VN N# # SCIENCE
Assessing the Burden of Cold-Related Illness and Death in Minnesota
Madison Kircher, MPH Tess Konen, MPH Jessie Carr, MPH, DrPH
Environmental Health Division, Minnesota Department of Health
illness and death that capture a broad range of known risk factors and exposure circum- stances, as well as emergent climate change- related conditions, using methods that can be duplicated in other jurisdictions. Cold-related illness occurs when the body loses heat faster than it can be produced. This category of conditions includes hypothermia (a reduction in the body’s core temperature to below 95 °F [35 °C]) and injuries such as frostbite, trench foot, or chilblains (skin sores or bumps that occur after exposure to cold temperatures but rarely cause perma- nent damage). While these conditions are most likely to occur due to prolonged expo- sure to subfreezing temperatures (i.e., <32 °F), they can occur at temperatures as high as 40 °F in wind or rain, or 70 °F in some individuals with underlying medical condi- tions (Nixdorf-Miller et al., 2006). Most previous research has focused on the impacts of climate change on heat-related illness, with few studies describing vulner- able populations or contributing factors to cold-related illness and death. Similar to heat-related illness, infants, older adults (>65 years), and individuals with specific chronic conditions (e.g., respiratory disease, cardio- vascular disease) are more susceptible to cold-related illness and death (Berko et al., 2014; Gronlund et al., 2018; Nixdorf-Miller et al., 2006). Individuals who consume alco- hol, take illicit drugs, or use some medica- tions are also more susceptible, as these sub- stances can adversely aect the body’s ability to sense the cold (Gronlund et al., 2018; Nixdorf-Miller et al., 2006). One study found that hyperthermia- related visits were more frequent than hypothermia-related visits among Medicare
b89r(*9 Exposure to cold temperatures can have negative health impacts that lead to cold-related illness or death. We explored the case definition for cold-related illness that was developed and piloted by the National Environmental Public Health Tracking Network within the Centers for Disease Control and Prevention. Using their case definition, we assessed the burden of cold-related illness and death in Minnesota. We analyzed the results by season, demographics, and chronic disease. Overall, <10% of all cold-related events in Minnesota occurred during the hot season; we did not identify any distinct dierences between the type of cases by seasons. During the cold season, there was an average annual rate of 13.3 cold-related emer- gency department visits per 100,000 population ( n = 704) and 2.8 cold-relat- ed hospitalizations per 100,000 population ( n = 155). There was an average annual rate of 0.6 cold-related deaths per 100,000 population ( n = 33). Cli- mate change is extending the typical winter season. Therefore, we recommend other jurisdictions consider expanding their surveillance window to include all seasons. Cold-related illness surveillance can detect changes over time and identify high-risk populations for prevention initiatives.
Introduction Cold-related illness and death are common and occur across dierent U.S. regions. The National Center for Health Statistics within the Centers for Disease Control and Preven- tion (CDC) found that almost two thirds (63%) of all mortality coded as weather- related from 2006 to 2010 in the U.S. was due to cold exposure, while less than one third (31%) was attributable to heat expo- sure (Berko et al., 2014). While climate change is contributing to increasing average winter temperatures, cold-related illness and death will continue to be health risks. One study found that most cold-related mortality
was caused by exposure to moderately cold temperatures, but that the contribution of extremely cold temperatures was compara- tively low, suggesting that reductions in cold- related mortality from climate change might be smaller than initially assumed (Gasparrini et al., 2015). Climate change can have other impacts on cold weather, such as increases in the inten- sity of extreme cold events and winter storms, which in turn have important implications for cold-related illness and death (Conlon et al., 2011; Noe et al., 2012). The purpose of our assessment was to develop and evaluate locally relevant surveillance measures for cold-related
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Volume 86 • Number 4
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