Who is Sensitive to Extremes of Temperature?: A Case-Only Analysis
Abstract
BACKGROUND: Extremes of temperature are well known to be associated with excess mortality. Less is known about the characteristics of persons that put them at higher risk, particularly the role of medical conditions. METHODS: To investigate these effects, I used a case-only approach to analyze 160,062 deaths in Wayne County, Michigan, among persons who were 65 years of age or older, who were covered by Medicare, and who had a previous hospital admission for heart and lung disease. Using their unique Medicare identification number, I traced deaths through Medicare hospital admission records to identify primary and secondary diagnoses for all admissions before death. I investigated the role of diabetes, myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, and pneumonia as modifiers of the risk of dying on an extreme temperature day. Hot days were defined as those greater than the 99th percentile of all days and cold days as those less than the 1st percentile. I also examined the role of sex, age (85 years of age and older), and nonwhite race as modifiers. RESULTS: I found that patients with diabetes had a higher risk of dying on hot days than other subjects (odds ratio=1.17; 95% confidence interval=1.04-1.32). Persons with chronic obstructive pulmonary disease had elevated risks of dying on cold days (1.19; 1.07-1.33). Nonwhites had greater risks on both hot (1.22; 1.09-1.37) and cold (1.25; 1.12-1.40) days, and women had elevated risks on cold days (1.14; 1.02-1.26). The other conditions conveyed no higher risks than average. CONCLUSIONS: Sociodemographic characteristics and medical conditions can increase the likelihood of death associated with temperature extremes.
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People with diabetes mellitus have lower skin blood flow and dysregulated thermoregulatory responses during heat exposure.
“Furthermore, people with DM have been reported to have lower skin blood flow and dysregulated thermoregulatory responses during heat exposure, which is associated with dysregulated thermal, cardiovascular, and glycemic control6–8.”
From Sleep and temperature data from wearable devices support noninvasive detection of diabetes mellitus in a large-scale, retrospective analysis (2026) · cites this paper as [8]
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- Authors
- Schwartz, J.
- Affiliations
- Harvard University (US)
- Corresponding author
- Schwartz, Joel
- ORCID
- Schwartz, Joel
- Venue
- Epidemiology
- Published
- 2005-01
- Volume
- 16
- Issue
- 1
- Pages
- 67-72
- ISSN
- 1044-3983 (ISSN-L)
- OpenAlex
- W2147490300
- Cited by
- 387
- References
- 22
- Citations by year
- 2026: 13 · 2025: 19 · 2024: 18 · 2023: 17 · 2022: 20 · 2021: 16 · 2020: 16 · 2019: 14 · 2018: 21 · 2017: 20 · 2016: 23 · 2015: 24 · 2014: 30 · 2013: 30 · 2012: 17
- FWCI
- 4.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Environmental Health Sciences (ES0002, P30ES000002)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Climate Change and Health Impacts
- Health Sciences › Medicine › Physiology › Thermoregulation and physiological responses
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Keywords
- temperature extremes, heat-related mortality, cold-related mortality, diabetes mellitus, chronic obstructive pulmonary disease, myocardial infarction, congestive heart failure, pneumonia, sex differences, racial disparities, older adults, Medicare beneficiaries, hospitalization, sociodemographic risk factors
- MeSH terms
- Aged, Aged, 80 and over, Algorithms, Chronic Disease, Demography, Environmental Exposure, Female, Health Status, Heart Diseases, Humans, Lung Diseases, Male, Michigan, Risk Factors, Seasons, Socioeconomic Factors, Temperature, Logistic Models
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