MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH
DIVISION OF DISEASE CONTROL
OFFICE OF EPIDEMIOLOGY

HEAT-ASSOCIATED DEATHS IN
MARICOPA COUNTY, AZ
REPORT FOR 2011
July 2012

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Table of Contents
Acknowledgements ............................................................................................................... 3
Background............................................................................................................................ 4
Method .................................................................................................................................... 4
Results ................................................................................................................................... 6
Heat-Associated Deaths by Year ...................................................................................... 6
Heat-Associated Deaths for Select Months, 2011 ........................................................... 7
Heat-Associated Deaths by Residency and Years Spent in Arizona ............................. 8
Heat-Associated Deaths by Gender................................................................................ 10
Heat-Associated Deaths by Race.................................................................................... 12
Heat-Associated Deaths by Place of Occurrence and Air Conditioning Status ......... 16
Heat-Associated Deaths Among the Homeless ............................................................. 18
Conclusions – Heat-Associated Deaths 2011 ................................................................... 20
Special Case ........................................................................................................................ 21
Future Plans ......................................................................................................................... 21
APPENDIX ............................................................................................................................ 22
Table A. Heat-Associated Deaths by Gender and Age, Maricopa County, 2011 ......... 22
Table B. Heat-Associated Death Rates per 100,000 Residents (and Counts) by
Gender and Age, Maricopa County, 2011 ....................................................................... 23
Table C. Heat-Associated Death Rates per 100,000 Residents (and Counts) by Age
Group and Race/Ethnicity, Maricopa County, 2011 ....................................................... 24
Table D. Heat-Associated Death Rates per 100,000 Residents (and Counts) by
Gender and Race/Ethnicity, Maricopa County, 2011 ..................................................... 25
Table E. Heat-Associated Deaths by Place Injury Occurred and Age, Maricopa
County, 2011 ..................................................................................................................... 26
Table F. Heat-Associated Deaths by Indoor or Outdoor Occurrence, Age, and Gender
Maricopa County, 2011 .................................................................................................... 26
Table G. Heat-Associated Deaths by Use of Air Conditioning and Age Group, (Indoor
Only) Maricopa County, 2011 .......................................................................................... 27
Table H. Drug and Alcohol Use, as Mentioned on the Death Certificate for HeatAssociated Deaths, by Homelessness, Maricopa County, 2011 .................................. 27

Maricopa County Heat-Associated Deaths, 2011

3
Acknowledgements
The Maricopa County Department of Public Health, Office of Epidemiology would like to
thank the following agencies for their contributions to this report’s findings:







Maricopa County Office of the Medical Examiner (OME)
Maricopa County Office of Vital Registration
Arizona Department of Health Service, Office of Vital Registration
National Weather Service (NWS)
Maricopa Association of Governments (MAG)
Local hospitals (infection preventionists, emergency departments, social worker staff)

Maricopa County Heat-Associated Deaths, 2011

4
Background
In July 2005, Maricopa County (MC) experienced exceptionally high temperatures that
contributed to 45 deaths, 35 occurring over 9 consecutive days. Temperatures reached
116°_F and three excessive heat warnings were issued during this month. To track these
deaths, the Maricopa County Department of Public Health (MCDPH) created a novel and
effective approach for surveillance of heat-associated deaths and has continued to use this
system annually. The enhanced heat surveillance season begins in May and ends in
October.

Method
Surveillance data is obtained from the following sources:
1. The Maricopa County Office of the Medical Examiner (OME) forwards suspected heatrelated deaths to the MCDPH and provides data including demographics, preliminary
information regarding how the death occurred, and the circumstances of death.
2. The Arizona Department of Health Services has a vital records database containing
death certificates. MCDPH searches this database looking for causes of death
associated with environmental heat. A Statistical Analysis Software (SAS) program
looks for the key phrases and International Classification of Disease-10 (ICD-10)
codes listed below.
Key Phrases
HEAT EXPOSURE
ENVIRON
EXHAUSTION
SUN
HEAT STRESS
HEAT STROKE
HYPERTHERMIA
ICD 10 Code
X30
T67.X
P810

Corresponding Definition
Exposure to excessive natural heat
Effects of heat and light
Environmental hyperthermia of newborn

3. Hospital and media reports can sometimes initiate a heat death investigation, for
example, if a child is reportedly left in a hot car.

