, Volume 15, Issue 3, pp 485–496 | Cite as

Climate Change and Heat-Related Excess Mortality in the Eastern USA

  • Vijay S. LimayeEmail author
  • Jason Vargo
  • Monica Harkey
  • Tracey Holloway
  • Jonathan A. Patz
Original Contribution


Climate change will increase extreme heat-related health risks. To quantify the health impacts of mid-century climate change, we assess heat-related excess mortality across the eastern USA. Health risks are estimated using the US Environmental Protection Agency’s Environmental Benefits Mapping and Analysis Program (BenMAP). Mid-century temperature estimates, downscaled using the Weather Research and Forecasting model, are compared to 2007 temperatures at 36 km and 12 km resolutions. Models indicate the average apparent and actual summer temperatures rise by 4.5° and 3.3° C, respectively. Warmer average apparent temperatures could cause 11,562 additional annual deaths (95% confidence interval, CI: 2641–20,095) due to cardiovascular stress in the population aged 65 years and above, while higher minimum temperatures could cause 8767 (95% CI: 5030–12,475) additional deaths each year. Modeled future climate data available at both coarse (36 km) and fine (12 km) resolutions predict significant human health impacts from warmer climates. The findings suggest that currently available information on future climates is sufficient to guide regional planning for the protection of public health. Higher resolution climate and demographic data are still needed to inform more targeted interventions.


Heat wave Heat stress Climate modeling Health impact assessment Downscaling Scenario Climate change 



Research was supported by the U.S. National Institute of Environmental Health Sciences (NIEHS) Grant 1R21ES020232-01. V.L. was also supported by NSF Grant DGE-0549407, an Integrative Graduate Education and Research Traineeship (IGERT) titled “Vulnerability and Sustainability in Coupled Human-Natural Systems.” TH and MH were also supported by the NASA Air Quality Applied Sciences Team (AQAST). We acknowledge the North American Regional Climate Change Assessment Program (NARCCAP) and the National Climatic Data Center (NCDC) for providing the data used in this paper. NARCCAP is funded by the National Science Foundation, the U.S. Department of Energy, the National Oceanic and Atmospheric Administration, and the U.S. Environmental Protection Agency Office of Research and Development. The NCDC provided North American Regional Reanalysis (NARR) data from the National Centers for Environmental Prediction (NCEP), a division of NOAA/National Weather Service.


