Abstract
The extreme heat wave in Australia in 2009 resulted in significantly increased number of daily deaths. The circumstances that lead to deaths during extreme heat have not been explored before in Australia. This study aims to identify the individual and community risk factors for deaths during this extreme heat wave in Adelaide. A matched case-control study was conducted. Cases were those who died in the Adelaide metropolitan area during the heat wave period. For each case, two community controls were randomly selected, matched by age and gender. Face-to-face or telephone interviews were conducted to collect data of demographic information, living environment, social support, health status and behavioural changes during the heat wave. Descriptive analysis, as well as simple and multiple conditional logistic regressions were performed. In total, 82 deaths and 164 matched community controls were included in the analysis, with a median age of 77.5 (range 26.6–100.7). The multiple logistic regression model indicated that, compared with controls, the risk of death during the heat wave was significantly increased for people living alone (AOR = 42.31, 95 % CI 2.3, 792.8) or having existing chronic heart disease (AOR = 22.4, 95 % CI 1.7, 303.0). In addition, having air conditioning in bedrooms (AOR = 0.004, 95 % CI 0.00006, 0.28) and participating in social activities more than once a week (AOR = 0.011, 95 % CI 0.0004, 0.29) indicated significant protective effects. We have identified factors that could significantly impact on the likelihood of deaths during heat waves. Our findings could assist in the development of future intervention programs and policies to reduce mortality associated with a warmer climate.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Abrahamson V, Wolf J, Lorenzoni I, Fenn B, Kovats S, Wilkinson P, et al. (2009) Perceptions of heatwave risks to health: interview-based study of older people in London and Norwich, UK. J Public Health (Oxf) 31:119–126
Australian Bureau of Meteorology (2014) State of climate report 2014. Canberra
CAWCR. The Centre for Australian Weather and Climate Research (2013) Defining heatwaves: heatwave defined as a heat-impact event servicing all community and business sectors in Australia. CAWCR Technical Report No. 060. Available at http://www.cawcr.gov.au/technical-reports/CTR_060.pdf
Davido A, Patzak A, Dart T, Sadier M, Méraud P, Masmoudi R, et al. (2006) Risk factors for heat related death during the august 2003 heat wave in Paris, France, in patients evaluated at the emergency department of the hôpital européen georges pompidou. Emerg Med J 23:515–518
Dupont W (1988) Power calculations for matched case-control studies. Biometrics 44:1157–1168
Foroni M, Salvioli G, Rielli R, Goldoni CA, Orlandi G, Sajani SZ, et al. (2007) A retrospective study on heat-related mortality in an elderly population during the 2003 heat wave in Modena, Italy: the argento project. J Gerontol A 62:647–651
Hajat S, Kovats S, Lachowycz K (2007) Heat-related and cold-related deaths in England and wales: who is at risk? Occup Environ Med 64:93–100
Hajat S, O’Connor M, Kosatsky T (2010) Health effects of hot weather: from awareness of risk factors to effective health protection. Lancet 375:856–863
Hansen AL, Bi P, Ryan P, Nitschke M, Pisaniello D, Tucker G (2008a) He effect of heat waves on hospital admissions for renal disease in a temperate city of Australia. Int J Epidemiol 37:1359–1365
Hansen A, Bi P, Nitschke M, Ryan P, Pisaniello D, Tucker G (2008b) The effect of heat waves on mental health in a temperate Australian city. Environ Health Perspect 116:1369–1375
Hansen A, Bi P, Pisaniello D, Nitschke M, Tucker G, Newbury J, et al. (2014) Heat-health behaviours of older people in two Australian states. Australas J Ageing 34:E19–E25
Hanson-Easey S, Bi P, Walker I, Hansen A, Williams SI, Nitschke M, et al. (2013) Public understandings of climate change and adaptation in South Australia, Australia. National Climate Change Adaptation Research Facility, Gold Coast
Harlan SL, Declet-Barreto JH, Stefanov WL, Petitti DB (2013) Neighborhood effects on heat deaths: social and environmental predictors of vulnerability in Maricopa county, Arizona. Environ Health Perspect. doi:10.1289/ehp.1104625