Maricopa County Heat-Associated Deaths, 2011

5
Once data are received, analysis of the information is required to identify only those deaths
caused as a result of environmental heat. Environmental heat is heat generated by the
climate (sun, humidity, etc.) rather than heat from man-made sources such as ovens or
manufacturing equipment.
Heat-associated deaths are categorized based on the
classification criteria listed below:
Heat-caused (HC) deaths are those in which environmental heat was directly involved in the sequence
of conditions causing deaths. These are deaths where environmental heat terms were mentioned in
Part I of the death certificate causes of death (diseases or conditions in the direct sequence causing
death), for cause of death variables (cod_a, cod_b, cod_c, or cod_d). County of death: Maricopa.
Heat-related (HR) deaths are those in which environmental heat contributed to the deaths but was not
in the sequence of conditions causing these deaths. These are cases where environmental heat terms
were mentioned in Part II of the death certificate causes of death (diseases and conditions contributing
but not directly resulting in the death sequence), but not in any of the Part I death variables (cod_a,
cod_b, cod_c, or cod_d). County of death: Maricopa.

Part I and Part II of the death certificate are as follows:
Part I of the death certificate: cod a – is the immediate cause (final disease or condition resulting
in death) cod b, cod c, cod d – are sequentially listed conditions leading to the cause listed on cod
a.
Part II of the death certificate: Other significant conditions contributing to death but not resulting in
the underlying cause given in Part I.

For the purposes of this report, heat-caused and heat-related deaths are combined and
referred to as “heat-associated deaths.” Please note that most jurisdictions report only heatcaused deaths. This should be considered when comparing Maricopa County data with data
from other locations.
Death certificate data, in combination with the OME notes, are used to produce the
information that is contained in this report. Total case count, demographics, residency,
drug/alcohol use, and years lived in Arizona are directly retrieved from death certificate data.
Place of death, place of death occurrence, air conditioning use, and homelessness are
retrieved based on explicit notations made in the death certificate and/or OME notes.
Homelessness is defined as having an address on the death certificate that matches a
homeless shelter, government agency, business, or an intersection. Cases are also classified
as homeless if there is an indication on the death certificate. If the address is listed as
unknown on the death certificate then an examination of the medical examiner’s notes is
made to determine if there is a reference to an address - if none, then the person is classified
as homeless. If the address is listed as out of jurisdiction then time spent in Arizona, as
provided by the death certificate, is taken into consideration.
Once classification is completed, the data are summarized for the production and
dissemination of reports. Reports are generated weekly during the season and posted to the
MCDPH website which can be found at:
http://www.maricopa.gov/publichealth/Services/EPI/Reports/heat.aspx

Maricopa County Heat-Associated Deaths, 2011

6
Results

Heat-Associated Deaths by Year
Table 1. On average, over 100 suspect heat-caused/heat-related deaths (heat-associated
deaths) were investigated each year from 2006 through 2011 totaling 732 cases over the six
year period. Of these cases, 61% were confirmed as being heat-associated deaths. In 2011,
74% of the investigated cases were also confirmed as heat-associated deaths.
Table 1. Heat-Associated Deaths Reported in Maricopa County: 2006-2011
Cases

2006

%

2007

%

2008

%

2009

%

2010

%

2011

%

TOTAL

%

Total Reported

104

100

131

100

97

100

114

100

142

100

144

100

732

100

Confirmed

85

83

51

39

50

52

74

65

82

58

106

74

448

61

Ruled Out

19

17

80

61

47

48

40

35

60

42

38

26

284

39

Graph 1. The number of heat-associated deaths confirmed in 2011 was 106, indicating the
highest number of heat-associated deaths over ten years. The graph shows that after a
decline in 2007 and 2008, heat mortality increased for three consecutive years. Cases
increased from 2010 to 2011 by 29%.
Graph 1. Heat-Associated Deaths by Year, Maricopa County: 2001-2011*
120
106**
100

Number of Deaths

85

82

75

80

74

60
49

50

2007

2008

42

38

40

51

21
20

0
2001

2002

2003

2004

2005

2006

2009

2010

2011

Year of Reported Death
Data Sources: Maricopa County, Office of Vital Registration and Office of Medical Examiner; Arizona Department of Health
Services, Office of Vital Registration
*The numbers reported here are for heat-associated deaths reported to MCDPH as of 7/18/2012
** Although included here, one case was excluded from further detailed analyses. This case was pronounced dead in January 2011, but
likely died during the summer of 2010. For more information, please see the “Special Case” section at the end of this document.

