Professional Documents
Culture Documents
by Jeffrey Berko, M.P.H., Deborah D. Ingram, Ph.D., National Center for Health Statistics; Shubhayu Saha, Ph.D.,
National Center for Environmental Health; and Jennifer D. Parker, Ph.D., National Center for Health Statistics
Abstract
Introduction
Page 2
Methods
This study used 20062010
microdata death files produced by the
National Center for Health Statistics
(NCHS) (54). These files are derived
from death records in the National Vital
Statistics System. Death records in the
National Vital Statistics System are
Page 3
Page 4
misclassification by region or
urban-rural status for the Hispanic
population. Despite this, death rates for
Hispanic persons should be interpreted
with caution because of
underreporting (55).
The county where the death
occurred was used to assign census
region, county median household
income, and county urbanization level.
The urbanization level of counties was
based on the 2006 NCHS Urban-Rural
Classification Scheme for Counties (62).
The 2006 NCHS scheme categorizes all
U.S. counties and county equivalent
entities into six levels: four for
metropolitan counties (large central
metro, large fringe metro, medium
metro, and small metro) and two for
nonmetropolitan counties (micropolitan
and noncore). The assignment of
counties as metropolitan or
nonmetropolitan is based on the Office
of Management and Budgets (OMB)
metropolitan-nonmetropolitan
classification. The large central metro
category contains counties in
metropolitan statistical areas (MSAs) of
1 million or more population that have
been identified by NCHS classification
rules as central because they contain all
or part of a principal city of the area.
The large fringe metro category contains
the remaining counties (similar to
suburbs) in MSAs of 1 million or more.
Counties in MSAs of 250,000999,999
population are assigned to the medium
metro category, and counties in MSAs
with populations under 250,000 are
assigned to the small metro category.
Nonmetropolitan counties that are
designated by OMB as belonging to a
micropolitan statistical area are assigned
to the micropolitan category of the
NCHS scheme. The remaining
nonmetropolitan counties are assigned to
the noncore category. The large central
metro category is the most urban
category, and the noncore category is
the most rural category.
The U.S. Census Bureaus Small
Area Income and Poverty Estimate
program of 2008 county median
household income was used to
categorize counties into income
quartiles (63). The U.S. population is
not evenly distributed across the four
Results
During 20062010, 10,649 deaths
of U.S. residents were attributed to
weather-related causes of death
(Table 2). Exposure to excessive natural
heat, heat stroke, sun stroke, or all were
cited as either the underlying cause or a
contributing cause of death for 3,332
(31%) of these deaths, and exposure to
excessive natural cold, hypothermia, or
both was cited for 6,660 (63%) of
deaths. The remaining weather-related
deaths were attributed to floods, storms,
or lightning.
Page 5
60
50
40
30
20
Cold-related death rate1
10
Heat-related death rate2
Flood-stormlightning-related
death rate3
0
Under 1
14
514
1524
2534
3544
4554
5564
6574
7584
85 and
over
Deaths attributed to exposure to excessive natural cold (X31) (underlying or contributing cause of death or both), to hypothermia (T68) (contributing cause of death), or to both, according
to the International Classification of Diseases, 10th Revision.
Deaths attributed to exposure to excessive natural heat (X30) (underlying or contributing cause of death or both), to heat stroke or sunstroke (T67) (contributing cause of death), or to
both, according to the International Classification of Diseases, 10th Revision.
3
Deaths attributed to floods (X38), cataclysmic storms (X37), or lightning (X33) (underlying or contributing cause of death or both), according to the International Classification of Diseases,
10th Revision.
SOURCE: CDC/NCHS, National Vital Statistics System, 20062010.
2
Figure 1. Crude death rates for weather-related mortality, by age: United States, 20062010
Page 6
Page 7
4
South
West
Midwest
1
Northeast
0
Large central
metro
Large fringe
metro
35
Medium
metro
Small
metro
Micropolitan
Noncore
30
25
20
15
Midwest
10
Northeast
South
5
0
Large central
metro
Large fringe
metro
Medium
metro
Small
metro
Micropolitan
Noncore
Deaths attributed to exposure to excessive natural heat (X30) (underlying or contributing cause of death or both), to heat stroke or sunstroke (T67) (contributing cause of
death), or to both, according to the International Classification of Diseases, 10th Revision.
Deaths attributed to exposure to excessive natural cold (X31) (underlying or contributing cause of death or both), to hypothermia (T68) (contributing cause of death), or to
both, according to the International Classification of Diseases, 10th Revision.
