Geographic dimensions of heat-related mortality in seven U.S. cities.

Spatially targeted interventions may help protect the public when extreme heat occurs. Health outcome data are increasingly being used to map intra-urban variability in heat-health risks, but there has been little effort to compare patterns and risk factors between cities. We sought to identify places within large metropolitan areas where the mortality rate is highest on hot summer days and determine if characteristics of high-risk areas are consistent from one city to another. A Poisson regression model was adapted to quantify temperature-mortality relationships at the postal code scale based on 2.1 million records of daily all-cause mortality counts from seven U.S. cities. Multivariate spatial regression models were then used to determine the demographic and environmental variables most closely associated with intra-city variability in risk. Significant mortality increases on extreme heat days were confined to 12-44% of postal codes comprising each city. Places with greater risk had more developed land, young, elderly, and minority residents, and lower income and educational attainment, but the key explanatory variables varied from one city to another. Regression models accounted for 14-34% of the spatial variability in heat-related mortality. The results emphasize the need for public health plans for heat to be locally tailored and not assume that pre-identified vulnerability indicators are universally applicable. As known risk factors accounted for no more than one third of the spatial variability in heat-health outcomes, consideration of health outcome data is important in efforts to identify and protect residents of the places where the heat-related health risks are the highest.