Maricopa County Heat-Associated Deaths, 2011

7

Heat-Associated Deaths for Select Months, 2011
Graph 2. In 2011, August was the most deadly month for heat-associated deaths with more
than a third of the year’s 105 deaths occurring in this month. For the full year, the majority of
deaths were classified as heat-caused (56, 53.3%), with the remainder classified as heatrelated (49, 46.7%).
Graph 2. Heat-Associated Deaths by Month, Maricopa County, 2011
45
40

Number of Deaths

35
30
25
20

15
10
5
0
Heat Caused (N=56)
Heat Related (N=49)
Total* (N=105)

MAR
1
0
1

APR
1
0
1

MAY
1
1
2

JUN
10
5
15

JUL
15
17
32

AUG
20
19
39

Month of Death
*Excluded one case that was pronounced dead in January 2011, but likely died during the summer of 2010.

Maricopa County Heat-Associated Deaths, 2011

SEP
8
7
15

OCT
0
0
0

8

Heat-Associated Deaths by Residency and Years Spent in Arizona
Graph 3. Residency was identified for 102 heat-associated deaths in 2011. (The three cases
for which residency could not be established were excluded from this graph). Most of the
cases (84, 82.4%) were Maricopa County residents. About ten percent of the 102 cases
resided in an Arizona County other than Maricopa. Nearly eight percent of the 102 cases
were residents of other states or countries.
Graph 3. Heat-Associated Deaths by Residency in Maricopa County, 2011
90

80

Number of Deaths

70

60
50
40
30
20

10
0
Heat Caused (N=54)
Heat Related (N=48)
Total* (N=102)

Maricopa Co.
38
46
84

Non-Maricopa Co.**
9
1
10

Non-Arizona***
7
1
8

Residency
*Excludes three cases where residency could not be established, and one case that was pronounced dead in January 2011, but likely died
during the summer of 2010.
**Non-Maricopa residents include Coconino (1) and other unidentified AZ counties (9)
***Non-Arizona residents include three US residents (KS, TX, WA) and five non-US residents (four from Mexico and one from Canada)

Maricopa County Heat-Associated Deaths, 2011

9
Graph 4. For cases where time spent in Arizona was known (85 decedents), 61% (52/85)
resided in Arizona for 20 years or more. Additionally, the majority of decedents (74/85, 87%)
had lived in Arizona for at least 3 years. This distribution is not directly related to age, as
decedents from the various age groups can be seen in most of the “Years in Arizona”
categories.
Graph 4. Heat-Associated Deaths by Years Lifetime Spent in Arizona and Age Group,
Maricopa County, 2011

Number of Deaths

25

20

15

10

5

0

<3

3-9

10-19

20+

0-4 (N=0)

0

0

0

0

5-19 (N=1)

1

0

0

0

20-34 (N=6)

2

0

3

1

35-49 (N=18)

5

3

1

9

50-64 (N=29)

2

4

3

20

65-74 (N=19)

0

1

1

9

75+ (N=13)

1

1

5

13

11

9

13

52

All Ages* (N=85)

Years in Arizona
*Excluded twenty cases for which time spent in Arizona was unknown at the time of analysis. Also excluded one case that was pronounced
dead in January 2011, but likely died during the summer of 2010.

Maricopa County Heat-Associated Deaths, 2011

10

Heat-Associated Deaths by Gender
Graph 5. The majority of heat-associated deaths were males (76, 72.4%). Most male cases
were under the age of 65 (51, 67.1% of male cases). In contrast, female cases were
distributed almost equally above and below the age of 65. There was only one pediatric
death in 2011 which was a female between the ages of 5 and 19. There were no heatassociated deaths among children under the age of five. [For more detailed results on age,
See Appendix, Table A]
Graph 5. Age at Death, Heat-Associated Deaths by Gender and Age Group, Maricopa
County, 2011
40

Number of Deaths

35
30
25
20
15
10
5
0
Male (N=76)
Female (N=29)
Total* (N=105)

0-4
0
0
0

5-19
0
1
1

20-34
5
2
7

35-49
17
4
21

50-64
29
8
37

Age Groups (in Years)
*Excluded one case that was pronounced dead in January 2011, but likely died during the summer of 2010.

