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Impact of two recent extreme heat episodes on morbidity and mortality in Adelaide, South Australia: a case-series analysis.

Nitschke M, Tucker GR, Hansen AL, Williams S, Zhang Y, Bi P - Environ Health (2011)

Bottom Line: During the 2009 heatwave, direct heat-related admissions increased up to 14-fold compared to a three-fold increase seen during the 2008 event and during previous heatwaves.Only the 2009 heatwave was associated with considerable increases in total mortality that particularly affected the 15-64 year age group (1.37; 95% CI, 1.09, 1.71), while older age groups were unaffected.It is important that risk factors contributing to the adverse health outcomes are investigated to further improve preventive strategies.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Health, South Australia, 11 Hindmarsh Square Adelaide, South Australia 5000, Australia. monika.nitschke@health.sa.gov.au

ABSTRACT

Background: Extreme heatwaves occurred in Adelaide, South Australia, in the summers of 2008 and 2009. Both heatwaves were unique in terms of their duration (15 days and 13 days respectively), and the 2009 heatwave was also remarkable in its intensity with a maximum temperature reaching 45.7 °C. It is of interest to compare the health impacts of these two unprecedented heatwaves with those of previous heatwaves in Adelaide.

Methods: Using case-series analysis, daily morbidity and mortality rates during heatwaves (≥ 35 °C for three or more days) occurring in 2008 and 2009 and previous heatwaves occurring between 1993 and 2008 were compared with rates during all non-heatwave days (1 October to 31 March). Incidence rate ratios (IRRs) were established for ambulance call-outs, hospital admissions, emergency department presentations and mortality. Dose response effects of heatwave duration and intensity were examined.

Results: Ambulance call-outs during the extreme 2008 and 2009 events were increased by 10% and 16% respectively compared to 4.4% during previous heatwaves. Overall increases in hospital and emergency settings were marginal, except for emergency department presentations in 2008, but increases in specific health categories were observed. Renal morbidity in the elderly was increased during both heatwaves. During the 2009 heatwave, direct heat-related admissions increased up to 14-fold compared to a three-fold increase seen during the 2008 event and during previous heatwaves. In 2009, marked increases in ischaemic heart disease were seen in the 15-64 year age group. Only the 2009 heatwave was associated with considerable increases in total mortality that particularly affected the 15-64 year age group (1.37; 95% CI, 1.09, 1.71), while older age groups were unaffected. Significant dose-response relationships were observed for heatwave duration (ambulance, hospital and emergency setting) and intensity (ambulance and mortality).

Conclusions: While only incremental increases in morbidity and mortality above previous findings occurred in 2008, health impacts of the 2009 heatwave stand out. These findings send a signal that the intense and long 2009 heatwave may have exceeded the capacity of the population to cope. It is important that risk factors contributing to the adverse health outcomes are investigated to further improve preventive strategies.

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Related in: MedlinePlus

Mortality and temperature during the 2009 heatwave. Daily number of deaths, minimum and maximum temperatures during the 2009 heatwave (26 January-7 February 2009)
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Figure 2: Mortality and temperature during the 2009 heatwave. Daily number of deaths, minimum and maximum temperatures during the 2009 heatwave (26 January-7 February 2009)

Mentions: A key difference between the 2008 and 2009 heatwaves compared with previous averaged heatwaves was the effect on mortality. During previous averaged heatwaves, there was no evidence of an increase in total or age-specific mortality. Table 5 indicates that during the 2008 heatwave total mortality increased modestly, with the exception of a significant rise in the 0-4 year age group (IRR 3.23; CI, 1.30-7.99). During the 2009 heatwave, a borderline significant increase in total mortality (IRR 1.10; 95% CI, 0.99-1.22) was observed with a significant increase of 37% (IRR 1.37; 95%CI, 1.09-1.71) in the 15-64 year age group. The older age groups were unaffected. Total estimated excess mortality for the 2009 heatwave was 32.4 (95% CI,-5.5-67) with 23 (95%CI, 7.4-35.7) excess deaths in the 15-64 year age groups. Figure 2 shows the progression of mortality during the 2009 heatwave (26 January - 7 February), with a steep increase in mortality during four days when consecutive temperatures were in excess of 43°C accompanied by unusually hot nights.


