Kathryn Lane

Health Effects of Coastal Storms and Flooding in Urban Areas: A Review and Vulnerability Assessment

Coastal storms can take a devastating toll on the publics health. Urban areas like New York City (NYC) may be particularly at risk, given their dense population, reliance on transportation, energy infrastructure that is vulnerable to flood damage, and high-rise residential housing, which may be hard-hit by power and utility outages. Climate change will exacerbate these risks in the coming decades. Sea levels are rising due to global warming, which will intensify storm surge. These projections make preparing for the health impacts of storms even more important. We conducted a broad review of the health impacts of US coastal storms to inform climate adaptation planning efforts, with a focus on outcomes relevant to NYC and urban coastal areas, and incorporated some lessons learned from recent experience with Superstorm Sandy. Based on the literature, indicators of health vulnerability were selected and mapped within NYC neighborhoods. Preparing for the broad range of anticipated effects of coastal storms and floods may help reduce the public health burden from these events.

Excess Mortality Attributable to Extreme Heat in New York City, 1997-2013

Extreme heat event excess mortality has been estimated statistically to assess impacts, evaluate heat emergency response, and project climate change risks. We estimated annual excess non-external-cause deaths associated with extreme heat events in New York City (NYC). Extreme heat events were defined as days meeting current National Weather Service forecast criteria for issuing heat advisories in NYC based on observed maximum daily heat index values from LaGuardia Airport. Outcomes were daily non-external-cause death counts for NYC residents from May through September from 1997 to 2013 (n = 337,162). The cumulative relative risk (CRR) of death associated with extreme heat events was estimated in a Poisson time-series model for each year using an unconstrained distributed lag for days 0-3 accommodating over dispersion, and adjusting for within-season trends and day of week. Attributable death counts were computed by year based on individual year CRRs. The pooled CRR per extreme heat event day was 1.11 (95%CI 1.08-1.14). The estimated annual excess non-external-cause deaths attributable to heat waves ranged from -14 to 358, with a median of 121. Point estimates of heat wave-attributable deaths were greater than 0 in all years but one and were correlated with the number of heat wave days (r = 0.81). Average excess non-external-cause deaths associated with extreme heat events were nearly 11-fold greater than hyperthermia deaths. Estimated extreme heat event-associated excess deaths may be a useful indicator of the impact of extreme heat events, but single-year estimates are currently too imprecise to identify short-term changes in risk.

Real-time surveillance of heat-related morbidity: Relation to excess mortality associated with extreme heat

The impact of heat on mortality is well documented but deaths tend to occur after (or lag) extreme heat events, and mortality data is generally not available for timely surveillance during extreme heat events. Recently, systems for near-real time surveillance of heat illness have been reported but have not been validated as predictors of non-external cause of deaths associated with extreme heat events. We analyzed associations between daily weather conditions, emergency medical system (EMS) calls flagged as heat-related by EMS dispatchers, emergency department (ED) visits classified as heat-related based on chief complaint text, and excess non-external cause mortality in New York City. EMS and ED data were obtained from data reported daily to the city health department for syndromic surveillance. We fit generalized linear models to assess the relationships of daily counts of heat related EMS and ED visits to non-external cause deaths after adjustment for weather conditions during the months of May-September between 1999 and 2013. Controlling for temporal trends, a 7% (95% confidence interval (CI): 2–12) and 6% (95% CI: 3–10) increase in non-external cause mortality was associated with an increase from the 50th percentile to 99th percentile of same-day and one-day lagged heat-related EMS calls and ED visits, respectively. After controlling for both temporal trends and weather, we observed a 7% (95% CI: 3–12) increase in non-external cause mortality associated with one-day lagged heat-related EMS calls and a 5% mortality increase with one-day lagged ED visits (95% CI: 2–8). Heat-related illness can be tracked during extreme heat events using EMS and ED data which are indicators of heat associated excess non-external cause mortality during the warm weather season.

The Science of Adaptation to Extreme Heat

Abstract Heat is a leading cause of weather-related death globally. Recent heat waves have been responsible for tens of thousands of excess deaths, damage to infrastructure, crop losses, and economic disruption. Many of these events have been in part attributed to climate change and in coming decades the frequency, magnitude, and duration of extreme heat waves are very likely to rise across the world. Given the high probability of increasingly severe temperatures and their moderate to high impact on human health, heat impacts are projected to expand dramatically. This chapter examines the state of the science concerning heat stress and its impacts on human health, the urban heat island, and heat adaptation strategies in both low- and high-income countries, and considers how adaptation can be guided by evidence to yield improved results. Adaptation solutions based on sound science—physical, social, and behavioral—are essential to target the most vulnerable populations and decrease impacts on human health and well-being.

Awareness, Risk Perception, and Protective Behaviors for Extreme Heat and Climate Change in New York City

Preventing heat-related illness and death requires an understanding of who is at risk and why, and options for intervention. We sought to understand the drivers of socioeconomic disparities in heat-related vulnerability in New York City (NYC), the perceived risk of heat exposure and climate change, and barriers to protective behaviors. A random digit dial telephone survey of 801 NYC adults aged 18 and older was conducted from 22 September–1 October, 2015. Thirteen percent of the population did not possess an air conditioner (AC), and another 15% used AC never/infrequently. In adjusted models, odds of not possessing AC were greater for non-Hispanic blacks compared with other races/ethnicities, odds ratio (OR) = 2.0 (95% CI: 1.1, 3.5), and for those with low annual household income, OR = 3.1 (95% CI: 1.8, 5.5). Only 12% reported going to a public place with AC if they could not keep cool at home. While low-income individuals were less likely to be aware of heat warnings, they were more likely to be concerned that heat could make them ill and that climate change would affect their health than participants with a higher household income, OR = 1.6 (95% CI: 1.0, 2.3). In NYC, lack of access to AC partially explains disparities in heat-related health outcomes. Our results point to opportunities for knowledge building and engagement on heat-health awareness and climate change adaptation that can be applied in NYC and other metropolitan areas to improve and target public health prevention efforts.

Burden and Risk Factors for Cold-Related Illness and Death in New York City

Exposure to cold weather can cause cold-related illness and death, which are preventable. To understand the current burden, risk factors, and circumstances of exposure for illness and death directly attributed to cold, we examined hospital discharge, death certificate, and medical examiner data during the cold season from 2005 to 2014 in New York City (NYC), the largest city in the United States. On average each year, there were 180 treat-and-release emergency department visits (average annual rate of 21.6 per million) and 240 hospital admissions (29.6 per million) for cold-related illness, and 15 cold-related deaths (1.8 per million). Seventy-five percent of decedents were exposed outdoors. About half of those exposed outdoors were homeless or suspected to be homeless. Of the 25% of decedents exposed indoors, none had home heat and nearly all were living in single-family or row homes. The majority of deaths and illnesses occurred outside of periods of extreme cold. Unsheltered homeless individuals, people who use substances and become incapacitated outdoors, and older adults with medical and psychiatric conditions without home heat are most at risk. This information can inform public health prevention strategies and interventions.