et al., 2018; Nixdorf-Miller et al., 2006). Additionally, the most common co-occur- ring diagnosis with cold-related illness and death was substance use. We hypothesized that cases in the hot season might be related to cold water expo- sure rather than cold weather or air tem- perature exposure. There were very few cases with water-related ICD codes, however, that occurred in the cold or hot seasons in Minne- sota. Hypothermia could be due to cold water exposure in addition to cold temperature exposure; it is also possible that water-related hypothermia cases did not get properly docu- mented with the ICD codes to indicate that water exposure was involved. Our analysis also found that the highest proportion of cases in the hot season occurred during May, suggesting that a possible next step could involve expanding the definition to include this “shoulder-season” month. As climate change continues to disrupt patterns and distribution of rain and snow, we could see more snowfall outside of the typical cold season, further emphasizing the importance of expanding the surveillance window to include events in the hot season. Based on these find- ings, we recommend that other jurisdictions explore and present data on cold-related ill- ness and death using both the case definition restricted to the cold season and the case defi- nition that includes cases year-round. In Minnesota, there were almost 2 times more cold-related illness ED cases than heat- related illness during the most recent 5 years of data (Minnesota Department of Health, n.d.). Both conditions had the same high- risk group profile of ED visits: highest among males 15–34 years and hospitalizations highest among males ≥65 years (Minnesota Department of Health, n.d.). Additionally, there were more cold-related deaths annually compared with heat-related deaths during the study period, which is consistent with existing research comparing hyperthermia and hypothermia (Noe et al., 2012). Previous studies have also found that hyperthermia deaths were related to extreme heat events, while most cold-related deaths occurred on days that were colder than aver- age, but not extremely cold—suggesting that it is important to prevent exposure to the cold even when the temperatures are not extreme (Gasparrini et al., 2015; Gronlund et al., 2018). Additional research could assess this
FIGURE 1
Number and Rate of Cold-Related Illness Emergency Department Visits in Minnesota by Year, 2000–2018
1 ,60 0
3 0
1 ,40 0
2 5
1 ,2 0 0
2 0
1 ,0 0 0
80 0
1 5
60 0
1 0
40 0
5
2 0 0
0
0
2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5 2 0 0 6 2 0 0 7 2 0 0 8 2 0 0 9 2 0 1 0 2 0 1 1 2 0 1 2 2 0 1 3 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 # of Emergency Department V isits Age-Adjusted Rate per 1 0 0 ,0 0 0
Note. Rates from 2000–2014 should not be compared with rates from 2015 onward due to a change in the International Classification of Diseases (ICD) coding from ICD-9 to ICD-10 on October 1, 2015. Source: Minnesota Environmental Public Health Tracking Program data access portal (https://data.web.health.state. mn.us/web/mndata/cold_related_illness).
FIGURE 2
Number and Rate of Cold-Related Illness Hospitalizations in Minnesota by Year, 2000–2018
6
3 50
3 0 0
5
2 50
4
2 0 0
0 1 2 3
1 50
1 0 0
50
0
2 0 0 0 2 0 0 1 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 5 2 0 0 6 2 0 0 7 2 0 0 8 2 0 0 9 2 0 1 0 2 0 1 1 2 0 1 2 2 0 1 3 2 0 1 4 2 0 1 5 2 0 1 6 2 0 1 7 2 0 1 8 # of Hospitalizations Age-Adjusted Rate per 1 0 0 ,0 0 0
Note. Rates from 2000–2014 should not be compared with rates from 2015 onward due to a change in the International Classification of Diseases (ICD) coding from ICD-9 to ICD-10 on October 1, 2015. Source: Minnesota Environmental Public Health Tracking Program data access portal (https://data.web.health.state. mn.us/web/mndata/cold_related_illness).
11
November 2023 • Journal of Environmental Health
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