A Case-Crossover Analysis of Indoor Heat Exposure on Mortality and Hospitalizations among the Elderly in Houston, Texas

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Abstract

Background:

Despite the substantial role indoor exposure has played in heat wave–related mortality, few epidemiological studies have examined the health effects of exposure to indoor heat. As a result, knowledge gaps regarding indoor heat–health thresholds, vulnerability, and adaptive capacity persist.

Objective:

We evaluated the role of indoor heat exposure on mortality and morbidity among the elderly ( $\geq 65 years$ of age) in Houston, Texas.

Methods:

Mortality and emergency hospital admission data were obtained through the Texas Department of State Health Services. Summer indoor heat exposure was modeled at the U.S. Census block group (CBG) level using building energy models, outdoor weather data, and building characteristic data. Indoor heat–health associations were examined using time-stratified case-crossover models, controlling for temporal trends and meteorology, and matching on CBG of residence, year, month, and weekday of the adverse health event. Separate models were fitted for three indoor exposure metrics, for individual lag days 0–6, and for 3-d moving averages (lag 0–2). Effect measure modification was explored via stratification on individual- and area-level vulnerability factors.

Results:

We estimated positive associations between short-term changes in indoor heat exposure and cause-specific mortality and morbidity [e.g., circulatory deaths, $odds ratio per 5 ° C increase = 1.16$ (95% CI: 1.03, 1.30)]. Associations were generally positive for earlier lag periods and weaker across later lag periods. Stratified analyses suggest stronger associations between indoor heat and emergency hospital admissions among African Americans compared with Whites.

Discussion:

Findings suggest excess mortality among certain elderly populations in Houston who are likely exposed to high indoor heat. We developed a novel methodology to estimate indoor heat exposure that can be adapted to other U.S. locations. In locations with high air conditioning prevalence, simplified modeling approaches may adequately account for indoor heat exposure in vulnerable neighborhoods. Accounting for indoor heat exposure may improve the estimation of the total impact of heat on health. https://doi.org/10.1289/EHP6340

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Most cited references 80

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The National Human Activity Pattern Survey (NHAPS): a resource for assessing exposure to environmental pollutants.

N E Klepeis, W C Nelson, W R Ott … (2001)

Because human activities impact the timing, location, and degree of pollutant exposure, they play a key role in explaining exposure variation. This fact has motivated the collection of activity pattern data for their specific use in exposure assessments. The largest of these recent efforts is the National Human Activity Pattern Survey (NHAPS), a 2-year probability-based telephone survey (n=9386) of exposure-related human activities in the United States (U.S.) sponsored by the U.S. Environmental Protection Agency (EPA). The primary purpose of NHAPS was to provide comprehensive and current exposure information over broad geographical and temporal scales, particularly for use in probabilistic population exposure models. NHAPS was conducted on a virtually daily basis from late September 1992 through September 1994 by the University of Maryland's Survey Research Center using a computer-assisted telephone interview instrument (CATI) to collect 24-h retrospective diaries and answers to a number of personal and exposure-related questions from each respondent. The resulting diary records contain beginning and ending times for each distinct combination of location and activity occurring on the diary day (i.e., each microenvironment). Between 340 and 1713 respondents of all ages were interviewed in each of the 10 EPA regions across the 48 contiguous states. Interviews were completed in 63% of the households contacted. NHAPS respondents reported spending an average of 87% of their time in enclosed buildings and about 6% of their time in enclosed vehicles. These proportions are fairly constant across the various regions of the U.S. and Canada and for the California population between the late 1980s, when the California Air Resources Board (CARB) sponsored a state-wide activity pattern study, and the mid-1990s, when NHAPS was conducted. However, the number of people exposed to environmental tobacco smoke (ETS) in California seems to have decreased over the same time period, where exposure is determined by the reported time spent with a smoker. In both California and the entire nation, the most time spent exposed to ETS was reported to take place in residential locations.