  1. Abel DW, Holloway T, Harkey M, Meier P, Ahl D, Limaye VS, Patz JA (2018) Air-quality-related health impacts from climate change and from adaptation of cooling demand for buildings in the Eastern United States: an interdisciplinary modeling study. PLoS Medicine 15 (7): 27. CrossRefGoogle Scholar
  2. Abt Associates (2010) BenMAP manual appendices.
  3. Anderson G. Brooke, and Michelle L. Bell 2011. “Heat Waves in the United States: Mortality Risk during Heat Waves and Effect Modification by Heat Wave Characteristics in 43 US communities.” Environmental Health Perspectives 119 (2): 210.CrossRefGoogle Scholar
  4. Basu, R. 2002. “Relation between Elevated Ambient Temperature and Mortality: A Review of the Epidemiologic Evidence.” Epidemiologic Reviews 24 (2): 190–202.CrossRefGoogle Scholar
  5. Basu R (2008) Characterizing temperature and mortality in nine California counties, 1999–2003CrossRefGoogle Scholar
  6. Basu, Rupa. 2009. “High Ambient Temperature and Mortality: A Review of Epidemiologic Studies from 2001 to 2008.” Environmental Health 8 (1): 40. Scholar
  7. Basu, R., and B. D. Ostro. 2008. “A Multicounty Analysis Identifying the Populations Vulnerable to Mortality Associated with High Ambient Temperature in California.” American Journal of Epidemiology 168 (6): 632–637.CrossRefGoogle Scholar
  8. Basu, Rupa, Francesca Domini, and Jonathan M. Samet. 2005. “Temperature and Mortality among the Elderly in the United States: A Comparison of Epidemiologic Methods.” Epidemiology 16 (1): 58–66.CrossRefGoogle Scholar
  9. Bateson, Thomas F., and Joel Schwartz. 2001. “Selection Bias and Confounding in Case-Crossover Analyses of Environmental Time-Series Data.” Epidemiology 12 (6): 654–661.CrossRefGoogle Scholar
  10. Braga, Alfésio Luís Ferreira, Antonella Zanobetti, and Joel Schwartz. 2001. “The Time Course of Weather-Related Deaths.” Epidemiology 12 (6): 662–667.CrossRefGoogle Scholar
  11. Centers for Disease Control and Prevention (2013) Heat-related deaths after an extreme heat event—four states, 2012, and United States, 1999–2009. MMWR Weekly.
  12. Centers for Disease Control and Prevention (2014) NCHS urban-rural classification scheme for counties. Accessed March 8, 2014.
  13. Deschênes O, Greenstone M (2007) Climate Change, Mortality, and Adaptation: Evidence from Annual Fluctuations in Weather in the US. Working Paper 07-19. Cambridge, MA: Massachusetts Institute of TechnologyGoogle Scholar
  14. Diffenbaugh NS (2005) Fine-Scale Processes Regulate the Response of Extreme Events to Global Climate Change.” Proceedings of the National Academy of Sciences 102 (44): 15774–78. Scholar
  15. Donoghue ER, Graham MA, Jentzen JM, Lifschultz BD, Luke JL, Mirchandani HG, National Association of Medical Examiners Ad Hoc Committee on the Definition of Heat-Related Fatalities (1997) Criteria for the diagnosis of heat-related deaths: national association of medical examiners: position paper. The American Journal of Forensic Medicine and Pathology 18 (1).
  16. Doyon D, Belanger O, Grosselin P (2008) The potential impact of climate change on annual and seasonal mortals to three cities in Qwebec, Canada. International Journal of Health Geographics 7(1):23CrossRefGoogle Scholar
  17. Fann N, Lamson AD, Anenberg SC, Wesson K, Risley D, Hubbell BJ (2012) Estimating the national public health burden associated with exposure to ambient PM2.5 and Ozone: U.S. Public Health Burden of PM2.5 and Ozone.” Risk Analysis 32 (1): 81–95. Scholar
  18. Filleul, Laurent, Sylvie Cassadou, Sylvia Médina, Pascal Fabres, Agnés Lefranc, Daniel Eilstein, Alain Le Tertre, et al. 2006. “The Relation Between Temperature, Ozone, and Mortality in Nine French Cities During the Heat Wave of 2003.” Environmental Health Perspectives 114 (9): 1344–47. Scholar
  19. Goodess, Clare M. 2013. “How Is the Frequency, Location and Severity of Extreme Events Likely to Change up to 2060?” Environmental Science & Policy 27 (March): S4–14. Scholar
