Heat-Associated Deaths in Maricopa County, AZ Final Report for 2015 Photograph by Dan Sorensen: http://www.dansorensenphotography.com/ Maricopa County Department of Public Health http://www.maricopa.gov/publichealth/ Heat Death Report| 2015 ACKNOWLEDGEMENTS .......................................................................................................... 2 INTRODUCTION ..................................................................................................................... 3 RESULTS ................................................................................................................................ 4 Heat-Associated Deaths by Year ............................................................................................................................ 4 Heat-Associated Deaths by Month ........................................................................................................................ 5 Heat-Associated Deaths and Temperatures ........................................................................................................... 6 Heat-Associated Deaths by Residency ................................................................................................................... 6 Heat-Associated Deaths by Time Spent in Arizona ................................................................................................. 8 Demographic Characteristics of Heat-Associated Deaths ....................................................................................... 9 Heat-Associated Death Rates ............................................................................................................................... 11 Potential Years of Life Lost ……………………………………………………………………………………………………………………………… 12 Heat-Associated Deaths by Place of Injury ........................................................................................................... 14 Air Conditioning Use for Indoor Deaths ............................................................................................................... 18 Substance Use among Heat-Associated Deaths ................................................................................................... 20 Living Situation among Heat-Associated Deaths .................................................................................................. 21 CONCLUSIONS ..................................................................................................................... 22 FUTURE PLANS .................................................................................................................... 23 APPENDIX............................................................................................................................ 24 Background.......................................................................................................................................................... 24 Methodology ....................................................................................................................................................... 25 Appendix Tables .................................................................................................................................................. 