Heatwaves, medications, and heat-related hospitalization in older Medicare beneficiaries with chronic conditions.



Heatwaves kill more people than floods, tornadoes, and earthquakes combined and disproportionally affect older persons and those with chronic conditions. Commonly used medications for chronic conditions, e.g., diuretics, antipsychotics disrupt thermoregulation or fluid/electrolyte balance and may sensitive patients to heat. However, the effect of heat-sensitizing medications and their interactions with heatwaves are not well-quantified. We evaluated effects of potentially heat-sensitizing medications in vulnerable older patients.


US Medicare data were linked at the zip code level to climate data with surface air temperatures for June-August of 2007-2012. Patients were Medicare beneficiaries aged ≥65 years with chronic conditions including diabetes, dementia, and cardiovascular, lung, or kidney disease. Exposures were potentially heat-sensitizing medications including diuretics, anticholinergics, antipsychotics, beta blockers, stimulants, and anti-hypertensives. A heatwave was defined as ≥2 days above the 95th percentile of historical zip code-specific surface air temperatures. We estimated associations of heat-sensitizing medications and heatwaves with heat-related hospitalization using self-controlled case series analysis.


We identified 9,721 patients with at least one chronic condition and heat-related hospitalization; 42.1% of these patients experienced a heatwave. Heatwaves were associated with an increase in heat-related hospitalizations ranging from 21% (95% CI: 7% to 38%) to 33% (95% CI: 14% to 55%) across medication classes. Several drug classes were associated with moderately elevated risk of heat-related hospitalization in the absence of heatwaves, with rate ratios ranging from 1.16 (95% CI: 1.00 to 1.35) to 1.37 (95% CI: 1.14 to 1.66). We did not observe meaningful synergistic interactions between heatwaves and medications.


Older patients with chronic conditions may be at heightened risk for heat-related hospitalization due to the use of heat-sensitizing medications throughout the summer months, even in the absence of heatwaves. Further studies are needed to confirm these findings and also to understand the effect of milder and shorter heat exposure.





Published Version (Please cite this version)


Publication Info

Layton, J Bradley, Wenhong Li, Jiacan Yuan, Joshua P Gilman, Daniel B Horton and Soko Setoguchi (2020). Heatwaves, medications, and heat-related hospitalization in older Medicare beneficiaries with chronic conditions. PloS one, 15(12). p. e0243665. 10.1371/journal.pone.0243665 Retrieved from https://hdl.handle.net/10161/22255.

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Wenhong Li

Associate Professor of Climate

Dr. Li's research interests focus primarily on climate dynamics, land-atmosphere interaction, hydroclimatology, and climate modeling. Her current research is to understand how the hydrological cycle changes in the current and future climate and their impacts on the ecosystems, subtropical high variability and change, unforced global temperature variability, and climate and health issues.

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