Impact of two recent extreme heat episodes on morbidity and mortality in Adelaide, South Australia: a case-series analysis.

Nitschke M, Tucker GR, Hansen AL, Williams S, Zhang Y, Bi P - Environ Health (2011)

Mortality and temperature during the 2009 heatwave. Daily number of deaths, minimum and maximum temperatures during the 2009 heatwave (26 January-7 February 2009)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3116460&req=5

Figure 2: Mortality and temperature during the 2009 heatwave. Daily number of deaths, minimum and maximum temperatures during the 2009 heatwave (26 January-7 February 2009)
Mentions: A key difference between the 2008 and 2009 heatwaves compared with previous averaged heatwaves was the effect on mortality. During previous averaged heatwaves, there was no evidence of an increase in total or age-specific mortality. Table 5 indicates that during the 2008 heatwave total mortality increased modestly, with the exception of a significant rise in the 0-4 year age group (IRR 3.23; CI, 1.30-7.99). During the 2009 heatwave, a borderline significant increase in total mortality (IRR 1.10; 95% CI, 0.99-1.22) was observed with a significant increase of 37% (IRR 1.37; 95%CI, 1.09-1.71) in the 15-64 year age group. The older age groups were unaffected. Total estimated excess mortality for the 2009 heatwave was 32.4 (95% CI,-5.5-67) with 23 (95%CI, 7.4-35.7) excess deaths in the 15-64 year age groups. Figure 2 shows the progression of mortality during the 2009 heatwave (26 January - 7 February), with a steep increase in mortality during four days when consecutive temperatures were in excess of 43°C accompanied by unusually hot nights.

Bottom Line: During the 2009 heatwave, direct heat-related admissions increased up to 14-fold compared to a three-fold increase seen during the 2008 event and during previous heatwaves.Only the 2009 heatwave was associated with considerable increases in total mortality that particularly affected the 15-64 year age group (1.37; 95% CI, 1.09, 1.71), while older age groups were unaffected.It is important that risk factors contributing to the adverse health outcomes are investigated to further improve preventive strategies.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Health, South Australia, 11 Hindmarsh Square Adelaide, South Australia 5000, Australia. monika.nitschke@health.sa.gov.au

ABSTRACT

Background: Extreme heatwaves occurred in Adelaide, South Australia, in the summers of 2008 and 2009. Both heatwaves were unique in terms of their duration (15 days and 13 days respectively), and the 2009 heatwave was also remarkable in its intensity with a maximum temperature reaching 45.7 °C. It is of interest to compare the health impacts of these two unprecedented heatwaves with those of previous heatwaves in Adelaide.

Methods: Using case-series analysis, daily morbidity and mortality rates during heatwaves (≥ 35 °C for three or more days) occurring in 2008 and 2009 and previous heatwaves occurring between 1993 and 2008 were compared with rates during all non-heatwave days (1 October to 31 March). Incidence rate ratios (IRRs) were established for ambulance call-outs, hospital admissions, emergency department presentations and mortality. Dose response effects of heatwave duration and intensity were examined.

Results: Ambulance call-outs during the extreme 2008 and 2009 events were increased by 10% and 16% respectively compared to 4.4% during previous heatwaves. Overall increases in hospital and emergency settings were marginal, except for emergency department presentations in 2008, but increases in specific health categories were observed. Renal morbidity in the elderly was increased during both heatwaves. During the 2009 heatwave, direct heat-related admissions increased up to 14-fold compared to a three-fold increase seen during the 2008 event and during previous heatwaves. In 2009, marked increases in ischaemic heart disease were seen in the 15-64 year age group. Only the 2009 heatwave was associated with considerable increases in total mortality that particularly affected the 15-64 year age group (1.37; 95% CI, 1.09, 1.71), while older age groups were unaffected. Significant dose-response relationships were observed for heatwave duration (ambulance, hospital and emergency setting) and intensity (ambulance and mortality).

Conclusions: While only incremental increases in morbidity and mortality above previous findings occurred in 2008, health impacts of the 2009 heatwave stand out. These findings send a signal that the intense and long 2009 heatwave may have exceeded the capacity of the population to cope. It is important that risk factors contributing to the adverse health outcomes are investigated to further improve preventive strategies.

Show MeSH
Related in: MedlinePlus