---
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  Abstract: "PURPOSE: To estimate the association between environmental temperatures and the occurrence of emergency department visits for heat-related illness in North Carolina, a large Southern state with 85 rural and 15 urban counties; approximately half the state's population resides in urban counties. METHODS: County-level daily emergency department visit counts and daily mean temperatures for the period 1/1/2007-12/31/2008 were merged to form a time-series data structure. Incidence rates were calculated by sex, age group, region, day of week, and month. Incidence rate ratios were estimated using categorical and linear spline Poisson regression models and heterogeneity of the temperature-emergency department visit association was assessed using product interaction terms in the Poisson models. RESULTS: In 2007-2008, there were 2539 emergency department visits with heat-related illness as the primary diagnosis. Incidence rates were highest among young adult males (19-44 year age group), in rural counties, and in the Sandhills region. Incidence rates increased exponentially with temperatures over 15.6 degrees C (60 degrees F). The overall incidence rate ratio for each 1 degrees C increase over 15.6 degrees C in daily mean temperature was 1.43 (95%CI: 1.41, 1.45); temperature effects were greater for males than females, for 45-64 year olds, and for residents of rural counties than residents of urban counties. CONCLUSIONS: As heat response plans are developed, they should incorporate findings on climate effects for both mortality and morbidity. While forecast-triggered heat health warning systems are essential to mitigate the effects of extreme heat events, public health preparedness plans should not ignore the effects of more persistently observed high environmental temperatures like those that occur throughout the warm season in North Carolina."
  Author: 'Lippmann, S. J.; Fuhrmann, C. M.; Waller, A. E.; Richardson, D. B.'
  DOI: 10.1016/j.envres.2013.03.009
  Date: Jul
  ISSN: 0013-9351
  Journal: Environmental Research
  Keywords: 'Adolescent; Adult; Aged; Child; Child, Preschool; Emergency Service, Hospital/ statistics & numerical data; Female; Heat Stress Disorders/ epidemiology; Hot Temperature; Humans; Infant; Male; Middle Aged; North Carolina/epidemiology; Regression Analysis; Rural Population; Seasons; Urban Population; Young Adult'
  Language: eng
  Notes: "Lippmann, Steven J Fuhrmann, Christopher M Waller, Anna E Richardson, David B Research Support, Non-U.S. Gov't United States Environ Res. 2013 Jul;124:35-42. doi: 10.1016/j.envres.2013.03.009. Epub 2013 Apr 30."
  Pages: 35-42
  Title: 'Ambient temperature and emergency department visits for heat-related illness in North Carolina, 2007-2008'
  Volume: 124
  Year: 2013
  _record_number: 4740
  _uuid: 7be7dd5f-5970-45ec-a14c-1fed7851517b
  reftype: Journal Article
child_publication: /article/10.1016/j.envres.2013.03.009
description: 'Ambient temperature and emergency department visits for heat-related illness in North Carolina, 2007-2008'
display_name: 'Ambient temperature and emergency department visits for heat-related illness in North Carolina, 2007-2008'
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publications:
  - /report/usgcrp-climate-human-health-assessment-2016/chapter/temperature-related-death-and-illness/finding/even-small-differences-seasonal-average-temperatures-result-illness-death
  - /report/usgcrp-climate-human-health-assessment-2016/chapter/temperature-related-death-and-illness
  - /report/usgcrp-climate-human-health-assessment-2016
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