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The Effect of High Ambient Temperature on Emergency Room Visits

Basu, Rupaa; Pearson, Dharshanib; Malig, Briana; Broadwin, Rachela; Green, Rochellea

doi: 10.1097/EDE.0b013e31826b7f97

Background: The association between temperature and mortality has been widely researched, although the association between temperature and morbidity has been less studied. We examined the association between mean daily apparent temperature and emergency room (ER) visits in California.

Methods: We used a time-stratified case-crossover design, restricting our data to the warm seasons of 2005–2008 in 16 climate zones. The study population included cases residing within 10 km of meteorologic monitors. Conditional logistic regression models with apparent temperature were applied by climate zone; these models were then combined in meta-analyses to estimate overall effects. Our analyses considered the effects by disease subgroup, race/ethnic group, age group, and potential confounding by air pollutants.

Results: More than 1.2 million ER visits were included. Positive associations were found for same-day apparent temperature and ischemic heart disease (% excess risk per 10°F = 1.7 [95% confidence interval = 0.2 to 3.3]), ischemic stroke (2.8 [0.9 to 4.7]), cardiac dysrhythmia (2.8 [0.9 to 4.9]), hypotension (12.7 [8.3 to 17.4]), diabetes (4.3 [2.8 to 5.9]), intestinal infection (6.1 [3.3 to 9.0]), dehydration (25.6 [21.9 to 29.4]), acute renal failure (15.9 [12.7 to 19.3]), and heat illness (393.3 [331.2 to 464.5]). Negative associations were found for aneurysm, hemorrhagic stroke, and hypertension. Most of these estimates remained relatively unchanged after adjusting for air pollutants. Risks often varied by age or racial/ethnic group.

Conclusions: Increased temperatures were found to have same-day effects on ER admission for several outcomes. Age and race/ethnicity seemed to modify some of these impacts.

Supplemental Digital Content is available in the text.

From the aCalifornia Office of Environmental Health Hazard Assessment, Air Pollution Epidemiology Section, Oakland, CA; and bSchool of Public Health, University of California, Berkeley, CA.

Submitted 8 August 2011; accepted 3 April 2012; posted 21 September 2012.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article ( This content is not peer-reviewed or copy-edited; it is the sole responsibility of the author.

The opinions expressed in this article are those of the authors and do not represent those of the California Environmental Protection Agency or the Office of Environmental Health Hazard Assessment. The authors declare they have no competing financial interests.

Correspondence: Rupa Basu, Air Pollution Epidemiology Section, California Office of Environmental Health Hazard Assessment, 1515 Clay Street, 16th floor, Oakland, CA 94612. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.