Abstract
High and low daily ambient temperatures are associated with higher mortality in the general population. People experiencing homelessness (PEH) are thought to be particularly vulnerable, but there is almost no direct evidence available. We examined the temperature-mortality association among PEH in 2 populous, urban counties in hot-climate regions of the United States, focusing on heat effects. Study setting was Los Angeles County, CA, and Clark County, NV, which encompass the cities of Los Angeles and Las Vegas, respectively. Outcomes were 2015-2022 deaths among decedents categorized as homeless in county administrative records. We used quasi-Poisson distributed lag nonlinear models to estimate the association of mortality with daily temperatures and with 7-day lagged temperatures, adjusting for day of week, seasonality, and long-term trends. We estimated the minimum mortality temperature and fraction of mortality attributable to temperatures above and below minimum mortality temperature. The association between daily temperature and PEH mortality was skewed towards greater risk at higher temperatures, especially in Clark County. Temperature-attributable mortality equaled 50.1% of deaths in Clark County (95% CI, 29.0-62.8) and 7.0% in Los Angeles County (95% CI, 1.4-12.1). In both counties, most temperature-attributable deaths were attributable to heat rather than cold. In these hot-climate urban counties, our estimates of heat-attributable mortality among PEH were orders of magnitude greater than those reported in prior research on the general population. These results indicate that temperature vulnerability, particularly heat vulnerability, requires stronger public health and policy responses.
https://academic.oup.com/aje/advance-article-abstract/doi/10.1093/aje/kwae084/7689061?redirectedFrom=fulltext
Alright, let’s break this down: a study concludes that people lying out in the street—most of whom are drug addicts—are more likely to die on a hot day than those who are inside with air conditioning. Well, stop the presses! Who could have guessed that baking on asphalt like an egg on a skillet might not be conducive to longevity?
This kind of study is a prime example of the mind-bending banality that passes for scientific insight these days. Our elite academic institutions, seemingly incapable of grappling with real problems, give us these groundbreaking revelations. Next up, perhaps they’ll inform us that people are more likely to drown in water than on dry land.
What makes this situation truly absurd isn’t just the waste of time and money on such a blindingly obvious conclusion. No, it’s the fact that these “findings” will inevitably be spun into policy recommendations. Cue the sanctimonious cries for more taxpayer dollars to fund air-conditioned safe spaces for those suffering from addiction. Because that’s the real solution, right? Just give the government more control and money to fix the problem, as if bureaucrats are going to solve the complex, entrenched issues of homelessness, addiction, and mental illness with central air conditioning and sun hats.
There’s a more serious issue here, though, and it’s one the media won’t touch: why are people lying in the streets in the first place? Could it be that decades of permissive policies, under the guise of “compassion,” have only exacerbated the homelessness and addiction crises? We’ve effectively normalized drug use, failed to enforce laws, and allowed cities to deteriorate into open-air homeless encampments. But instead of addressing those uncomfortable truths, we get another ivory tower study reminding us that it’s hot outside.
Let’s be real here. The tragic deaths of people sweltering in the streets are a symptom of a much larger problem. These individuals aren’t victims of climate change—they’re victims of societal breakdown, enabled by politicians who refuse to enforce laws and by a culture that increasingly rejects personal responsibility. But instead of confronting that, we get a study that hand-wrings about the obvious: heat kills.
What’s next? Perhaps we’ll get a follow-up study: “Drug addicts lying in snow are more likely to freeze to death than those who are inside with central heating.” It would be funny if it weren’t so tragically stupid.
Here is the entire press release from EurekAlert!
Boston University School of Public Health
FOR IMMEDIATE RELEASE
Thursday, October 10, 2024
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By nature of their living situation, people experiencing homelessness (PEH) are considered one of the most vulnerable populations to the health impacts of extreme weather.
PEH are particularly vulnerable to heat, and the impact of heat on mortality in this group is substantially greater than for the general population, according to a new study by Boston University School of Public Health (BUSPH).
Published in the American Journal of Epidemiology, the study examined mortality rates in two hot-climate US counties—Clark County in Nevada, which includes Las Vegas, and Los Angeles County in California—and found that daily heat played a significant role in mortality among PEH.
