Association Between Work-Related Hyperthermia Emergency Department Visits and Ambient Heat in Five Southeastern States, 2010–2012—A Case-Crossover Study

Jeffrey Shire, Ambarish Vaidyanathan, Michelle Lackovic, Terry Bunn

Research output: Contribution to journalArticlepeer-review


The objective of this study is to assess ambient temperatures' and extreme heat events' contribution to work-related emergency department (ED) visits for hyperthermia in the southeastern United States to inform prevention. Through a collaborative network and established data framework, work-related ED hyperthermia visits in five participating southeastern U.S. states were analyzed using a time stratified case-crossover design. For exposure metrics, day- and location-specific measures of ambient temperatures and county-specific identification of extreme heat events were used. From 2010 to 2012, 5,017 work-related hyperthermia ED visits were seen; 2,298 (~46%) of these visits occurred on days when the daily maximum heat index was at temperatures the Occupational Safety and Health Administration designates as having “lower” or “moderate” heat risk. A 14% increase in risk of ED visit was seen for a 1°F increase in average daily mean temperature, modeled as linear predictor across all temperatures. A 54% increase in risk was seen for work-related hyperthermia ED visits during extreme heat events (two or more consecutive days of unusually high temperatures) when controlling for average daily mean temperature. Despite ambient heat being a well-known risk to workers' health, this study's findings indicate ambient heat contributed to work-related ED hyperthermia visits in these five states. Used alone, existing OSHA heat-risk levels for ambient temperatures did not appear to successfully communicate workers' risk for hyperthermia in this study. Findings should inform future heat-alert communications and policies, heat prevention efforts, and heat-illness prevention research for workers in the southeastern United States.

Original languageEnglish
Article numbere2019GH000241
Issue number8
StatePublished - Aug 1 2020

Bibliographical note

Publisher Copyright:
© 2020. The Authors.


  • ambient temperature
  • case-crossover
  • extreme heat
  • heat stress disorders
  • primary prevention
  • workers

ASJC Scopus subject areas

  • Global and Planetary Change
  • Epidemiology
  • Water Science and Technology
  • Waste Management and Disposal
  • Pollution
  • Public Health, Environmental and Occupational Health
  • Management, Monitoring, Policy and Law
  • Health, Toxicology and Mutagenesis


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