Skip to main content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Environ Health Perspect. 2003 Nov; 111(14): 1712–1718.
doi: 10.1289/ehp.6336
PMCID: PMC1241712
PMID: 14594620

Changing heat-related mortality in the United States.

Robert E Davis, Paul C Knappenberger, Patrick J Michaels, and Wendy M Novicoff
Author information Copyright and License information PMC Disclaimer

Abstract

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.

Full Text

The Full Text of this article is available as a PDF (227K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  • Applegate WB, Runyan JW, Jr, Brasfield L, Williams ML, Konigsberg C, Fouche C. Analysis of the 1980 heat wave in Memphis. J Am Geriatr Soc. 1981 Aug;29(8):337–342. [PubMed] [Google Scholar]
  • Bonner RM, Harrison MH, Hall CJ, Edwards RJ. Effect of heat acclimatization on intravascular responses to acute heat stress in man. J Appl Physiol. 1976 Nov;41(5 Pt 1):708–713. [PubMed] [Google Scholar]
  • Bridger CA, Ellis FP, Taylor HL. Mortality in St. Louis, Missouri, during heat waves in 1936, 1953, 1954, 1955, and 1966. Environ Res. 1976 Aug;12(1):38–48. [PubMed] [Google Scholar]
  • Bull GM. Meteorological correlates with myocardial and cerebral infarction and respiratory disease. Br J Prev Soc Med. 1973 May;27(2):108–113. [PMC free article] [PubMed] [Google Scholar]
  • Bull GM, Morton J. Environment, temperature and death rates. Age Ageing. 1978 Nov;7(4):210–224. [PubMed] [Google Scholar]
  • Donaldson GC, Keatinge WR. Early increases in ischaemic heart disease mortality dissociated from and later changes associated with respiratory mortality after cold weather in south east England. J Epidemiol Community Health. 1997 Dec;51(6):643–648. [PMC free article] [PubMed] [Google Scholar]
  • Donaldson GC, Keatinge WR, Näyhä S. Changes in summer temperature and heat-related mortality since 1971 in North Carolina, South Finland, and Southeast England. Environ Res. 2003 Jan;91(1):1–7. [PubMed] [Google Scholar]
  • Ellis FP. Mortality from heat illness and heat-aggravated illness in the United States. Environ Res. 1972 Mar;5(1):1–58. [PubMed] [Google Scholar]
  • Ellis FP, Princé HP, Lovatt G, Whittington RM. Mortality and morbidity in Birmingham during the 1976 heatwave. Q J Med. 1980 Winter;49(193):1–8. [PubMed] [Google Scholar]
  • Frost DB, Auliciems A. Myocardial infarct death, the population at risk, and temperature habituation. Int J Biometeorol. 1993 Feb;37(1):46–51. [PubMed] [Google Scholar]
  • Goldman L, Cook EF. The decline in ischemic heart disease mortality rates. An analysis of the comparative effects of medical interventions and changes in lifestyle. Ann Intern Med. 1984 Dec;101(6):825–836. [PubMed] [Google Scholar]
  • Gorjanc ML, Flanders WD, VanDerslice J, Hersh J, Malilay J. Effects of temperature and snowfall on mortality in Pennsylvania. Am J Epidemiol. 1999 Jun 15;149(12):1152–1160. [PubMed] [Google Scholar]
  • Hansen J, Sato M, Glascoe J, Ruedy R. A common-sense climate index: is climate changing noticeably? Proc Natl Acad Sci U S A. 1998 Apr 14;95(8):4113–4120. [PMC free article] [PubMed] [Google Scholar]
  • Henschel A, Burton LL, Margolies L, Smith JE. An analysis of the heat deaths in St. Louis during July, 1966. Am J Public Health Nations Health. 1969 Dec;59(12):2232–2242. [PMC free article] [PubMed] [Google Scholar]
  • Höppe PR. Heat balance modelling. Experientia. 1993 Sep 15;49(9):741–746. [PubMed] [Google Scholar]
  • Jendritzky G, Bucher K, Laschewski G, Walther H. Atmospheric heat exchange of the human being, bioclimate assessments, mortality and thermal stress. Int J Circumpolar Health. 2000 Oct;59(3-4):222–227. [PubMed] [Google Scholar]
  • Jones TS, Liang AP, Kilbourne EM, Griffin MR, Patriarca PA, Wassilak SG, Mullan RJ, Herrick RF, Donnell HD, Jr, Choi K, et al. Morbidity and mortality associated with the July 1980 heat wave in St Louis and Kansas City, Mo. JAMA. 1982 Jun 25;247(24):3327–3331. [PubMed] [Google Scholar]
  • Kalkstein LS. Health and climate change. Direct impacts in cities. Lancet. 1993 Dec 4;342(8884):1397–1399. [PubMed] [Google Scholar]
  • Kalkstein LS, Greene JS. An evaluation of climate/mortality relationships in large U.S. cities and the possible impacts of a climate change. Environ Health Perspect. 1997 Jan;105(1):84–93. [PMC free article] [PubMed] [Google Scholar]