27 1 Heat Death Report| 2015 Acknowledgements The Maricopa County Department of Public Health (MCDPH), Office of Epidemiology would like to thank the following agencies for their contributions to this report:  Maricopa County Office of the Medical Examiner (OME)  Maricopa County Office of Vital Registration (OVR)  Arizona Department of Health Services (ADHS), Office of Vital Registration  National Weather Service (NWS)  Maricopa Association of Governments (MAG)  Local hospitals (infection preventionists, emergency departments, social worker staff)  City of Phoenix Heat Relief Network 2 Heat Death Report| 2015 Introduction Mortality from environmental heat is a significant public health problem in Maricopa County, especially because it is largely preventable. Maricopa County has conducted heat surveillance since 2006. Each year, the enhanced heat surveillance season usually begins in May and ends in October. The main goals of heat surveillance are to identify the demographic characteristics of heat-associated deaths (e.g., age and gender) and the risk factors for mortality (e.g., homelessness). Sharing this information helps community stakeholders to design interventions in an effort to prevent heat-associated deaths among vulnerable populations. The two main sources of data for heat surveillance are: preliminary reports of death (PRODs) from the Office of the Medical Examiner (OME) and death certificates from the MCDPH Office of Vital Registration. Heat-associated deaths are classified as heat-caused or heat related. Heat-caused deaths are those in which environmental heat was directly involved in the sequence of conditions causing deaths. Heatrelated deaths are those in which environmental heat contributed to the deaths but was not in the sequence of conditions causing these deaths. For more information on how heat-associated deaths are classified, see the definitions in Appendix. For more information on MCDPH’s surveillance system, see Background and Methodology. 3 Heat Death Report| 2015 Results Heat-Associated Deaths by Year •There were 84 heat-associated deaths reported in 2015. •One case is still pending classification. • See Appendix Table A for more information about the number of confirmed, ruled-out, and pending cases by year. Graph 1. Confirmed Heat-Associated Deaths by Year (n=1,004), Maricopa County, 2001-2015* 120 106 110 100 Number of Deaths 85 80 84† 82 75 74 76 61 60 51 49 38 40 50 42 21 20 0 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 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 * These numbers are for heat-associated deaths reported to MCDPH as of 03/02/2015. † One case is still pending a final cause of death 4 Heat Death Report| 2015 Heat-Associated Deaths by Month • Most deaths occurred between June and August. • Eighty Six percent of all deaths occurred in the months of June, July and August (n=72). • More than half (54% n=45) of the deaths were classified as heat-caused. Graph 2. Heat-Associated Deaths by Month and Classification (N=84)*, Maricopa County, 2015 30 Number of Deahts 25 20 15 10 5 0 MAR APR MAY JUN JUL AUG SEP OCT NOV Heat Related (N=39) 0 0 2 7 14 12 3 0 1 Heat Caused (N=45) 1 1 1 13 11 15 3 0 0 Total (N=84) 1 1 3 20 25 27 6 0 1 Month of Death 5 Heat Death Report| 2015 6 Heat-Associated Deaths and Temperatures • The graph below shows the number of deaths that occurred each day, as well as the daily minimum and maximum temperatures. • Excessive heat warnings are issued by the National Weather Service (NWS) for days with higher than normal temperatures. • Three excessive heat warnings were issued in 2015. • The highest daily maximum temperature this summer was 117°F and occurred on 8/14/2015. • Twelve (15%) heat-associated deaths occurred during the days when an excessive heat warning was issued. Graph 3. Maricopa County Heat-Associated Deaths by Date of Death, Maximum and Minimum Temperatures and Excessive Heat Warnings [4/02/2015-10/31/2015 (N=84)]* *Exact Dates of Excessive Heat Warnings: 6/16/2015-6/23/2015 (8 days), 8/04/2015- 8/05/2015 (2 days), 8/13/2015-8/16/2016 (4 days) • In a study done by Maricopa County on the Effects of Maximum and Minimum Temperature on Deaths attributed to Environmental Heat it was found that 88% of heat associated deaths occur in the summer months. • In the same study it was also found that both minimum and maximum are correlated to the number of deaths. • For