Maricopa County Heat-Associated Deaths, 2011

65-74
13
3
16

75+
12
11
23

11
Graph 6. The pattern for heat-associated deaths by age is different for males and females.
The data show, that for women, the rate of heat-associated deaths begins to increase in the
35-49 year-old age group, with a substantial increase among the 75+ age group. Among
men, the rates for heat-associated deaths increase steadily beyond the 20-34 age group, and
exceed the rates of death in women for all equivalent age groups. The highest rate of heatassociated death is 12.2, among males aged 75+, and inclusive of both genders, the 75+ age
group has the highest rate of death (10.2). [See Appendix, Table B]
Graph 6. Heat-Associated Death Rates per 100,000 Maricopa County Residents* by
Gender and Age Group, Maricopa County, 2011
14.0

Rate of Death
(per 100,000 Residents)

12.0

10.0

8.0

6.0

4.0

2.0

0.0

Male (N=58)
Female (N=26)
Total** (N=84)

0-4
0.0
0.0
0.0

5-19
0.0
0.2
0.1

20-34
0.5
0.2
0.4

35-49
2.5
0.8
1.7

50-64
7.2
2.0
4.5

65-74
9.6
2.1
5.6

75+
12.2
8.8
10.2

Age Group (in years)
*Based on 2011 Census population estimates for Maricopa County.
**Excluded twenty one cases that were not Maricopa County residents. Also excluded one case that was pronounced dead in January
2011, but likely died during the summer of 2010.

Maricopa County Heat-Associated Deaths, 2011

12

Heat-Associated Deaths by Race
Graph 7 – 8. Graph 7 shows that White males had the highest number of heat-associated
deaths (47) of all race/gender groups. For almost all of the other race/ethnicity groups, the
majority of deaths were among males (73). As shown in Graph 8, African Americans had the
highest rate (4.4) of heat-associated death of all races, with African American males dying of
heat-associated death at a rate of 6.5 deaths per 100,000 residents (Graph 8).
Graph 7. Heat-Associated Deaths by Race and Gender for Deaths Occurring in
Maricopa County, 2011
70
60

Number of Deaths

50
40
30
20
10
0
Male (N=73)
Female (N=29)
Total* (N=102)

White

Hispanic

47
20
67

18
5
23

African
American
7
3
10

Asian/Pac.
Islander
1
0
1

Native American

Multiple

0
0
0

0
1
1

Race
*Excluded three cases where Race was Unknown, and one case that was pronounced dead in January 2011, but likely died during the
summer of 2010.

Maricopa County Heat-Associated Deaths, 2011

13
Graph 8. Heat-Associated Death Rates per 100,000 Residents* by Race and Gender
Group, Maricopa County, 2011
7.0

Rate of Death
(per 100,000 Residents)

6.0

5.0

4.0

3.0

2.0

1.0

0.0

Male (N=57)
Female (N=26)
Total* (N=83)

White

Hispanic

3.2
1.7
2.4

2.4
0.7
1.5

African
American
6.5
2.2
4.4

Race
* Based on 2011 Census population estimates for Maricopa County.
**Excluded one Maricopa County resident where Race was Unknown.

Maricopa County Heat-Associated Deaths, 2011

Asian/Pac.
Islander
1.5
0.0
0.7

Native
American
0.0
0.0
0.0

Multiple
0.0
2.8
1.4

14
Graph 9. As shown in Graph 9, nearly all race/ethnicities reported the highest number of
heat-associated deaths among persons aged 50 and over. Whites reported the highest
number of heat-associated deaths (67, 64%). Hispanics (23, 21.9%) were the second largest
group for heat-associated deaths with Hispanic deaths mostly in the 35-64 age range. The
remaining fifteen cases were distributed between the following race groups: African American
(10, 9.5%), Asian/Pacific Islander (1, 0.01%), Multiple (1, 0.01%), and 3 cases where race
was Unknown (3, 2.9%).
Graph 9. Heat-Associated Deaths by Race and Age Group for Maricopa County, 2011
25

Number of Deaths

20

15

10

5

0
White (N=67)
Hispanic (N=23)
African American (N=10)
Asian/Pac. Isl (N=1)
Native American (N=0)
Multiple (N=1)
Unknown (N=3)
Total* (N=105)

0-4
0
0
0
0
0
0
0
0

5-19
1
0
0
0
0
0
0
1

20-34
4
3
0
0
0
0
0
7

35-49
13
6
2
0
0
0
0
21

50-64
20
10
4
0
0
1
2
37

Age Groups (in Years)
*Excluded one case that was pronounced dead in January 2011, but likely died during the summer of 2010.