SOURCE: CDC/NCHS, National Vital Statistics System, 20062010.
2
Figure 2. Age-adjusted death rates for heat-related and cold-related mortality, by region and urbanization level: United States, 20062010
Conclusions
Based on information from death
certificates, 10,649 deaths were
attributed to weather-related causes in
the United States during 20062010.
Nearly one-third of the deaths were
attributed to excessive natural heat, and
almost two-thirds were attributed to
excessive natural cold. Weather-related
death rates differed among demographic
subgroups, regions, and counties at
Page 8
References
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van der Linden PJ, Hanson CE
(editors). Contribution of Working
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Cambridge University Press. 2007.
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Selanikio JD, Flanders WD, Howe
HL, Wilhelm JL. Heat-related deaths
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R. Estimating the mortality effect of
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8. Braga AL, Zanobetti A, Schwartz J.
The effect of weather on respiratory
and cardiovascular deaths in 12 U.S.
cities. Environ Health Perspect
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9. Curriero FC, Heiner KS, Samet JM,
Zeger SL, Strug L, Patz JA.
Temperature and mortality in 11
Page 9
Page 10
November 3, 2011.
Page 11
Table 1. Number of deaths with a weather-related cause listed as the underlying cause of death only, as a contributing cause of death
only, or both: United States, 20062010
Cause of death listed as the
underlying cause of death only
Any mention
Percent
Percent
Heat-related deaths1. . . . . . . . . . . .
X30 only . . . . . . . . . . . . . . . . .
X30 and T672 . . . . . . . . . . . .
T67 only . . . . . . . . . . . . . . . . .
Cold-related deaths3 . . . . . .. . . . . .
X31 only . . . . . . . . . . . . . . . . .
X31 and T682 . . . . . . . . . . . .
T68 only . . . . . . . . . . . . . . . . .
Flood, storm, and lightning4 . . . . . .
X38 (flood) . . . . . . . . . . . . . . . .
X37 (storm) . . . . . . . . . . . . . . .
X33 (lightning). . . . . . . . . . . . . .
2,027
13
2,014
...
3,192
252
2,940
...
646
93
371
182
61
38
66
...
48
41
53
...
98
99
97
97
1,305
21
1,032
252
3,468
362
2,605
501
16
1
10
5
39
62
34
100
52
59
47
100
2
1
3
3
3,332
34
3,046
252
6,660
614
5,545
501
662
94
381
187
Percent
100
100
100
100
100
100
100
100
100
100
100
100
1
Deaths attributed to exposure to excessive natural heat (X30) (underlying or contributing cause of death or both), to heatstroke or sunstroke (T67) (contributing cause of death), or to both,
2
The ICD10 codes T67 and T68 can only be contributing causes, not the underlying cause of death. T68 is often mentioned on the death certificate with code X31; T67 is often mentioned on the
3
Deaths attributed to exposure to excessive natural cold (X31) (underlying or contributing cause of death or both), to hypothermia (T68) (contributing cause of death), or to both, according to the
4
Deaths attributed to exposure to floods (X38), cataclysmic storms (X37), or lightning (X33) (underlying or contributing cause of death or both), according to the International Classification of
Page 12
Table 2. Death counts and death rates (per million resident population) for weather-related mortality, by age: United States, 20062010
Heat-related deaths1
Cold-related deaths2
Flood-storm-lightning-related deaths3
Number
of
deaths
Death
rate
Standard
error
Number
of
deaths
Death
rate
Standard
error
Number
of
deaths
Death
rate
Standard
error
Number
of
deaths
Death
rate
Standard
error
All ages . . . . . . . . . . . . . . . . . . .
Under 15 . . . . . . . . . . . . . . . .
145 . . . . . . . . . . . . . . . . . .
5145 . . . . . . . . . . . . . . . . . .
1524 . . . . . . . . . . . . . . . . . . .
2534 . . . . . . . . . . . . . . . . . . .
3544 . . . . . . . . . . . . . . . . . . .
4554 . . . . . . . . . . . . . . . . . . .
5564 . . . . . . . . . . . . . . . . . . .
6574 . . . . . . . . . . . . . . . . . . .
7584 . . . . . . . . . . . . . . . . . . .
85 and over . . . . . . . . . . . . . . .