  20. Grabow, Maggie L, Scott N Spak, Tracey Holloway, Brian Stone Jr, Adam C Mednick, and Jonathan A Patz. 2012. “Air Quality and Exercise-Related Health Benefits from Reduced Car Travel in the Midwestern United States.” Environmental Health Perspectives 120 (1): 68.CrossRefGoogle Scholar
  21. Greene, Scott, Laurence S. Kalkstein, David M. Mills, and Jason Samenow. 2011. “An Examination of Climate Change on Extreme Heat Events and Climate–Mortality Relationships in Large U.S. Cities.” Weather, Climate, and Society 3 (4): 281–92. Scholar
  22. Hajat, Shakoor, R Sari Kovats, Richard W Atkinson, and Andy Haines. 2002. “Impact of Hot Temperatures on Death in London: A Time Series Approach.” Journal of Epidemiology & Community Health 56 (5): 367–72.CrossRefGoogle Scholar
  23. Hajat, Shakoor, Madeline O’Connor, and Tom Kosatsky. 2010. “Health Effects of Hot Weather: From Awareness of Risk Factors to Effective Health Protection.” The Lancet 375 (9717): 856–863.CrossRefGoogle Scholar
  24. Harkey, M., and T. Holloway. 2013. “Constrained Dynamical Downscaling for Assessment of Climate Impacts.” Journal of Geophysical Research: Atmospheres 118 (5): 2136–48.Google Scholar
  25. Harlan, Sharon L., Anthony J. Brazel, Lela Prashad, William L. Stefanov, and Larissa Larsen. 2006. “Neighborhood Microclimates and Vulnerability to Heat Stress.” Social Science & Medicine 63 (11): 2847–63. Scholar
  26. Kinney, Patrick L., Marie S. O’Neill, Michelle L. Bell, and Joel Schwartz. 2008. “Approaches for Estimating Effects of Climate Change on Heat-Related Deaths: Challenges and Opportunities.” Environmental Science & Policy 11 (1): 87–96. Scholar
  27. Kloog, Itai, Alexandra Chudnovsky, Petros Koutrakis, and Joel Schwartz. 2012. “Temporal and Spatial Assessments of Minimum Air Temperature Using Satellite Surface Temperature Measurements in Massachusetts, USA.” Science of The Total Environment 432 (August): 85–92. Scholar
  28. Kovats, R. Sari, and Shakoor Hajat. 2008. “Heat Stress and Public Health: A Critical Review.” Annual Review of Public Health 29 (1): 41–55. Scholar
  29. Li, Tiantian, Radley M. Horton, and Patrick L. Kinney. 2013. “Projections of Seasonal Patterns in Temperature- Related Deaths for Manhattan, New York.” Nature Climate Change, 3(8), 717. Scholar
  30. Luber, George, and Michael McGeehin. 2008. “Climate Change and Extreme Heat Events.” American Journal of Preventive Medicine 35 (5): 429–35. Scholar
  31. Maclure, M. 1991. “The Case-Crossover Design: A Method for Studying Transient Effects on the Risk of Acute Events.” American Journal of Epidemiology 133 (2): 144–53.CrossRefGoogle Scholar
  32. Matsueda M (2011) Predictability of Euro-Russian blocking in summer of 2010. Geophysical Research Letters 38(6). CrossRefGoogle Scholar
  33. McGeehin, Michael A., and Maria Mirabelli. 2001. “The Potential Impacts of Climate Variability and Change on Temperature-Related Morbidity and Mortality in the United States.” Environmental Health Perspectives 109 (Suppl 2): 185.CrossRefGoogle Scholar
  34. McMichael, Anthony J., Rosalie E. Woodruff, and Simon Hales. 2006. “Climate Change and Human Health: Present and Future Risks.” The Lancet 367 (9513): 859–869.CrossRefGoogle Scholar
  35. Mearns, Linda O., William Gutowski, Richard Jones, Ruby Leung, Seth McGinnis, Ana Nunes, and Yun Qian. 2009. “A Regional Climate Change Assessment Program for North America.” Eos, Transactions American Geophysical Union 90 (36): 311.CrossRefGoogle Scholar
  36. Medina-Ramón, M., and J. Schwartz. 2007. “Temperature, Temperature Extremes, and Mortality: A Study of Acclimatisation and Effect Modification in 50 US Cities.” Occupational and Environmental Medicine 64 (12): 827–833.CrossRefGoogle Scholar
  37. Meehl GA (2004) More intense, more frequent, and longer lasting heat waves in the 21st Century. Science 305 (5686): 994–97. CrossRefGoogle Scholar