Maricopa County Heat-Associated Deaths, 2011

65-74
12
3
0
0
0
0
1
16

75+
17
1
4
1
0
0
0
23

15
Graph 10. Graph 10 shows that the rate of heat-associated death for Whites increases with
age, with the highest rate of death (8.5) in the 75+ age group. Among Hispanics, the highest
death rate is 10.1 among the 65-74 age group. The highest death rate of any age or
race/ethnicity group is 85.1 among African Americans, aged 75+. Relatively high rates of
death are also seen in 75+ Asian/Pacific Islanders (25.6), and Multiple race, aged 50-64
(18.8). However, because there are so few heat-associated deaths in all of the race/ethnic
groups other than White and Hispanic, these results will vary widely from year to year. [See
Appendix, Table C-D].
Graph 10. Heat-Associated Death Rates per 100,000 Residents* by Race and Age
Group, Maricopa County, 2011
90
80

Rate of Death
(per 100,000 Residents)

70
60

50
40
30

20
10
0

White (N=55)
Hispanic (N=18)
African American (N=8)
Asian/Pac. Isl (N=1)
Native American (N=0)
Multiple (N=1)
Total* (N=83)

0-4
0
0
0
0
0
0
0

5-19
0.3
0.0
0.0
0.0
0.0
0.0
0.1

20-34
0.5
0.3
0.0
0.0
0.0
0.0
0.4

35-49
1.7
1.3
5.2
0.0
0.0
0.0
1.7

50-64
3.3
8.8
7.0
0.0
0.0
18.8
4.3

65-74
5.4
10.1
0.0
0.0
0.0
0.0
5.6

75+
8.5
5.8
85.1
25.6
0.0
0.0
10.2

Age Groups (in Years)
* Based on 2011 Census population estimates for Maricopa County.
**Excluded one Maricopa County resident where Race was Unknown, twenty one cases that were not Maricopa County residents, and one
case that was pronounced dead in January 2011, but likely died during the summer of 2010.

Maricopa County Heat-Associated Deaths, 2011

16

Heat-Associated Deaths by Place of Occurrence and Air Conditioning
Status
Graphs 11 – 13. Graph 11 illustrates that 45% of heat deaths in 2011 occurred outdoors.
These deaths most often occurred in urban areas (43%). For men, the proportion of indoor
and outdoor deaths was equivalent, while more women (66%) died indoors than outdoors
(Graph 12). Fifty three percent of all deaths occurred indoors. Where deaths occurred
indoors, 36% did not have air conditioning in use, 63% had an unknown air conditioning
status, and 2% had functioning air conditioning that was turned on (Graph 13). Considering
that 63% of deaths had an unknown air conditioning status, the percentage of indoor deaths
with or without air conditioning may actually be higher. [See Appendix, Tables E-G]
Graph 11. Heat-Associated Deaths by Place of Occurrence and Place of Outdoor
Injury, Maricopa County, 2011

Place of Injury Occurence
(N=105*)

Place of Outdoor Injury Occurence
(N=47)

Unknown
(2, 2%)

Urban Area

(15, 32%)

Desert Area/Trail

Indoor
(56, 53%)

Outdoor
(47, 45%)

(20, 43%)

Private Residence

(10, 21%)

(2, 4%)

*Excluded one case that was pronounced dead in January 2011, but likely died during the summer of 2010.

