Abstract
Background and Objectives: Extreme heat events are increasing with climate change impacting human health. This study investigates the impact of extreme heat events on Emergency Department (ED) utilization by older adult patients. Materials and Methods: We conducted a study of all 324 non-federal hospital EDs in California during an 8-year period from data extracted from the California Department of Health Care Access and Information (HCAI). The study utilized a time-stratified case-crossover design to investigate ED visited in patients aged 65 years and older during 1-day and 2-day heat wave events. Extreme heat temperatures were measured and weighted using historical data at the zip code level at the 95th, 97.5th, and 99th percentiles 2012 through 2019. Conditional logistical regression was used to estimate the odds of ED visits during extreme heat events compared to non-extreme heat days. Stratified analyses by age and comorbidity status were conducted. Results: During the study period, 8,744,001 of ED visits among older patients were included in the study analysis. Odds ratios (OR) increased for during 1-day heat events (95th percentile (OR = 1.023, 95%CI: 1.020, 1.027), 97.5th percentile (OR = 1.030, 95%CI: 1.025, 1.035), 99th percentile (OR = 1.039, 95%CI: 1.032, 1.058)) and more so with 2-day heat wave events (95th percentile (OR = 1.031, 95%CI: 1.026, 1.036), 97.5th percentile (OR = 1.039, 95%CI: 1.031, 1.046), 99th percentile (OR = 1.044, 95%CI: 1.032, 1.058)). Older patients with three or more comorbidities had the highest odds of ED visits (OR = 1.085, 95%CI: 1.068, 1.112) at the 99th percentile. Conclusions: Our findings indicate that ED visits increase for older patients during extreme heat events, particularly with event intensity and duration. Older patients with at least one comorbidity were at greater risk.