Generalizability of heat-related health risk associations observed in a large healthcare claims database of patients with commercial health insurance.

BACKGROUND: Extreme ambient heat is unambiguously associated with higher risk of illness and death. The Optum Labs Data Warehouse (OLDW), a database of medical claims from US-based patients with commercial or Medicare Advantage health insurance, has been used to quantify heat-related health impacts. Whether results for the insured sub-population are generalizable to the broader population has to our knowledge not been documented. We sought to address this question, for the US population in California from 2012 to 2019. METHODS: We examined changes in daily rates of emergency department (ED) encounters and in-patient hospitalization encounters for all-causes, heat-related outcomes, renal disease, mental/behavioral disorders, cardiovascular disease, and respiratory disease. OLDW was the source for health data for insured individuals in California, and health data for the broader population were gathered from the California Department of Health Care Access and Information (HCAI). We defined extreme heat exposure as any day in a group of 2 or more days with maximum temperatures exceeding the county-specific 97.5 th percentile and used a space-time-stratified case-crossover design to assess and compare the impacts of heat on health. RESULTS: Average incidence rates of medical encounters differed by dataset. However, rate ratios for ED encounters were similar across datasets for all causes (ratio of incidence rate ratios (rIRR) = 0.989; 95% confidence interval (CI) = 0.973, 1.011), heat-related causes (rIRR = 1.080; 95% CI = 0.999, 1.168), renal disease (rIRR = 0.963; 95% CI = 0.718, 1.292), and mental health disorders (rIRR = 1.098; 95% CI = 1.004, 1.201). Rate ratios for inpatient encounters were also similar. CONCLUSIONS: This work presents evidence that OLDW can continue to be a resource for estimating the health impacts of extreme heat.

Heterogeneous climate change impacts on electricity demand in world cities circa mid-century.

Rising ambient temperatures due to climate change will increase urban populations' exposures to extreme heat. During hot hours, a key protective adaptation is increased air conditioning and associated consumption of electricity for cooling. But during cold hours, milder temperatures have the offsetting effect of reducing consumption of electricity and other fuels for heating. We elucidate the net consequences of these opposing effects in 36 cities in different world regions. We couple reduced-form statistical models of cities' hourly responses of electric load to temperature with temporally downscaled projections of temperatures simulated by 21 global climate models (GCMs), projecting the effects of warming on the demand for electricity circa 2050. Cities' responses, temperature exposures and impacts are heterogeneous, with changes in total annual consumption ranging from [Formula: see text] to 5.7%, and peak power demand increasing by as much as 9.5% at the multi-GCM median. The largest increases are concentrated in more economically developed mid-latitude cities, with less developed urban areas in the tropics exhibiting relatively small changes. The results highlight the important role of the structure of electricity demand: large temperature increases in tropical cities are offset by their inelastic responses, which can be attributed to lower air-conditioning penetration.

Inequality in the availability of residential air conditioning across 115 US metropolitan areas.

Continued climate change is increasing the frequency, severity, and duration of populations' high temperature exposures. Indoor cooling is a key adaptation, especially in urban areas, where heat extremes are intensified-the urban heat island effect (UHI)-making residential air conditioning (AC) availability critical to protecting human health. In the United States, the differences in residential AC prevalence from one metropolitan area to another is well understood, but its intra-urban variation is poorly characterized, obscuring neighborhood-scale variability in populations' heat vulnerability and adaptive capacity. We address this gap by constructing empirically derived probabilities of residential AC for 45,995 census tracts across 115 metropolitan areas. Within cities, AC is unequally distributed, with census tracts in the urban "core" exhibiting systematically lower prevalence than their suburban counterparts. Moreover, this disparity correlates strongly with multiple indicators of social vulnerability and summer daytime surface UHI intensity, highlighting the challenges that vulnerable urban populations face in adapting to climate-change driven heat stress amplification.