Maricopa County Heat-Associated Deaths, 2011

Car

17
Graph 12. Heat-Associated Deaths by Gender and Place of Injury Occurrence,
Maricopa County, 2011*

*Excluded one case that was pronounced dead in January 2011, but likely died during the summer of 2010.
**Excluded two male cases where Place of Injury (Indoor, Outdoor) was Unknown

Graph 13. Heat-Associated Deaths by Use of Air Conditioning (Indoor Only),
Maricopa County, 2011

Indoor
(N=56)

A/C Status Unknown
(35, 63%)

A/C Not in Use
(20, 36%)

Maricopa County Heat-Associated Deaths, 2011

A/C in Use
(1, 2%)

18

Heat-Associated Deaths Among the Homeless
Graphs 14 – 15. In 2006, 32 heat-associated deaths (38% of the 2006 total) were among
homeless persons. In 2007, homeless heat-associated deaths decreased to 6 (12%), and
decreased again in 2008, to 3 (6%). In 2009 and 2010 the number of heat-associated deaths
in homeless persons increased to 21 (28%) and 22 (27%), respectively. Heat-associated
deaths in homeless persons in 2011 decreased to 13 (12%) (Graph 14). Graph 15 shows
that of the 13 homeless individuals who died in 2011, 23% of the homeless persons were
using drugs or alcohol upon their death, which is comparable to 23% of the non-homeless
persons who were using drugs or alcohol upon their death. [See Appendix, Table H]
Graph 14. Homeless Heat-Associated Deaths, Maricopa County, 2006-2011
120

Number of Deaths

100

80

60

40

20

0
Non-Homeless (N=350)
Homeless Deaths (N=97)
Total (N=447)

2006
53
32
85

2007
45
6
51

2008
47
3
50

2009
53
21
74

2010
60
22
82

2011*
92
13
105

Year
*Excluded one non-homeless case that was pronounced dead in January 2011, but likely died during the summer of 2010. This case was
not added to the Total cases for 2010.

Maricopa County Heat-Associated Deaths, 2011

19
Graph 15. Drug and Alcohol Use, as Mentioned on the Death Certificate for HeatAssociated Deaths by Homelessness, Maricopa County, 2011

*Excluded one case that was pronounced dead in January 2011, but likely died during the summer of 2010

Maricopa County Heat-Associated Deaths, 2011

20
Conclusions – Heat-Associated Deaths 2011
1. The number of heat-associated deaths increased in 2011 to the highest number of deaths
recorded since enhanced surveillance began in 2006.

2. The majority of heat-associated deaths were heat-caused (as opposed to heat-related). This
means that the majority of deaths were cases in which environmental heat was directly
involved in the sequence of conditions causing death.

3. Many of the heat-associated deaths occurred during the month of August. August had
fourteen days of Excessive Heat Warnings. Ten of these August Excessive Heat Warning
days were consecutive, and part of a larger, eleven consecutive day interval of Excessive Heat
Warnings (8/22/2011 – 9/1/2011). For comparison, July had only three days of Excessive
Heat Warnings, which were consecutive.

4. Most decedents for whom residency was known were residents of Maricopa County or
Arizona.
5. Most of the decedents were not newcomers – for decedents whose location and length of
residency were known, only about one in eight lived in Arizona for less than three years.

6. Most heat-associated deaths occurred among males 20-64 years of age.

7. One pediatric heat-associated death occurred this year, none occurred in a child less than 5
years of age.

8. Heat-associated deaths among men tended to occur among those under 65 years old, while
deaths among women were almost equally distributed above and below 65 years of age.

9. For this first time since 2006, indoor deaths exceeded outdoor deaths, all of which occurred at
a private residence. Nearly half of all outdoor deaths occurred in urban areas.

10. Heat-associated deaths occurred indoors and outdoors in similar proportions among men; but
among women, a larger proportion of deaths occurred indoors.

11. All heat-associated deaths that occurred indoors, occurred at a private residence or in the
garage of a private residence. For over a quarter of these indoor deaths, the air conditioning
unit was not in use. (For the remaining indoor deaths air conditioning status was unknown,
suggesting that there may have been additional instances when the air conditioning was not in
use.)

Maricopa County Heat-Associated Deaths, 2011

21
12. Homeless individuals are more vulnerable to increased environmental temperatures.
Approximately one in eight heat-associated deaths in 2011 was an individual identified as
homeless. After increasing since 2008, the number of homeless deaths decreased in 2011.

13. The proportion of heat-associated deaths where drug or alcohol use was indicated at the time
of death was nearly equivalent for homeless and non-homeless individuals.