IPCC (2013) Climate change 2013. The 5th assessment report. New York
Knowlton K, Rotkin-Ellman M, King G, Margolis HG, Smith D, Solomon G, et al. (2009) The 2006 California heat wave: impacts on hospitalizations and emergency department visits. Environ Health Perspect 117:61–67
Loughnan ME, Nicholls N, Tapper N (2010) When the heat is on: Threshold temperatures for AMI admissions to hospital in Melbourne Australia. Appl Geogr 30:63–69
Lowe D, Ebi K, Forsberg B (2011) Heatwave early warning systems and adaptation advice to reduce human health consequences of heatwaves. J Environ Res Public Health 8:4623–4648
Nitschke M, Tucker G (2010) The unfolding story of heat waves in Metropolitan Adelaide. SA Health, Adelaide
Nitschke M, Tucker GR, Hansen AL, Williams S, Zhang Y, Bi P. 2011. Impact of two recent extreme heat episodes on morbidity and mortality in Adelaide, South Australia: a case-series analysis. Environ Health 10:42. http://www.ehjournal.net/content/10/41/42
Nitschke M, Hansen AL, Bi P, Pisaniello DL, Newbury J, Kitson A, et al. (2013) Risk factors, health effects and behaviour in older people during extreme heat: a survey in South Australia. Int J Environ Res Public Health 10:6721–6733
Page LA, Hajat S, Kovats RS, Howard LM (2012a) Temperature-related deaths in people with psychosis, dementia and substance misuse. Br J Psychiatry. doi:10.1192/bjp.bp.111.100404 Published 100401 June 102012
Page LA, Hajat S, Kovats RS, Howard LM (2012b) Temperature-related deaths in people with psychosis, dementia and substance misuse. Br J Psychiatry 200:485–490
Sampson NR, Gronlund CJ, Buxton MA, Catalano L, White-Newsome JL, Conlonb KC, et al. (2013) Staying cool in a changing climate: reaching vulnerable populations during heat events. Glob Environ Chang 23:475–484
Semenza JC, Rubin CH, Falter KH, Selanikio JD, Flanders WD, Howe HL, et al. (1996) Heat-related deaths during the july 1995 heat wave in Chicago. N Engl J Med 335:84–90
Vandentorren S, Bretin P, Zeghnoun A, Mandereau-Bruno L, Croisier A, Cochet C, et al. (2006) August 2003 heat wave in France: risk factors for death of elderly people living at home. Eur J Pub Health 16:583–591
Williams S, Nitschke M, Weinstein P, Pisaniello D, Parton K, Bi P (2012) The impact of summer temperatures and heatwaves on mortality and morbidity in Perth, Australia 1994–2008. Environ Int 40:33–38
Williams S, Bi P, Newbury J, Robinson G, Pisaniello D, Saniotis A, et al. (2013) Extreme heat and health: perspectives from health service providers in rural and remote communities in South Australia. Int J Environ Res Public Health 10:5565–5583
Xiang J, Bi P, Pisaniello D, Hansen A (2014) The impact of heatwaves on workers’ health and safety in Adelaide, South Australia. Environ Res 133:90–95
Zhang Y, Nitschke M, P B (2013) Risk factors for direct heat-related hospitalization during the 2009 Adelaide heatwave: a case crossover study. Sci Total Environ 442:1–5
Acknowledgments
The study was supported by the Australian Research Council Linkage Project (LP110200820 to PBI et al) and the Department for Health and Ageing SA. Dr. Ying Zhang was an Australian National Health and Medical Research Council Public Health Training Fellow (602749).
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
This project was approved by the Human Research Ethics Committees (HREC) from both the University of Adelaide (H-101-2010) and the South Australian DHA (376/06/2013). Due to the ethical sensitivity of the study, work was carried out within the DHA in SA as required by the ethical approvals. In order to collect deceased patients’ data from the hospitals’ medical records, ethical approvals were also obtained from each Ethics Committee of relevant hospitals. Consent from subjects participating in the study was received prior to conducting the study.
Competing interests
The authors declare that they have no competing interests.
Appendix: The Questionnaire
Appendix: The Questionnaire
Rights and permissions
About this article
Cite this article
Zhang, Y., Nitschke, M., Krackowizer, A. et al. Risk factors for deaths during the 2009 heat wave in Adelaide, Australia: a matched case-control study. Int J Biometeorol 61, 35–47 (2017). https://doi.org/10.1007/s00484-016-1189-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00484-016-1189-9