• Aayush Visaria, Euntaik Kang, Ashwaghosha Parthasarathi, David Robinson, John Read, Rachel Nethery, Kevin Josey, Poonam Gandhi, Benjamin Bates, Melanie Rua, Arnab K Ghosh, and Soko Setoguchi.
• Department of Medicine, Rutgers Robert Wood Johnson Medical School, One Robert Wood Johnson Pl., New Brunswick, NJ 08901, United States of America. Electronic address: aayush.visaria@rutgers.edu.
• Am J Emerg Med. 2024 Jul 1; 81: 191-9.

ObjectiveTo assess the association between ambient heat and all-cause and cause-specific emergency department (ED) visits and acute hospitalizations among Medicare beneficiaries in the conterminous United States.DesignRetrospective cohort study.SettingConterminous US from 2008 and 2019.Participants2% random sample of all Medicare fee-for-service beneficiaries eligible for Parts A, B, and D.Main Outcome MeasuresAll-cause and cause-specific (cardiovascular, renal, and heat-related) ED visits and unplanned hospitalizations were identified using primary ICD-9 or ICD-10 diagnosis codes. We measured the association between ambient temperature - defined as daily mean temperature percentile of summer (June through September) - and the outcomes. Hazard ratios and their associated 95% confidence intervals were estimated using multivariable Cox proportional hazards regression, adjusting for individual level demographics, comorbidities, healthcare utilization factors and zip-code level social factors.ResultsAmong 809,636 Medicare beneficiaries (58% female, 81% non-Hispanic White, 24% <65), older beneficiaries (aged ≥65) exposed to >95th percentile temperature had a 64% elevated adjusted risk of heat-related ED visits (HR [95% CI], 1.64 [1.46,1.85]) and a 4% higher risk of all-cause acute hospitalization (1.04 [1.01,1.06]) relative to <25th temperature percentile. Younger beneficiaries (aged <65) showed increased risk of heat-related ED visits (2.69 [2.23,3.23]) and all-cause ED visits (1.03 [1.01,1.05]). The associations with heat related events were stronger in males and individuals dually eligible for Medicare and Medicaid. No significant differences were observed by climatic region. We observed no significant relationship between temperature percentile and risk of CV-related ED visits or renal-related ED visits.ConclusionsAmong Medicare beneficiaries from 2008 to 2019, exposure to daily mean temperature ≥ 95th percentile was associated with increased risk of heat-related ED visits, with stronger associations seen among beneficiaries <65, males, and patients with low socioeconomic position. Further longitudinal studies are needed to understand the impact of heat duration, intensity, and frequency on cause-specific hospitalization outcomes.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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