This association was especially notable in Clark County, where nearly 50 percent of deaths during the study period were attributable to higher daily temperatures. Although LA County observed a smaller percentage of heat-attributable deaths, at 5.2 percent, daily heat appeared to contribute to many more deaths than daily cold in both counties.
The study is the first to examine heat-attributable mortality among PEH, providing valuable public health insight as the West Coast reels from an unprecedented October heatwave that has prompted numerous heat alerts in parts of LA and Las Vegas, where temperatures soared to 111 degrees and 104 degrees, respectively, in recent days. Both cities also continue to grapple with persistently high homelessness rates that far exceed the national average. Quantifying the impacts of extreme heat on PEH can inform new interventions and policies that reduce illness and mortality rates among this largely unsheltered population.
“It wasn’t a surprise that our team found an association between heat and mortality for unhoused people, but the magnitude was staggering,” says study senior and corresponding author Dr. Jonathan Jay, assistant professor of community health sciences at BUSPH. “Our estimates are 10 to 100 times greater than the known associations between daily heat and mortality for the general population in LA and Las Vegas, and this finding highlights the moral imperative for our systems to do more.”
He says the new findings also show that heat exposure is an important factor amplifying the vast health inequities for PEH, and highlight the need to center the most marginalized populations in research on climate and health.
For the study, Dr. Jay and colleagues from BUSPH and the David Geffen School of Medicine at the University of California, Los Angeles utilized mortality and daily temperature data for Clark and Los Angeles counties from January 2015 to August 2022 (for Clark County) and November 2022 (for LA County). The team analyzed deaths from all causes, rather than just deaths that were acutely heat- or cold-related (such as fatal heat stroke or hyperthermia), to ensure that the analysis captured all external causes of death as a result of high temperatures. Hot weather was defined as daily temperatures above the minimum mortality temperature (MMT)—the temperature at which mortality risk is lowest in each area—which was 11.6 Celsius (52.8 degrees Fahrenheit) for Clark County and 19.3 Celsius for LA County (66.7 degrees Fahrenheit).
After accounting for long-term and seasonal trends, days of the week, and cumulative effects of consecutive days’ temperatures, the researchers found that mortality risk among PEH increased in both hotter and colder temperatures. The heat was especially harmful in Clark County, where 15 percent of deaths were due to acutely heat-related causes, compared to 0.2 percent in LA County. Extremely hot days accounted for nearly 25 percent of all deaths in Clark County and 2.2 percent of all deaths in LA County.
“It was important to see that deaths increased as daily temperatures increased, from cool days to warmer days, and they spiked on hotter days, starting around 90 degrees Fahrenheit and higher,” Dr. Jay says. “That’s hot, but it’s not even close to the hottest temperatures these cities experience,” he adds, which suggests that public health advocates should be extra vigilant in providing heat-related support beyond the summer season, as climate change continues to extend the number and length of heat waves each year.
Public health strategies that can mitigate heat impacts among PEH in communities include cooling centers, water stations, greening, and reflective painting, the researchers say. But, ultimately, these strategies should embrace a “Housing First” approach, as the primary cause of homelessness is a lack of affordable housing. California, in particular, is consistently ranked as one of the most expensive states to live in the US. Policies that promote stable housing and other financial support for PEH are even more critical following the Supreme Court’s ruling in June that permits cities to ban people from sleeping and camping in public places.
“Too much of our policy is driven by the impulse to hide homelessness from view, rather than to recognize people’s dignity, protect their health, and improve our systems,” says Dr. Jay. “The idea that policing is key to solving this problem is false, and it’s a miscalculation we make over and over again as a society.”
The lead author of the study is Dr. Zihan Lin, a BUSPH postdoctoral fellow at the time of the study and a current assistant professor of biological, geographical and environmental sciences at Cleveland State University.
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About Boston University School of Public Health
Founded in 1976, Boston University School of Public Health is one of the top ten ranked schools of public health in the world. It offers master’s- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.
Journal
American Journal of Epidemiology
DOI
10.1093/aje/kwae084
Method of Research
Observational study
Subject of Research
People
Article Title
Daily heat and mortality among people experiencing homelessness in 2 urban US counties, 2015-2022 Get access Arrow
Article Publication Date
25-Sep-2024
COI Statement
G.A.W. serves as a consultant to the Health Effects Institute and recently served as a consultant for Google, LLC.
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