more information please refer to poster 1 in the appendix. Heat Death Report| 2015 Heat-Associated Deaths by Residency • Maricopa County residents accounted for 83% (N=61) of all heat associated deaths reported in 2015. • There were 8 residents of Arizona who lived outside of Maricopa County. • Non-Arizona residents included 2 U.S. residents and 1 non-U.S. resident. • Residency was not identified for twelve heat-associated deaths in 2015. Graph 4. Heat-Associated Deaths by Residency (n=74)* and Classification, Maricopa County, 2015 70 Number of Deaths 60 50 40 30 20 10 0 Maricopa Co. Non-Maricopa Co. Non-Arizona Heat Related (n=36) 32 3 1 Heat Caused (N=38) 29 5 4 Total (N=74) 61 8 5 * Excluded 10 cases with unknown residency status * Non-Maricopa County residents include eight cases from other AZ counties (Mohave (1), Pinal (3), Yavapai (1), Graham (1), Pima (1) and Navajo (1)). †Non-Arizona residents include two U.S. residents (California and Indiana) and three non-U.S. resident (Guatemala, Mexico and Great Britain) 7 Heat Death Report| 2015 Heat-Associated Deaths by Time Spent in Arizona • Of the 69 decedents for whom time spent in Arizona was known, 61% resided in Arizona for 20 years or more. Graph 5. Heat-Associated Deaths by Years of Life Spent in Arizona (n=69)*, Maricopa County, 2015 45 42 40 35 Number of deaths 30 25 20 15 10 10 10 7 5 0 <3 3-9 10-19 20+ Years of life spent in Arizona * Excludes fifteen cases for which time spent in Arizona was unknown at the time of analysis. 8 Heat Death Report| 2015 Demographic Characteristics of Heat-Associated Deaths • The overwhelming majority of deaths were male (73%, n=61) (Table B). • Three deaths occurred among individuals who were 19 years old or younger. • Most deaths occurred among individuals who were 50-64 years old (36% N=30). • Most of the decedents were White (64%, n=54). Table 1. Heat-Associated Deaths by Gender, Age, and Race/Ethnicity; Maricopa County, 2015 GENDER Male Female Total AGE GROUP 0-4 years old 5-19 years old 20-34 years old 35-49 years old 50-64 years old 65-74 years old 75+ years old Total RACE/ETHNICITY White Hispanic Black Native American Asian/Pacific Islander Other Unknown Total TOTAL % 61 23 84 73% 27% 100% 2 1 9 13 30 14 15 84 2% 1% 11% 15% 36% 17% 18% 100% 54 4 5 3 2 1 16 84 64% 5% 6% 4% 2% 1% 19% 100% 9 Heat Death Report| 2015 Heat-Associated Deaths by Age and Gender • For males, the highest proportion of deaths occurred in the 50-64 age group (36%, n=22). • For females, the highest proportions of deaths occurred in the 75+ age group (35%, n=8). • In general, there were far fewer female deaths than male deaths. Graph 6. Heat-Associated Deaths by Age Group and Gender (N=84), Maricopa County, 2015 35 30 Number of deaths 25 20 15 10 5 0 0-4 5-19 20-34 35-49 Female N=23) 1 0 2 2 Male (N=61) 1 1 7 11 Total (N=84) 2 1 9 13 30 Age groups (in years) 50-64 65-74 75+ 8 2 8 22 12 7 14 15 10 Heat Death Report| 2015 11 Heat-Associated Death Rates Death rate by Gender •The graph below and all other graphs involving death rates only include Maricopa County residents. •The death rate for males was 2.3 times greater than the rate for females (2.1 and 0.9 deaths per 100,000 residents, respectively). • See Appendix Table C and Table E for more information on gender. Rate of death (per 100,000 residents) Graph 7. Heat-Associated Crude Death Rate per 100,000 Maricopa County Residents* by Gender (n=61), Maricopa County, 2015 2.5 2.0 1.5 1.0 2.1 0.5 0.9 0.0 Male (N=43) Female (N=18) Gender * Based on 2014 Census population estimates for Maricopa County. Excludes thirteen cases that were not Maricopa County residents and ten cases where residence was unknown Heat Death Report| 2015 Death Rate by Age •The heat-associated crude death rate increases with age. • The 75+ age group has the highest rate of heat-associated death at 6.3 per 100,000 Maricopa County Residents. •See Appendix Table C and Table D for more information on age. Graph 8. Heat-Associated Crude Death Rate per 100,000 Maricopa County Residents* by Age Group (n=61), Maricopa County, 2015 8 Rate per 100,000 residents 7 6 5 4 3 2 1 0 0-4 5-19 20-34 35-49 50-64 65-74 75+ Male 0.7 0 0.5 1.7 4.3 7.2 6.8 Female 0.8 0 0.2 0 1.9 1.1 5.1 Male Female * Based on 2014 Census population estimates for Maricopa County. Excludes thirteen cases that were not Maricopa County residents and ten cases where residence was unknown. 