3,340
86
147
28
106
186
338
619
545
463
490
332
2.1
4.2
1.8
0.1
0.5
0.9
1.6
2.8
3.2
4.5
7.5
12.8
0.0
0.5
0.2
0.0
0.1
0.1
0.1
0.1
0.1
0.2
0.3
0.7
6,652
20
29
39
286
358
711
1,301
1,097
773
1,010
1,028
4.2
1.0
0.4
0.2
1.3
1.8
3.4
5.9
6.4
7.6
15.5
39.6
0.1
0.2
0.1
0.0
0.1
0.1
0.1
0.2
0.2
0.3
0.5
1.2
662
*
*
58
97
71
79
126
89
62
53
27
0.4
*
*
0.2
0.4
0.4
0.4
0.6
0.5
0.6
0.8
1.0
0.0
*
*
0.0
0.1
0.0
0.0
0.1
0.1
0.1
0.1
0.2
10,649
110
187
110
488
615
1,128
2,044
1,730
1,298
1,553
1,386
6.7
5.4
2.3
0.5
2.3
3.1
5.4
9.2
10.1
12.7
23.8
53.4
0.1
0.5
0.2
0.1
0.1
0.1
0.2
0.2
0.2
0.4
0.6
1.4
2
Deaths attributed to exposure to excessive natural cold (X31) (underlying or contributing cause of death or both), to hypothermia (T68) (contributing cause of death), or to both, according to the
4
Deaths attributed to exposure to natural heat (X30), or exposure to natural cold (X31), flood (X38), cataclysmic storm (X37), or lightning (X33) as the underlying or contributing causes of death,
5
Due to small death counts, flood-storm-lightning-related deaths for age groups under 1 year, 14, and 514 years have been combined, and only figures for ages 014 years are shown.
Page 13
Table 3. Death counts and age-adjusted death rates (per million resident population) for weather-related causes, by sex, race and
Hispanic origin, region, urbanization level, and income: United States, 20062010
Heat-related deaths1
Characteristic
Cold-related deaths2
Flood-storm-lightning-related deaths3
Number
of
deaths
Death
rate
Standard
error
Number
of
deaths
Death
rate
Standard
error
Number
of
deaths
Death
rate
Standard
error
Number
of
deaths
Death
rate
Standard
error
1,029
2,303
1.2
3.1
0.0
0.0
2,128
4,532
2.4
6.3
0.0
0.1
243
419
0.3
0.6
0.1
0.1
3,396
7,253
3.8
10.0
0.1
0.1
380
2,067
747
2.2
1.8
4.7
0.1
0.0
0.2
343
4,833
916
2.1
4.1
5.8
0.1
0.1
0.2
20
541
56
0.2
0.5
0.3
0.0
0.0
0.0
773
7,436
1,719
4.6
6.4
10.8
0.2
0.1
0.3
Sex
Female . . . . . . . . . . . . . . . . . . .
Male . . . . . . . . . . . . . . . . . . . . .
Race and Hispanic origin5
Hispanic or Latino . . . . . . . . . . . . .
White, not Hispanic or Latino . . . . . .
Black, not Hispanic or Latino . . . . . .
Region
Northeast
Midwest .
South . .
West . . .
.
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324
462
1,432
1,114
1.1
1.3
2.5
3.2
0.0
0.0
0.0
0.0
1,211
1,849
1,845
1,755
3.9
5.2
3.2
5.0
0.1
0.1
0.1
0.1
37
161
400
64
0.1
0.5
0.7
0.2
0.0
0.1
0.1
0.0
1,572
2,472
3,675
2,930
5.1
7.0
6.4
8.3
0.1
0.1
0.1
0.2
.
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.
1,356
488
554
327
319
288
3.1
1.3
1.8
2.2
1.9
2.6
0.0
0.0
0.0
0.1
0.1
0.1
1,398
1,076
1,270
835
997
1,084
3.2
2.8
4.0
5.5
5.9
9.8
0.1
0.1
0.1
0.1
0.1
0.2
67
121
98
67
150
162
0.2
0.3
0.3
0.4
0.9
1.6
0.0
0.0
0.0
0.1
0.1
0.1
2,821
1,684
1,918
1,229
1,465
1,532
6.4
4.4
6.0
8.1
8.7
14.0
0.1
0.1
0.1
0.2
0.2
0.4
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
1,658
801
554
319
1.8
2.1
3.1
3.2
0.0
0.0
0.1
0.1
2,957
1,810
1,196
697
3.2
4.6
6.6
7.1
0.1
0.1
0.1
0.2
187
168
164
143
0.2
0.4
1.0
1.5
0.1
0.1
0.2
0.3
4,800
2,778
1,913
1,158
5.3
7.2
10.6
11.8
0.1
0.1
0.3
0.4
Urbanization level6
.
