Using the excess heat factor to indicate heatwave-related urinary disease: a case study in Adelaide, South Australia

  • Matthew Borg
  • Monika Nitschke
  • Susan Williams
  • Stephen McDonald
  • John Nairn
  • Peng BiEmail author
Original Paper


The excess heat factor (EHF) is being adopted nationally for heatwave forecasting in Australia, but there is limited research utilizing it as a predictor for heat-related morbidity from diseases of the urinary system (urinary diseases). In this study, the incidence of eight temperature-prone specific urinary disease categories was analyzed in relation to the EHF. Daily data for maximum and minimum temperature and data for metropolitan hospital emergency department presentations and inpatient admissions for urinary disease were acquired in Adelaide, South Australia, from 1 July 2003 to 31 March 2014. An increased incidence for urolithiasis, acute kidney injury (AKI), chronic kidney disease, and lower urinary tract infections was associated with the EHF. Using the Australian national heatwave definition with the EHF, emergency department presentations increased on heatwave days compared to non-heatwave days for total urinary disease (IRR 1.046, 95% CI 1.016–1.076), urolithiasis (IRR 1.106, 95% 1.046–1.169), and acute kidney injury (AKI) (IRR 1.416, 95% CI 1.258–1.594). Likewise, inpatient admissions increased for total urinary disease (IRR 1.090, 95% CI 1.048–1.133) and AKI (IRR 1.335, 95% CI 1.204–1.480). The EHF is a reliable metric for predicting heat-induced morbidity from urinary disease. Climate change-related elevations in temperature can increase morbidity from urinary disease, especially AKI and urolithiasis. Diseases of the urinary system should be highlighted when providing public health guidance during heatwaves indicated by the EHF.


Heat Heatwaves Excess heat factor Diseases of the urinary system Climate change 



We acknowledge the SA Department of Health for providing hospital admissions data and the Australian Bureau of Meteorology for providing climate data. We also acknowledge Mr. Graeme Tucker and Ms. Anh-Minh Nguyen for their advice on statistical analysis and Dr. Alana Hansen for her assistance and suggestions. Funding was not applicable for this project.


This project did not require funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study formal consent is not required.

Supplementary material

484_2019_1674_MOESM1_ESM.docx (167 kb)
ESM 1 (DOCX 166 kb)
484_2019_1674_MOESM2_ESM.csv (564 kb)
ESM 2 (CSV 564 kb)
484_2019_1674_MOESM3_ESM.csv (559 kb)
ESM 3 (CSV 559 kb)


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Copyright information

© ISB 2019

Authors and Affiliations

  1. 1.School of Public HealthUniversity of AdelaideAdelaideAustralia
  2. 2.SA Health, Government of South AustraliaAdelaideAustralia
  3. 3.The Central Northern Renal and Transplantation ServiceRoyal Adelaide HospitalAdelaideAustralia
  4. 4.South Australian State OfficeBureau of MeteorologyAdelaideAustralia

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