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Mortality risk attributable to high and low ambient temperature: a multicountry observational study

Antonio Gasparrini, Yuming Guo, Masahiro Hashizume … (2015)

Summary Background Although studies have provided estimates of premature deaths attributable to either heat or cold in selected countries, none has so far offered a systematic assessment across the whole temperature range in populations exposed to different climates. We aimed to quantify the total mortality burden attributable to non-optimum ambient temperature, and the relative contributions from heat and cold and from moderate and extreme temperatures. Methods We collected data for 384 locations in Australia, Brazil, Canada, China, Italy, Japan, South Korea, Spain, Sweden, Taiwan, Thailand, UK, and USA. We fitted a standard time-series Poisson model for each location, controlling for trends and day of the week. We estimated temperature–mortality associations with a distributed lag non-linear model with 21 days of lag, and then pooled them in a multivariate metaregression that included country indicators and temperature average and range. We calculated attributable deaths for heat and cold, defined as temperatures above and below the optimum temperature, which corresponded to the point of minimum mortality, and for moderate and extreme temperatures, defined using cutoffs at the 2·5th and 97·5th temperature percentiles. Findings We analysed 74 225 200 deaths in various periods between 1985 and 2012. In total, 7·71% (95% empirical CI 7·43–7·91) of mortality was attributable to non-optimum temperature in the selected countries within the study period, with substantial differences between countries, ranging from 3·37% (3·06 to 3·63) in Thailand to 11·00% (9·29 to 12·47) in China. The temperature percentile of minimum mortality varied from roughly the 60th percentile in tropical areas to about the 80–90th percentile in temperate regions. More temperature-attributable deaths were caused by cold (7·29%, 7·02–7·49) than by heat (0·42%, 0·39–0·44). Extreme cold and hot temperatures were responsible for 0·86% (0·84–0·87) of total mortality. Interpretation Most of the temperature-related mortality burden was attributable to the contribution of cold. The effect of days of extreme temperature was substantially less than that attributable to milder but non-optimum weather. This evidence has important implications for the planning of public-health interventions to minimise the health consequences of adverse temperatures, and for predictions of future effect in climate-change scenarios. Funding UK Medical Research Council.

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EnergyPlus: creating a new-generation building energy simulation program

Jason Glazer, Drury Crawley, Linda K. Lawrie … (2001)

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Author and article information

Journal

Journal ID (nlm-ta): Environ Health Perspect

Journal ID (iso-abbrev): Environ Health Perspect

Journal ID (publisher-id): EHP

Title: Environmental Health Perspectives

Publisher: Environmental Health Perspectives

ISSN (Print): 0091-6765

ISSN (Electronic): 1552-9924

Publication date (Electronic): 10 December 2020

Publication date Collection: December 2020

Volume: 128

Issue: 12

Electronic Location Identifier: 127007

Affiliations

[ ¹ ]Research Applications Laboratory, National Center for Atmospheric Research , Boulder, Colorado, USA

[ ² ]School of Sustainable Engineering and the Built Environment, Arizona State University , Tempe, Arizona, USA

[ ³ ]Harvard University , Cambridge, Massachusetts, USA

[ ⁴ ]University of Colorado-Boulder , Boulder, Colorado, USA

[ ⁵ ]Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston , Houston, Texas, USA

[ ⁶ ]University of Colorado-Colorado Springs , Colorado Springs, Colorado, USA

[ ⁷ ]Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston , Houston, Texas, USA

[ ⁸ ]Southwest Center for Occupational and Environmental Health, School of Public Health, University of Texas Health Science Center at Houston , Houston, Texas, USA

[ ⁹ ]School of Geographical Sciences and Urban Planning, Arizona State University , Tempe, Arizona, USA

[ ¹⁰ ]University of California, Los Angeles , Los Angeles, USA

Author notes

Address correspondence to Cassandra R. O’Lenick, 3450 Mitchell Ln., Boulder, CO 80301 USA. Telephone: (303) 497-2821. Email: cassie@ 123456ucar.edu

Article

Publisher ID: EHP6340

DOI: 10.1289/EHP6340

PMC ID: 7727721

PubMed ID: 33300819

SO-VID: 40d84928-dec3-4851-830a-db00a7eefa24

License:

EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted.

History

Date received : 04 October 2019

Date revision received : 09 November 2020

Date accepted : 13 November 2020

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A Case-Crossover Analysis of Indoor Heat Exposure on Mortality and Hospitalizations among the Elderly in Houston, Texas

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Abstract

Background:

Objective:

Methods:

Results:

Discussion:

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Most cited references 80

The National Human Activity Pattern Survey (NHAPS): a resource for assessing exposure to environmental pollutants.

Mortality risk attributable to high and low ambient temperature: a multicountry observational study

EnergyPlus: creating a new-generation building energy simulation program

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Cited by 12

Most referenced authors 1,042