12 Heat Death Report| 2015 Potential Years Life Lost •The median age of environmental heat related decedents is 57 years with a mode of 59 years. • The average number of Potential Years of Life Lost (PYLL) is 23.8 years for those with heat related illness. •The median age at death for the general population is 73.8 years with a mode of 85. Death Rate by Race/Ethnicity •Whites had the highest rate of heat-associated death at 1.8 per 100,000 Maricopa County residents. •See Appendix Table D and Table E for more information on race/ethnicity. Graph 9. Heat-Associated Crude Death Rate per 100,000 Maricopa County Residents* by Race/Ethnicity (n=51), Maricopa County, 2015 * Based on 2014 Census population estimates for Maricopa County. Excludes thirteen cases that were not Maricopa County residents, ten cases where residence was unknown and ten cases where race/ethnicity was unknown 13 Heat Death Report| 2015 Heat-Associated Deaths by Place of Injury •Most heat injuries occurred outdoors (61%, n=51). • The proportion of injuries occurring outdoors was higher for males than females. • See Appendix Map 2 for more information on place of injury. Graph 10. Heat-Associated Deaths by Place of Injury (n=84), Maricopa County 2015 61% 39% Outdoor (n=51) Indoor (n=33) Graph 11. Heat-Associated Deaths by Place of Injury and Gender, Maricopa County 2015 Male (n=61) Female (n=23) Indoor (n=20) Indoor (n=13) Outdoor (n=41) 33% Outdoor (n=10) 43% 67% 57% 14 Heat Death Report| 2015 •Most outdoor deaths were injured in an urban area (37%, n=19). • Nine cases were injured in a car. Of those, six were males and three were females. Two were between 0-4 years old, four were 35-49 years old, two were 50-64 years old, and one was 65-74 years old. • Most indoor deaths were injured in a house (52% n=17) or apartment (42% n=14). • See Appendix Table F , Table G, Map 1 and Map 2 for more information on place of injury. Graph 12. Outdoor Heat-Associated Deaths by Place of Injury (n=51), Maricopa County 2015 Urban Area (n=19) 18% Desert Area/Trail (n=12) 37% Private Residence (n=11) 22% Car (n=9) 23% Graph 13. Indoor Heat-Associated Deaths by Place of Injury* (n=33), Maricopa County 2015 6% Trailer/RV/Mobile Home (n=2) 42% House (n=17) 52% Apartment (n=14) *Definitions: Trailer: an unpowered vehicle that is towed by another vehicle Recreational vehicle (RV): a motor vehicle equipped with a living space and amenities found in a home. 1. Mobile home: a large house trailer that is parked in one particular place and used as a permanent living accommodation. 15 Heat Death Report| 2015 Map 1. Heat Deaths by Location, Maricopa County 2015 *Addresses for place of injury for three cases were unknown. 16 Heat Death Report| 2015 Map 2. Indoor Heat Deaths by Locations in Metro Phoenix by Poverty Rate, Maricopa County 2015 17 Heat Death Report| 2015 Graph 14. Frequency of Heat-Associated Deaths Discovered Through Welfare Check (N=38), Maricopa County,2015 35 Number of Deaths Discovered 30 25 20 15 10 5 0 Yes Indoor Deaths Welfare Check Outdoor Deaths Welfare Check 29 9 * Examples of places where people were found outdoors during welfare checks include porch, car, driveway and yard. Air Conditioning Use for Indoor Deaths • Seventy percent of all indoor deaths (23 out of 33) were injured in an indoor environment that was not cooled by air conditioning (AC) (graph 15). • Fifty-five percent (n=18) of indoor deaths had the AC unit turned off (graph 15). • Five indoor deaths (15%) did have the AC turned on; however it was blowing hot air (graph 15). • For the 23 indoor deaths that had an air conditioner present, the most common reason for not having properly running AC was that it was non-functioning (graph 16). • See Appendix Table H for more information on AC status. 