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2
Deaths attributed to exposure to excessive natural cold (X31) (underlying or contributing cause of death or both), to hypothermia (T68) (contributing cause of death), or to both, according to the
5
Deaths for origin not stated are not included.
6
Based on 2006 NCHS Urban-Rural Classification Scheme for Counties.
7
Based on 2008 county median household income quartiles.
NOTES: NCHS is National Center for Health Statistics. Death counts and rates by region, urbanization level, and median income are by place of occurrence. Death rates for Hispanic persons
should be interpreted with caution because of inconsistencies in reporting race and ethnicity on death certificates, compared with such reporting on censuses and surveys.
Page 14
Table 4. Death counts and age-adjusted death rates (per million resident population) for heat-related and cold-related causes, by region
and urbanization level: United States, 20062010
Heat-related deaths1
Cold-related deaths2
Number
of
deaths
Death
rate
Standard
error
Number
of
deaths
Death
rate
Standard
error
Northeast
Large central metro . . . . . . .
Large fringe metro. . . . . . . .
Medium metro . . . . . . . . . .
Small metro. . . . . . . . . . . .
Micropolitan (nonmetropolitan)
Noncore (nonmetropolitan) . .
.
.
.
.
.
.
.
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.
.
.
.
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.
.
.
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.
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.
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.
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.
164
82
44
*
17
*
1.9
0.7
0.8
0.6
0.8
1.1
0.2
0.1
0.1
0.2
0.2
0.4
324
310
291
75
133
78
3.8
2.7
4.5
5.1
6.0
9.2
0.2
0.2
0.3
0.6
0.5
1.1
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.
159
88
54
37
69
55
2.1
1.1
0.9
0.9
1.4
1.5
0.2
0.1
0.1
0.1
0.2
0.2
417
265
316
232
265
354
5.4
3.3
5.1
5.3
5.1
9.5
0.3
0.2
0.3
0.4
0.3
0.5
.
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.
384
220
274
179
190
185
3.2
1.6
2.2
2.9
2.7
3.6
0.2
0.1
0.1
0.2
0.2
0.3
356
360
369
219
269
272
3.0
2.5
2.9
3.5
3.7
5.0
0.2
0.1
0.2
0.2
0.2
0.3
.
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649
98
182
102
43
40
4.0
2.0
2.7
3.3
1.7
3.0
0.2
0.2
0.2
0.3
0.3
0.5
301
141
294
309
330
380
1.8
3.0
4.3
10.0
12.9
30.9
0.1
0.3
0.3
0.6
0.7
1.6
Midwest
Large central metro . . . . . . .
Large fringe metro. . . . . . . .
Medium metro . . . . . . . . . .
Small metro. . . . . . . . . . . .
Micropolitan (nonmetropolitan)
Noncore (nonmetropolitan) . .
South
Large central metro . . . . . . .
Large fringe metro. . . . . . . .
Medium metro . . . . . . . . . .
Small metro. . . . . . . . . . . .
Micropolitan (nonmetropolitan)
Noncore (nonmetropolitan) . .
West
Large central metro . . . . . . .
Large fringe metro. . . . . . . .
Medium metro . . . . . . . . . .
Small metro. . . . . . . . . . . .
Micropolitan (nonmetropolitan)
Noncore (nonmetropolitan) . .
2
Deaths attributed to exposure to excessive natural cold (X31) (underlying or contributing cause of death or both), to hypothermia (T68) (contributing cause of death), or to both, according to the
3
Urbanization level is based on the 2006 NCHS Urban-Rural Classification Scheme for Counties.
NOTES: NCHS is National Center for Health Statistics. Death counts and rates by region and urbanization level are by place of occurrence.
Page 15
Table 5. Risk of weather-related death adjusted for selected variables: United States, 20062010
Heat-related deaths1
Model 14
Characteristic
Cold-related deaths2
Model 25
Model 14
Flood-storm-lightning-related deaths3
Model 25
Model 14
Model 25
OR
95%
CI
OR
95%
CI
OR
95%
CI
OR
95%
CI
OR
95%
CI
OR
95%
CI
.
.
.
.
.
.
.
.
.
.
.
4.4
1.9
0.1
0.5
1.0
1.7
3.1
3.7
5.3
9.5
18.2
3.4
1.5
0.1
0.4
...
1.5
2.6
3.1
4.5
8.0
15.2
5.7
2.4
0.2
0.6
...
