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Environ Health Perspect. 2017 May 31;125(5):057009. doi: 10.1289/EHP44.

Time-series Analysis of Heat Waves and Emergency Department Visits in Atlanta, 1993 to 2012.

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Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA
Department of Environmental Health, Emory University, Atlanta, Georgia, USA
Department of Geography, University of Georgia, Athens, Georgia, USA



Heat waves are extreme weather events that have been associated with adverse health outcomes. However, there is limited knowledge of heat waves' impact on population morbidity, such as emergency department (ED) visits.


We investigated associations between heat waves and ED visits for 17 outcomes in Atlanta over a 20-year period, 1993-2012.


Associations were estimated using Poisson log-linear models controlling for continuous air temperature, dew-point temperature, day of week, holidays, and time trends. We defined heat waves as periods of consecutive days with temperatures beyond the 98th percentile of the temperature distribution over the period from 1945-2012. We considered six heat wave definitions using maximum, minimum, and average air temperatures and apparent temperatures. Associations by heat wave characteristics were examined.


Among all outcome-heat wave combinations, associations were strongest between ED visits for acute renal failure and heat waves defined by maximum apparent temperature at lag 0 [relative risk (RR) = 1.15; 95% confidence interval (CI): 1.03-1.29], ED visits for ischemic stroke and heat waves defined by minimum temperature at lag 0 (RR = 1.09; 95% CI: 1.02-1.17), and ED visits for intestinal infection and heat waves defined by average temperature at lag 1 (RR = 1.10; 95% CI: 1.00-1.21). ED visits for all internal causes were associated with heat waves defined by maximum temperature at lag 1 (RR = 1.02; 95% CI: 1.00, 1.04).


Heat waves can confer additional risks of ED visits beyond those of daily air temperature, even in a region with high air-conditioning prevalence.

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