplantation, transplacental transfer, and breastfeeding. During 1999-2005, a total of 19,525 cases of WNV disease in humans and 771 deaths were reported in the United States. In 2000, CDC first published guidelines for WNV surveillance, prevention, and control and created ArboNET, an electronic surveillance and reporting system. Beginning in 1999, WNV surveillance and prevention activities had been initiated in selected states and large cities through the CDC Epidemiology and Laboratory Capacity (ELC) cooperative agreements for emerging infectious diseases and subsequently expanded to all 50 states, six large cities/counties, and Puerto Rico. In 2005, to assess the capacity of state and large-city/county health departments to conduct WNV surveillance, prevention, and control activities, the Council of State and Territorial Epidemiologists (CSTE), with assistance from the Association of Public Health Laboratories (APHL) and CDC, surveyed WNV programs in the 50 states and six large-city/county health departments. This report describes the results of that assessment, which indicated that all participating states and cities had well-developed surveillance and control programs for human, avian, equine, or mosquito WNV.     

Measles--United States, 2005

Measles is a highly infectious, acute viral illness that can be complicated by severe pneumonia, diarrhea, and encephalitis and can result in death. In the prevaccine era, approximately 500,000 cases of measles occurred annually in the United States. During 2005, local and state health departments reported to CDC 66 confirmed cases of measles (incidence rate: less than one case per 1 million population), 34 of which were from a single outbreak in Indiana associated with infection in a traveler returning to the United States. This report describes the epidemiology of U.S. measles cases in 2005 and documents the absence of endemic measles and the continued risk for imported measles infections that can result in transmission within the United States. The findings underscore the need to maintain the highest possible measles vaccination coverage in the United States and to adhere to recommendations regarding measles vaccination.     

Heat wave morbidity and mortality, Milwaukee, Wis, 1999 vs 1995: an improved response?

OBJECTIVES: This study examined whether differences in heat alone, as opposed to public health interventions or other factors, accounted for the reduction in heat-related deaths and paramedic emergency medical service (EMS) runs between 1995 and 1999 during 2 heat waves occurring in Milwaukee, Wis. METHODS: Two previously described prediction models were adapted to compare expected and observed heat-related morbidity and mortality in 1999 based on the city's 1995 experience. RESULTS: Both models showed that heat-related deaths and EMS runs in 1999 were at least 49% lower than levels predicted by the 1995 relation between heat and heat-related deaths or EMS runs. CONCLUSIONS: Reductions in heat-related morbidity and mortality in 1999 were not attributable to differences in heat levels alone. Changes in public health preparedness and response may also have contributed to these reductions.     

Annual smoking-attributable mortality, years of potential life lost, and productivity losses--United States, 1997-2001

Smoking harms nearly every organ of the body, causing many diseases and reducing quality of life and life expectancy. This report assesses the health consequences and productivity losses attributable to smoking in the United States during 1997-2001. CDC calculated national estimates of annual smoking-attributable mortality (SAM), years of potential life lost (YPLL) for adults and infants, and productivity losses for adults. The findings indicated that, during 1997-2001, cigarette smoking and exposure to tobacco smoke resulted in approximately 438,000 premature deaths in the United States, 5.5 million YPLL, and 92 billion dollars in productivity losses annually. Implementation of comprehensive tobacco-control programs as recommended by CDC can reduce smoking prevalence and related mortality and health-care costs.     

Estimation and Uncertainty Analysis of Impacts of Future Heat Waves on Mortality in the Eastern United States

Background: Climate change is anticipated to influence heat-related mortality in the future. However, estimates of excess mortality attributable to future heat waves are subject to large uncertainties and have not been projected under the latest greenhouse gas emission scenarios.Objectives: We estimated future heat wave mortality in the eastern United States (approximately 1,700 counties) under two Representative Concentration Pathways (RCPs) and investigated sources of uncertainty.Methods: Using dynamically downscaled hourly temperature projections for 2057–2059, we projected heat wave days that were defined using four heat wave metrics and estimated the excess mortality attributable to them. We apportioned the sources of uncertainty in excess mortality estimates using a variance-decomposition method.Results: Estimates suggest that excess mortality attributable to heat waves in the eastern United States would result in 200–7,807 deaths/year (mean 2,379 deaths/year) in 2057–2059. Average excess mortality projections under RCP4.5 and RCP8.5 scenarios were 1,403 and 3,556 deaths/year, respectively. Excess mortality would be relatively high in the southern states and eastern coastal areas (excluding Maine). The major sources of uncertainty were the relative risk estimates for mortality on heat wave versus non–heat wave days, the RCP scenarios, and the heat wave definitions.Conclusions: Mortality risks from future heat waves may be an order of magnitude higher than the mortality risks reported in 2002–2004, with thousands of heat wave–related deaths per year in the study area projected under the RCP8.5 scenario. Substantial spatial variability in county-level heat mortality estimates suggests that effective mitigation and adaptation measures should be developed based on spatially resolved data.Citation: Wu J, Zhou Y, Gao Y, Fu JS, Johnson BA, Huang C, Kim YM, Liu Y. 2014. Estimation and uncertainty analysis of impacts of future heat waves on mortality in the eastern United States. Environ Health Perspect 122:10–16; http://dx.doi.org/10.1289/ehp.1306670