  38. Mesinger, Fedor, Geoff DiMego, Eugenia Kalnay, Kenneth Mitchell, Perry C. Shafran, Wesley Ebisuzaki, Dušan Jović, et al. 2006. “North American Regional Reanalysis.” Bulletin of the American Meteorological Society 87 (3): 343–60. Scholar
  39. Nakicenovic, Nebojsa, Joseph Alcamo, Gerald Davis, Bert de Vries, Joergen Fenhann, Stuart Gaffin, Kenneth Gregory, Arnulf Grubler, Tae Yong Jung, and Tom Kram. 2000. “Special Report on Emissions Scenarios: A Special Report of Working Group III of the Intergovernmental Panel on Climate Change.” Pacific Northwest National Laboratory, Richland, WA (US), Environmental Molecular Sciences Laboratory (US).Google Scholar
  40. O’Neill, M. S. 2005. “Disparities by Race in Heat-Related Mortality in Four US Cities: The Role of Air Conditioning Prevalence.” Journal of Urban Health: Bulletin of the New York Academy of Medicine 82 (2): 191–97. Scholar
  41. Semenza, Jan C., Carol H. Rubin, Kenneth H. Falter, Joel D. Selanikio, W. Dana Flanders, Holly L. Howe, and John L. Wilhelm. 1996. “Heat-Related Deaths during the July 1995 Heat Wave in Chicago.” New England Journal of Medicine 335 (2): 84–90.CrossRefGoogle Scholar
  42. Skamarock WC, Klemp JB, Dudhia J, Gill DO, Barker DM, Wang W, Powers JG (2005) A description of the advanced research WRF Version 2. DTIC DocumentGoogle Scholar
  43. Steadman, Robert G. 1984. “A Universal Scale of Apparent Temperature.” J. Climate Appl. Meteor. 23: 1674–1687.<1674:AUSOAT>2.0.CO;2.CrossRefGoogle Scholar
  44. Stone Jr, Brian, Jason Vargo, Peng Liu, Dana Habeeb, Anthony DeLucia, Marcus Trail, Yongtao Hu, and Armistead Russell. 2014. “Avoided Heat-Related Mortality through Climate Adaptation Strategies in Three US Cities.” PLoS One 9 (6): e100852.CrossRefGoogle Scholar
  45. Thompson, T. M., R. K. Saari, and N. E. Selin. 2014. “Air Quality Resolution for Health Impact Assessment: Influence of Regional Characteristics.” Atmospheric Chemistry and Physics 14 (2): 969–78. Scholar
  46. US Environmental Protection Agency. 2010. “BenMAP: Environmental Benefits Mapping and Analysis Program.” User’s Manual. Research Triangle Park, NC: Office of Air Quality Planning and StandardsGoogle Scholar
  47. Vandentorren, S., P. Bretin, A Zeghnoun, L. Mandereau-Bruno, A. Croisier, C. Cochet, J. Riberon, I. Siberan, B. Declercq, and M. Ledrans. 2006. “August 2003 Heat Wave in France: Risk Factors for Death of Elderly People Living at Home.” The European Journal of Public Health 16 (6): 583–91. Scholar
  48. Vargo, Jason, Brian Stone, Dana Habeeb, Peng Liu, and Armistead Russell. 2016. “The Social and Spatial Distribution of Temperature-Related Health Impacts from Urban Heat Island Reduction Policies.” Environmental Science & Policy 66: 366–74.CrossRefGoogle Scholar
  49. Voorhees, A. Scott, Neal Fann, Charles Fulcher, Patrick Dolwick, Bryan Hubbell, Britta Bierwagen, and Philip Morefield. 2011. “Climate Change-Related Temperature Impacts on Warm Season Heat Mortality: A Proof-of-Concept Methodology Using BenMAP.” Environmental Science & Technology 45 (4): 1450–57. Scholar
  50. Woods and Poole Economics, Inc. 2001. “Population by Single Year of Age.” Washington D.C.: Woods and Poole Economics, Inc.Google Scholar
  51. Yardley, Jane, Ronald J. Sigal, and Glen P. Kenny. 2011. “Heat Health Planning: The Importance of Social and Community Factors.” Global Environmental Change 21 (2): 670–79. Scholar
  52. Zanobetti A, Schwartz J (2008) Temperature and mortality in nine U.S. cities. California Energy Commission, PIER Energy-Related Environmental Research, no. CEC‐500‐2007‐094Google Scholar

Copyright information

© EcoHealth Alliance 2018

Authors and Affiliations

  1. 1.Nelson Institute for Environmental Studies, Center for Sustainability and the Global Environment (SAGE)University of Wisconsin-MadisonMadisonUSA
  2. 2.Department of Population Health SciencesUniversity of Wisconsin-MadisonMadisonUSA
  3. 3.Global Health InstituteUniversity of Wisconsin-MadisonMadisonUSA
  4. 4.Department of Atmospheric and Oceanic SciencesUniversity of Wisconsin-MadisonMadisonUSA

Personalised recommendations