Special Case
In 2011, a special case was reported to the MCDPH. Details are included below:
In January of 2011, a 49 year old male was found deceased in a desert area. The
man had last been seen alive during the summer of 2010, hiking in the vicinity of
where his body was found in 2011. His death was pronounced in January of 2011,
however, circumstantial evidence strongly supported that the decedent actually died
during the summer of 2010. In order to maintain consistency with heat-associated
death definitions, this case was included in the 2011 annual total. However, this case
was excluded from detailed analysis in the 2011 Annual Report in order to avoid
biasing data that reflects the excessive heat of 2011.
It is important to note that although this is a striking example of a heat-associated death, it is
one of the less common situations contributing to heat-associated deaths. Deaths of
individuals in outdoor desert area/trail settings made up only 14% of all heat-associated
deaths in 2011. This is in contrast to 19% who die outdoors in urban areas and 53% who
died indoors.
Future Plans
One of the goals of the MCDPH heat surveillance program is to obtain more detailed
information pertaining to the circumstances surrounding heat-associated mortality. Ideally,
the program would like to obtain complete data on air conditioning status, as well as activity
just prior to death (e.g. working, exercising, etc.). Program staff would also like to perform
analyses on additional risk factors, temperature variation, the geographic distribution of
deaths, and associated morbidity occurring through the heat season.
Finally, the primary goal of heat-associated death surveillance is to eliminate or reduce heatassociated deaths. Although the number of heat-associated deaths for 2011 increased over
previous years, community partners and the MCDPH continue to respond to the needs of the
community. Cooling and hydration stations were open to the public throughout the heat
season, with additional stations opening during particularly long periods of excessive heat.
Additionally, enhanced heat surveillance performed by the MCDPH provided timely reminders
to healthcare providers and community partners regarding the dangers of excessive heat.
To learn more about services provided for cooling and hydration during the summer
months, or how you can help, please visit:
http://www.maricopa.gov/publichealth/Programs/Heat/default.aspx
http://www.cir.org/
Maricopa County Heat-Associated Deaths, 2011

22
APPENDIX
Table A. Heat-Associated Deaths by Gender and Age, Maricopa County, 2011

2011 (N=105)

Age Group

Male

Female

Total

#

%

#

%

#

%

0-4

0

0%

0

0%

0

0%

5-19

0

0%

1

3%

1

1%

20-34

5

7%

2

7%

7

7%

35-49

17

22%

4

14%

21

20%

50-64

29

38%

8

28%

37

35%

65-74

13

17%

3

10%

16

15%

75+

12

16%

11

38%

23

22%

All Ages

76

100%

29

100%

105 100%

Maricopa County Heat-Associated Deaths, 2011

23
Table B. Heat-Associated Death Rates per 100,000 Residents (and Counts) by Gender
and Age, Maricopa County, 2011

Age Group
0-4
5-19
20-34
35-49
50-64
65-74
75+
All Ages

Male
0
(0)
0
(0)
0.5
(2)
2.5
(10)
7.2
(23)
9.6
(12)
12.2
(11)
3.0
(58)

Maricopa County Heat-Associated Deaths, 2011

2011 (N=84)
Female
0
(0)
0.2
(1)
0.2
(1)
0.8
(3)
2.0
(7)
2.1
(3)
8.8
(11)
1.3
(26)

Total
0
(0)
0.1
(1)
0.4
(3)
1.7
(13)
4.5
(30)
5.6
(15)
10.2
(22)
2.2
(84)

24
Table C. Heat-Associated Death Rates per 100,000 Residents (and Counts) by Age
Group and Race/Ethnicity, Maricopa County, 2011

Race/Ethnicity
White
Hispanic
African American
Asian/Pac. Islander
Native American
Multiple
All Race/Ethnicities

2011 (N=83)
0-4
0.0
(0)
0.0
(0)
0.0
(0)
0.0
(0)
0.0
(0)
0.0
(0)
0.0
(0)

5-19 20-34
0.3
0.5
(1)
(2)
0.0
0.3
(0)
(1)
0.0
0.0
(0) (10)
0.0
0.0
(0)
(0)
0.0
0.0
(0)
(0)
0.0
0.0
(0)
(0)
0.1
0.4
(1)
(3)

* Excluded one Maricopa County resident where Race was Unknown.