  • Katsouyanni K, Pantazopoulou A, Touloumi G, Tselepidaki I, Moustris K, Asimakopoulos D, Poulopoulou G, Trichopoulos D. Evidence for interaction between air pollution and high temperature in the causation of excess mortality. Arch Environ Health. 1993 Jul-Aug;48(4):235–242. [PubMed] [Google Scholar]
  • Keatinge WR, Coleshaw SR, Easton JC, Cotter F, Mattock MB, Chelliah R. Increased platelet and red cell counts, blood viscosity, and plasma cholesterol levels during heat stress, and mortality from coronary and cerebral thrombosis. Am J Med. 1986 Nov;81(5):795–800. [PubMed] [Google Scholar]
  • Keatinge WR, Donaldson GC, Cordioli E, Martinelli M, Kunst AE, Mackenbach JP, Nayha S, Vuori I. Heat related mortality in warm and cold regions of Europe: observational study. BMJ. 2000 Sep 16;321(7262):670–673. [PMC free article] [PubMed] [Google Scholar]
  • Khaw KT. Temperature and cardiovascular mortality. Lancet. 1995 Feb 11;345(8946):337–338. [PubMed] [Google Scholar]
  • Kilbourne EM, Choi K, Jones TS, Thacker SB. Risk factors for heatstroke. A case-control study. JAMA. 1982 Jun 25;247(24):3332–3336. [PubMed] [Google Scholar]
  • Kunst AE, Looman CW, Mackenbach JP. Outdoor air temperature and mortality in The Netherlands: a time-series analysis. Am J Epidemiol. 1993 Feb 1;137(3):331–341. [PubMed] [Google Scholar]
  • Langford IH, Bentham G. The potential effects of climate change on winter mortality in England and Wales. Int J Biometeorol. 1995 Mar;38(3):141–147. [PubMed] [Google Scholar]
  • Larsen U. Short-term fluctuations in death by cause, temperature, and income in the United States, 1930-1985. Soc Biol. 1990 Fall-Winter;37(3-4):172–187. [PubMed] [Google Scholar]
  • Lerchl A. Changes in the seasonality of mortality in Germany from 1946 to 1995: the role of temperature. Int J Biometeorol. 1998 Dec;42(2):84–88. [PubMed] [Google Scholar]
  • Lye M, Kamal A. Effects of a heatwave on mortality-rates in elderly inpatients. Lancet. 1977 Mar 5;1(8010):529–531. [PubMed] [Google Scholar]
  • Marmor M. Heat wave mortality in New York City, 1949 to 1970. Arch Environ Health. 1975 Mar;30(3):130–136. [PubMed] [Google Scholar]
  • McGeehin MA, Mirabelli M. The potential impacts of climate variability and change on temperature-related morbidity and mortality in the United States. Environ Health Perspect. 2001 May;109 (Suppl 2):185–189. [PMC free article] [PubMed] [Google Scholar]
  • McKee CM. Deaths in winter in Northern Ireland: the role of low temperature. Ulster Med J. 1990 Apr;59(1):17–22. [PMC free article] [PubMed] [Google Scholar]
  • Nakai S, Itoh T, Morimoto T. Deaths from heat-stroke in Japan: 1968-1994. Int J Biometeorol. 1999 Nov;43(3):124–127. [PubMed] [Google Scholar]
  • Oechsli FW, Buechley RW. Excess mortality associated with three Los Angeles September hot spells. Environ Res. 1970 Nov;3(4):277–284. [PubMed] [Google Scholar]
  • Rogot E, Padgett SJ. Associations of coronary and stroke mortality with temperature and snowfall in selected areas of the United States, 1962-1966. Am J Epidemiol. 1976 Jun;103(6):565–575. [PubMed] [Google Scholar]
  • Rogot E, Sorlie PD, Backlund E. Air-conditioning and mortality in hot weather. Am J Epidemiol. 1992 Jul 1;136(1):106–116. [PubMed] [Google Scholar]
  • Schuman SH. Patterns of urban heat-wave deaths and implications for prevention: data from New York and St. Louis during July, 1966. Environ Res. 1972 Mar;5(1):59–75. [PubMed] [Google Scholar]
  • Semenza JC, Rubin CH, Falter KH, Selanikio JD, Flanders WD, Howe HL, Wilhelm JL. Heat-related deaths during the July 1995 heat wave in Chicago. N Engl J Med. 1996 Jul 11;335(2):84–90. [PubMed] [Google Scholar]
  • Seretakis D, Lagiou P, Lipworth L, Signorello LB, Rothman KJ, Trichopoulos D. Changing seasonality of mortality from coronary heart disease. JAMA. 1997 Sep 24;278(12):1012–1014. [PubMed] [Google Scholar]
  • Smoyer KE, Rainham DG, Hewko JN. Heat-stress-related mortality in five cities in Southern Ontario: 1980-1996. Int J Biometeorol. 2000 Nov;44(4):190–197. [PubMed] [Google Scholar]
  • Wyndham CH, Fellingham SA. Climate and disease. S Afr Med J. 1978 Jun 24;53(26):1051–1061. [PubMed] [Google Scholar]
  • Wyndham CH, Rogers GG, Senay LC, Mitchell D. Acclimization in a hot, humid environment: cardiovascular adjustments. J Appl Physiol. 1976 May;40(5):779–785. [PubMed] [Google Scholar]
Articles from Environmental Health Perspectives are provided here courtesy of National Institute of Environmental Health Sciences