2.1
3.7
4.3
6.3
11.3
21.9
4.5
1.9
0.1
0.5
1.0
1.8
3.2
3.7
5.4
9.3
18.3
3.5
1.6
0.1
0.4
...
1.5
2.7
3.1
4.5
8.1
15.2
5.8
2.4
0.2
0.7
...
2.1
3.7
4.4
6.4
11.4
21.9
0.6
0.2
0.1
0.7
1.0
1.9
3.2
3.5
4.1
8.9
25.6
0.4
0.1
0.1
0.6
...
1.7
2.9
3.1
3.6
7.9
22.7
0.9
0.3
0.1
0.8
...
2.2
3.6
3.9
4.6
10.1
29.0
0.5
0.2
0.1
0.7
1.0
1.9
3.2
3.4
4.0
8.8
25.0
0.3
0.1
0.1
0.6
...
1.7
2.8
3.0
3.5
7.8
22.2
0.9
0.3
0.1
0.8
...
2.2
3.6
3.8
4.5
9.9
28.3
0.6
0.4
0.6
1.2
1.0
1.0
1.5
1.3
1.4
1.9
2.6
0.2
0.2
0.4
0.9
...
0.7
1.1
0.9
1.0
1.3
1.6
1.5
0.7
0.9
1.6
...
1.4
2.0
1.7
2.0
2.7
4.0
0.5
0.4
0.6
1.2
1.0
1.0
1.5
1.2
1.3
1.9
2.6
0.2
0.2
0.4
0.9
...
0.7
1.1
0.9
1.0
1.3
1.6
1.5
0.7
0.8
1.6
...
1.4
1.9
1.7
1.9
2.7
4.1
1.0
2.7
...
2.5
...
2.9
1.0
2.7
...
2.5
...
2.9
1.0
2.6
...
2.5
...
2.8
1.0
2.6
...
2.5
...
2.8
1.0
1.8
...
1.6
...
2.2
1.0
1.8
...
1.6
...
2.1
1.3
1.1
1.4
0.9
0.8
1.0
0.5
0.5
0.6
0.6
0.5
0.7
0.5
0.4
0.7
0.6
0.5
0.9
1.0
2.5
...
2.3
...
2.7
1.0
2.3
...
2.1
...
2.5
1.0
1.3
...
1.3
...
1.4
1.0
1.7
...
1.6
...
1.9
1.0
0.5
...
0.4
...
0.7
1.0
0.6
...
0.4
...
0.7
1.0
1.1
1.6
1.6
...
1.0
1.5
1.4
...
1.1
1.8
1.8
1.0
1.3
2.2
2.1
...
1.2
1.9
1.8
...
1.5
2.5
2.5
1.0
1.5
2.0
2.2
...
1.4
1.9
2.0
...
1.6
2.2
2.4
1.0
1.2
1.5
1.8
...
1.1
1.4
1.6
...
1.3
1.6
2.0
1.0
2.1
4.3
7.4
...
1.7
3.5
5.9
...
2.6
5.3
9.2
1.0
1.7
2.6
3.2
...
1.3
2.0
2.3
...
2.1
3.4
4.3
Age (years)
Under 1 . . . . . . .
14 . . . . . . . .
514. . . . . . . .
1524 . . . . . . .
2534 (reference
3544 . . . . . . .
4554 . . . . . . .
5564 . . . . . . .
6574 . . . . . . .
7584 . . . . . . .
85 and over . . .
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group)
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Sex
(reference group) .
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.
1
Deaths attributed to exposure to excessive natural heat (X30) (underlying or contributing cause of death or both), to heatstroke or sunstroke (T67) (contributing cause of death), or to both,
2
Deaths attributed to exposure to excessive natural cold (X31) (underlying or contributing cause of death or both), to hypothermia (T68) (contributing cause of death), or to both, according to the
4
Adjusted for age, sex, race and Hispanic origin, and county median household income quartile.
5
Adjusted for age, sex, race and Hispanic origin, county median household income quartile, region, and urbanization level.
6
Based on 2008 county median household income quartiles.
NOTES: OR is odds ratio. CI is confidence interval. Deaths with origin not stated were excluded. Death counts and rates by region, urbanization level, and median income are by place of
occurrence. Death rates for Hispanic persons should be interpreted with caution because of inconsistencies in reporting race and ethnicity on death certificates, compared with such reporting on
U.S. DEPARTMENT OF
HEALTH & HUMAN SERVICES
CDC/NCHS
Acknowledgments
The authors thank Dr. Margaret Warner of the National Center for Health Statistics Division of Vital Statistics for her helpful comments.
Suggested citation
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