Maricopa County Heat-Associated Deaths, 2011

35-49
1.7
(8)
1.3
(3)
5.2
(2)
0.0
(0)
0.0
(0)
0.0
(0)
1.7
(13)

50-64 65-74 75+ All Ages
3.3
5.4
8.5
2.4
(16) (12) (16)
(55)
8.8
10.1 5.8
1.5
(10)
(3)
(1)
(18)
7.0
0.0 85.1
4.4
(2)
(0)
(4)
(8)
0.0
0.0 25.6
0.7
(0)
(0)
(1)
(1)
0.0
0.0
0.0
0.0
(0)
(0)
(0)
(0)
18.8
0.0
0.0
1.4
(1)
(0)
(0)
(1)
4.3
5.6 10.2
2.1
(29) (15) (22)
(83*)

25
Table D. Heat-Associated Death Rates per 100,000 Residents (and Counts) by Gender
and Race/Ethnicity, Maricopa County, 2011

Race/Ethnicity
White
Hispanic
African American
Asian/Pac. Islander
Native American
Multiple
All Race/Ethnicities

Male (N=57)
3.2
(47)
2.4
(18)
6.5
(7)
1.5
(1)
0.0
(0)
0.0
(0)
3.0
(57)

* Excluded one Maricopa County resident where Race was Unknown.

Maricopa County Heat-Associated Deaths, 2011

2011 (N=83)
Female
(N=26)
1.7
(20)
0.7
(5)
2.2
(3)
0.0
(0)
0.0
(0)
2.8
(1)
1.3
(26)

Total (N=83)
2.4
(67)
1.5
(23)
4.4
(10)
0.7
(1)
0.0
(0)
1.4
(1)
2.1
(83*)

26
Table E. Heat-Associated Deaths by Place Injury Occurred and Age, Maricopa County,
2011
Age
Group
0-4
5-19
20-34
35-49
50-64
65-74
75+
Total**

Private
Residence

Business

In*

Out

In

Out

0
0
0
7
22
11
16
56

0
1
0
2
3
0
4
10

0
0
0
0
0
0
0
0

0
0
1
0
0
0
0
1

Desert
Area

Street

Parking
Lot

Car

0
0
3
4
3
0
0
10

0
0
1
2
4
2
2
11

0
0
0
1
0
0
1
2

0
0
0
0
2
0
0
2

Field/
Alley
Park

0
0
0
2
1
1
0
4

Trail

Total

0
0
2
2
1
0
0
5

0
1
7
21
36
14
23
102

0
0
0
1
0
0
0
1

*Includes one case that died in the garage of a private residence
**Excluded two cases where Place of Injury (Indoor/Outdoor) was Unknown, and one case that died Outdoors but lacked a specific Place of
Injury.

Table F. Heat-Associated Deaths by Indoor or Outdoor Occurrence, Age, and Gender
Maricopa County, 2011

Age
Group
0-4
5-19
20-34
35-49
50-64
65-74
75+
Total

2011 (N=103)
Indoor
Outdoor
Male* Female Total Male Female Total
0
0
0
4
18
8
7
37

0
0
0
3
4
3
9
19

0
0
0
7
22
11
16
56

0
0
5
13
10
4
5
37

*Excluded two male cases where place of injury (Indoor/Outdoor) was Unknown.

Maricopa County Heat-Associated Deaths, 2011

0
1
2
1
4
0
2
10

0
1
7
14
14
4
7
47

27
Table G. Heat-Associated Deaths by Use of Air Conditioning and Age Group, (Indoor
Only) Maricopa County, 2011

Age Groups A/C In Use A/C Not in Use A/C Status Unknown Total
0-4
5-19
20-34
35-49
50-64
65-74
75+
Total

0
0
0
0
1
0
0
1

0
0
0
1
9
4
6
20

0
0
0
6
12
7
10
35

0
0
0
7
22
11
16
56

Table H. Drug and Alcohol Use, as Mentioned on the Death Certificate for HeatAssociated Deaths, by Homelessness, Maricopa County, 2011

2011
Homeless
Yes (13, 12.4%)
No (92, 87.6%)
Total (105, 100%)

Drug and/or Alcohol Use No Drug or Alcohol Use
3 (23.1%)
21 (22.8%)
24 (22.9%)

Maricopa County Heat-Associated Deaths, 2011

10 (76.9%)
71 (77.2%)
81 (77.1%)