Heat-Associated Mortality in a Hot Climate : Maricopa County, Arizona, 2006-2016

Public Health Rep. 2020 Sep/Oct;135(5):631-639. doi: 10.1177/0033354920938006. Epub 2020 Jul 20.


Objectives: Maricopa County, Arizona (2017 population about 4.3 million), is located in the Sonoran Desert. In 2005, the Maricopa County Department of Public Health (MCDPH) established a heat-associated mortality surveillance system that captures data on circumstances of death for Maricopa County residents and visitors. We analyzed 2006-2016 surveillance system data to understand the characteristics and circumstances of heat-associated deaths.

Methods: We classified heat-associated deaths based on International Classification of Diseases, Tenth Revision codes (X30, T67.X, and P81.0) and phrases (heat exposure, environ, exhaustion, sun, heat stress, heat stroke, or hyperthermia) in part I or part II of the death certificate. We summarized data on decedents' demographic characteristics, years lived in Arizona, location of death (indoors vs outdoors), presence and functionality of air conditioning, and whether the decedent had been homeless. We examined significant associations between variables by using the Pearson χ2 tests and logistic regression.

Results: During 2006-2016, MCDPH recorded data on 920 heat-associated deaths, 912 of which included location of injury. Of 565 (62%) heat-associated deaths that occurred outdoors, 458 (81%) were among male decedents and 243 (43%) were among decedents aged 20-49. Of 347 (38%) heat-associated deaths that occurred indoors, 201 (58%) were among decedents aged ≥65. Non-Arizona residents were 5 times as likely as Arizona residents to have a heat-associated death outdoors (P < .001). Of 727 decedents with data on duration of Arizona residency, 438 (60%) had resided in Arizona ≥20 years.

Conclusions: Ongoing evaluation of interventions that target populations at risk for both outdoor and indoor heat-associated deaths can further inform refinement of the surveillance system and identify best practices to prevent heat-associated deaths.

Keywords: environmental; heat; mortality; surveillance.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Arizona / epidemiology
  • Child
  • Child, Preschool
  • Female
  • Forecasting
  • Heat Stress Disorders / epidemiology*
  • Heat Stress Disorders / mortality*
  • Humans
  • Infant
  • Infant, Newborn
  • Logistic Models
  • Male
  • Middle Aged
  • Mortality / trends*
  • Population Surveillance / methods*
  • Public Health / statistics & numerical data*
  • Public Health / trends*
  • Young Adult