18 Heat Death Report| 2015 Graph 15. Heat-Associated Deaths by Use of Air Conditioning for Indoor Deaths (n=33), Maricopa County 2015 15% AC Turned On (n=5) 30% AC Turned Off (n=18) AC Status Unknown (n=10) 55% Graph 16. Reasons for not having properly running AC (n=23), Maricopa County 2015 Non-Functioning (n=14) No Electricity (n=2) 30% 61% 9% Not in Use (n=7) 19 Heat Death Report| 2015 Substance Use among Heat-Associated Deaths • Thirty-seven percent of heat-associated deaths had substance use mentioned on their death certificates. • Drugs (both illicit and legal) were the most common form of substance use. Thirty-five percent (n=11) of all heat-associated deaths had drug use mentioned on their death certificate. Graph 17. Substance Use, as Mentioned on the Death Certificate for Heat-Associated Deaths (N=84), Maricopa County, 2015 Substance use mentioned on death certifcate (n=84) 37% Substance Use (n=31) No Substance Use (n=53) 63% Type of substance use (n=31) 6% 29% Drugs only (n=9) Alcohol only (n=20) 65% Both drugs and alcohol (n=2) 20 Heat Death Report| 2015 Living Situation among Heat-Associated Deaths • Ten percent of all heat-associated deaths in 2015 were homeless. • The majority of the homeless deaths were male and between 50 and 64 years old (63%, n=5). • All of the homeless deaths occurred outside. •For more information on how homeless status is determined, see the definition of homelessness in the Appendix. Graph 18. Living Situation of Heat-Associated Deaths, Maricopa County, 2015 10% 42% Homeless (n=8) Living Independently (n=28) 33% Co-Habitating/Roommate (n=13) Unknown (n=35) 15% 21 Heat Death Report| 2015 120 40% 35% Number of Deaths 100 30% 80 25% 60 20% 15% 40 10% 20 0 5% 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Non-Homeless 53 45 47 53 60 93 101 62 51 76 Homeless 32 6 3 21 22 13 9 12 7 8 Percent Homeless 37.65%11.76% 6.00% 28.38%26.83%12.26% 8.18% 16.22%12.07% 9.52% Years of Surveillance Conclusions 0% Percentage of Homeless Deaths Graph 19. Homeless Death and Non-Homeless Deaths 2006-2015, Maricopa County 22 Heat Death Report| 2015 • There were 38% more heat-associated deaths in 2015 compared to 2014. • Three excessive heat warnings were issued in the summer of 2015, and ranged in duration from2 to 8 days. • Most deaths occurred in the month of August. • There were slightly more heat-caused deaths than heat-related deaths. • The majority of cases were residents of Maricopa County. Furthermore, most cases had lived in Arizona for 20 years or more. • Overall, there were much fewer deaths among females than among males • Among Maricopa County residents, the rate of heat-associated deaths was the highest for males, those 75 years old and older, and Whites. • The majority of cases were injured outdoors. The most common place of injury for the outdoor deaths was an urban area. The most common place of injury for indoor deaths was at the decedents residents. • Most cases that were injured indoors in an environment that was not cooled by air conditioning (70%, n=23). -Some cases air conditioning status was unknown. For those that had access to AC, the air conditioner was non-functioning, not in use, or the house did not have electricity. • Drugs or alcohol were mentioned in the death certificate for 37% of the cases. • Ten percent of heat-associated deaths occurred among homeless