ADVANCEMENT OF THE SCIENCE
TABLE 2
Number, Proportion, and Rate of Cold-Related Events by Sex and Age Group in Minnesota
Emergency Department Visits, 2014–2018
Hospital Admissions, 2014–2018
Deaths, 2010–2019
# (%)
Rate per 100,000
95% CI
# (%)
Rate per 100,000
95% CI
# (%)
Rate per 100,000
95% CI
Total
5,227 (100)
–
–
1,048 (100)
–
–
426 (100)
–
–
Sex
Female
1,546 (30) 3,681 (70)
11.4
[10.8, 11.9] [26.3, 28.0]
300 (29) 748 (71)
2.0
[1.8, 2.2] [5.3, 6.1]
134 (31) 292 (69)
0.4
[0.3, 0.5] [0.9, 1.2]
Male
27.2 a
5.7 a
1.0 a
Female age group (years) 0–4
50 (3)
5.8 6.3
[4.3, 7.7] [5.1, 7.5]
9 (3) 3 (1)
1.0 c 0.2 c
[0.5, 2.0]
0 (0) 2 (0)
0
0
5–14
112 (7)
[0, 0.5]
0.1 c 0.2 c
[0, 0.2]
15–34 35–64
650 (42) 502 (33) 232 (15)
18.0 a
[16.6, 19.4] [8.6, 10.2] [8.8, 11.5]
69 (23)
1.9 2.3
[1.5, 2.4] [1.9, 2.7] [3.4, 5.2] [0.3, 1.6] [0.1, 0.6] [4.4, 5.9] [7.2, 8.7] [6.8, 9.4]
14 (10) 44 (33) 74 (55)
[0.1, 0.3] [0.3, 0.6] [1.3, 2.1]
9.4
122 (41)
0.4
≥65
10.2
97 (32)
4.2 a
1.7 a
Male age group (years) 0–4
62 (2)
6.9 6.8
[5.3, 8.8] [5.6, 7.9]
7 (1) 4 (1)
0.8 c 0.2 c 5.2 b 7.9 b 8.1 b
0 (0) 1 (0)
0
0
5–14
125 (3)
0 c
[0, 0.2]
15–34 35–64
1,422 (39) 1,702 (46)
37.9 b 31.6 b
[35.9, 39.9] [30.1, 33.1] [17.7, 21.8]
194 (25) 427 (55) 152 (19)
40 (14)
0.5 1.3
[0.4, 0.7] [1.1, 1.5] [2.6, 3.8]
137 (47) 114 (39)
≥65
370 (10)
19.8
3.2 a
Note. Data are restricted to cold-related events occurring in January to April and October to December. Rates are calculated using 2010 U.S. Census Bureau data for the denominators. CI = confidence interval. a Significantly higher than other groups ( p < .05). b Significantly higher than other groups but not significantly different from each other ( p < .05). c Rates based on counts <20 are flagged as unstable because they can change dramatically with the addition or subtraction of one case.
relationship further by exploring other con- tributing factors involved in cold-related ill- ness and death outside of temperature, such as occupational and social risk factors. Chronic conditions, such as substance use, co-occurred with cold-related illness and death in Minnesota, which is consistent with previous studies (Berko et al., 2014; Gronlund et al., 2018; Lane et al., 2018). Substance use can adversely aect the body’s ability to sense the cold and can cloud decision making, par- tially explaining this relationship. In Minne- sota, rates of drug overdoses and deaths have been increasing, which might be contributing to the rise in cold-related illness and death in recent years (DeLaquil et al., 2020). Substance use is both a cause and conse- quence of homelessness. Homelessness is an additional risk factor for cold-related ill- ness and death, which has been on the rise in Minnesota (Minnesota Department of
Health, 2023). People with mental health conditions might also be at increased risk for cold-related illness and death in part due to psychiatric medications that can impair ther- moregulation (Gronlund et al., 2018). While mental illness was listed on only 2% of death certificate records, a similar study from New York City found that it was noted on a higher proportion of decedents in medical examiner records (Lane et al., 2018). Future studies in Minnesota could explore medical examiner records to obtain more detailed information on contributing factors in cold-related deaths. There are several limitations to our analy- sis. These data only captured the individuals with the most severe or acute symptoms who were treated at the ED, hospitalized, or die. Thus, the cases likely are underestimated. We have provided a descriptive analysis of condi- tions co-occurring with a cold-related diag- nosis and recommend that a more rigorous
analysis be completed to elucidate the rela- tionship between these conditions and cold- related illness. Additionally, we do not have access to the full health records or patient history for individual hospitalizations and deaths, so we could be missing important contextual information. The data on hospitalization and death lack information on social factors, unhoused status, and occupation-related exposure, all of which would provide more insight into understanding the risk factors and context for the cases. The Minnesota Department of Health is expanding its syndromic surveillance pro- gram and plans to pilot the cold-related ill- ness case definition. These data often include more details and context that can give us a better understanding of the risk factors, high- risk groups, and geographical patterns of cold-related illness.
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Volume 86 • Number 4
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