individuals. • The average years lost for those with heat related deaths was 23.8 years. Future Plans 23 Heat Death Report| 2015       Implement Syndromic Surveillance using BioSense 2.0 data in future heat reports Explore heat associated data from the Arizona Prehospital Information and EMS Registry System (AZ-PIERS). Continue to provide community stakeholders with information related to heat mortality and morbidity that can be used for prevention efforts. Further expand use of Geographic Information System (GIS) maps in future heat reports. Explore vulnerable populations effected by exposure to environmental heat. Enhance and expand the partnership with community organizations. 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/ Appendix Background 24 Heat Death Report| 2015 In July 2005, Maricopa County (MC) experienced exceptionally high temperatures that contributed to 45 deaths, of which 35 occurred over nine consecutive days. Temperatures reached 116°_F and three excessive heat warnings were issued during this month. After this event, the Maricopa County Department of Public Health (MCDPH) created a novel and effective approach for surveillance of heatassociated deaths in 2006 and has continued to use this system annually. Methodology Surveillance data is obtained from the following sources: 1. The Maricopa County Office of the Medical Examiner (OME) forwards suspected heat-related deaths to MCDPH and provides data including demographics, preliminary information regarding how the death occurred, and the circumstances of death. In the past, this information came solely as a weekly line list with limited information for each case. However, in February of 2012, MCDPH started receiving all preliminary reports of death (PRODs) from the OME. These reports provide expanded information on a daily basis and have changed the screening methods used by MCDPH staff to ensure that all potential heat-related deaths are documented. 2. The MCDPH Office of Vital Registration registers all Maricopa County death certificates in the Arizona Department of Health Services vital records database. The MCDPH Office of Epidemiology 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 ICD 10 Code Corresponding Definition HEAT EXPOSURE X30 Exposure to excessive natural heat ENVIRON T67.X Effects of heat and light EXHAUSTION P810 Environmental hyperthermia of newborn SUN HEAT STRESS HEAT STROKE HYPERTHERMIA 3. Hospital and media reports can sometimes initiate a heat death investigation, for example, if a child is reportedly left in a hot car. 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: 25 Heat Death Report| 2015 Heat-caused (HC) deaths are those in which environmental heat was directly involved in the sequence of 1 conditions causing deaths. These are deaths where environmental heat terms were indicated 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 2 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. 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 heat-caused 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 location, indoor/outdoor 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 1 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. 2 Part II of the death certificate: Other significant conditions contributing to death but not resulting in the underlying cause given in Part I. 26 Heat Death Report| 2015 Appendix Tables Table A. Heat-Associated Deaths Reported by Investigation Status, Maricopa County, 2006-2015 Year Total Reported N N (%) RuledOut N (%) Confirmed Pending N (%) 2006 104 85 (82%) 19 (18%) 0 (0%) 2007 131 51 (39%) 80 (61%) 0 (0%) 2008 97 50 (52%) 47 (48%) 0 (0%) 2009 114 74 (65%) 40 (35%) 0 (0%) 2010 142 82 (58%) 60 (42%) 0 (0%) 2011 144 106 (74%) 38 (26%) 0 (0%) 2012 173 110 (64%) 63 (36%) 0 (0%) 2013 145 76 (52%) 69 (48%) 0 (0%) 2014 115 61 (53%) 54 (47%) 0 (0%) 2015 144 84 (58%) 59 (41%) 1* (1%) Total 1,309 777 (59%) 527 (40%) 2 (1%) 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 03/02/2016. * One case is still pending a final cause of death classification for 2015 27 Heat Death Report| 2015 Table B. Heat-Associated Deaths by Gender and Age Group, Maricopa County, 2015 Age Group 0-4 5-19 20-34 35-49 50-64 65-74 75+ All Ages Deaths by Gender Female n (%) Male n (%) 1 1 7 11 22 12 7 61 2% 2% 11% 18% 36% 20% 11% 73% 1 0 2 2 8 2 8 23 4% 0% 9% 9% 35% 9% 35% 27% Total n (%) 2 1 9 13 30 14 15 84 2% 1% 11% 15% 36% 17% 18% 100% Table C. Heat-Associated Deaths Rates per 100,000 Residents* by Gender and Age Group, Maricopa County, 2015 Age Group 0-4 5-19 20-34 35-49 50-64 65-74 75+ All Ages Gender Rate per 100,000 (n) Male Female Total 0.7 (1) 0.0 (0) 0.5 (2) 1.7 (7) 4.3 (15) 7.2 (11) 6.8 (7) 2.1 (43) 0.8 (1) 0.0 (0) 0.2 (1) 0.0 (0) 1.9 (7) 1.1 (2) 5.1 (7) 0.9 (18) 0.7 (2) 0.0 (0) 0.3 (3) 0.9 (7) 3.1 (22) 4.0 (13) 5.9 (14) 1.5 (61) * Based on 2014 Census population estimates for Maricopa County. Excludes eight cases that were not Maricopa County residents 28 Heat Death Report| 2015 Table D. Heat-Associated Deaths Rates per 100,000 Residents* by Age Group and Race/Ethnicity, Maricopa County, 2015 Age Group Rate per 100,000 (n) Race/Ethnicity White (n=42) Hispanic (n=3) Black (n=3) Asian (n=1) Native American (n=1) Multiple (n=1) Total (n=51) 0-4 5-19 0.9 0.0 0.0 0.0 0.0 7.8 0.7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 20-34 35-49 50-64 65-74 0.7 0.3 0.0 0.0 0.0 0.0 0.2 0.9 0.0 2.4 0.0 6.8 0.0 0.7 1.8 0.0 3.0 3.9 0.0 0.0 2.6 4.5 0.0 0.0 0.0 0.0 0.0 3.1 75+ Total 5.7 9.6 17.8 0.0 0.0 0.0 5.0 1.8 0.2 1.5 0.6 1.4 1.2 1.2 * Based on 2014 Census population estimates for Maricopa County. Excludes eight cases that were not Maricopa County residents and ten cases where race was unknown. Table E. Heat-Associated Deaths Rates per 100,000 Residents* by Gender and Age Group, Maricopa County, 2014 Race/Ethnicity Gender Rate per 100,000 (n) Male Female Total White 2.3 (26) 1.4 (16) 1.8 (42) Hispanic 0.5 (3) 0.0 (0) 0.2 (3) Black Asian/Pac. Islander Native American 2.0 (1.9) 1.0 (1) 1.5 (3) 2.6 (2) 0.0 (0) 1.2 (2) 3.1 (1) 2.3 (1) 1.5 (1) All Races 1.7 (34) 0.8 (17) 1.3 (51) * Based on 2014 Census population estimates for Maricopa County. Excludes eight cases that were not Maricopa County residents and ten cases where race was unknown 29 Heat Death Report| 2015 30 Table F. Heat-Associated Deaths by Place Injury Occurred and Age Group, Maricopa County, 2015 Indoor (n=33) Outdoor (n=51) Age Group Urban Area Private Residence Private Residence Desert Area/ Trail Car 0-4 0 0 0 19-May 0 0 20-34 2 35-49 Total Business Street/ Alley Field/ Park Shed 2 0 0 0 0 0 1 0 0 0 0 0 0 1 3 0 0 3 0 0 6 1 2 3 4 1 2 0 0 9 50-64 14 4 2 2 0 7 1 0 18 65-74 7 1 2 0 0 3 1 0 13 75+ 9 3 1 1 0 1 0 0 12 Total 33 11 12 9 1 16 2 0 51 Table G. Heat-Associated Deaths by Indoor or Outdoor Occurrence, Age Group, and Gender, Maricopa County, 2015 Age Group 0-4 5-19 20-34 35-49 50-64 65-74 75+ Total Male Indoor Female Total 0 0 1 1 8 5 5 20 0 0 1 0 6 2 4 13 0 0 2 1 14 7 9 33 Male Outdoor Female Total 1 1 6 10 14 7 2 41 1 0 1 2 2 0 4 10 2 1 7 12 16 7 6 51 Heat Death Report| 2015 31 Table H. Heat-Associated Deaths by Use of Air Conditioning (AC) and Age Group, (Indoor Only) Maricopa County, 2015 Age Group AC On 0-4 5-19 20-34 35-49 50-64 65-74 75+ Total AC Off 0 0 0 0 2 1 2 5 0 0 1 1 7 5 4 18 AC Not AC Status Present Unknown 0 0 0 0 0 0 0 0 Table I. Heat-Associated Deaths by Smoking/Tobacco Use, Maricopa County, 2015 Smoking/Tobacco Use Yes No Unknown Total n (%) 7 (9%) 76 (90%) 1 (1%) 84 (100%) 0 0 1 0 5 1 3 10 Total 0 0 2 1 14 7 9 33 Heat Death Report| 2015 Table J. Heat-Associated Deaths by Education Category, Maricopa County, 2015 Education Category n (%) 8th grade or less 6 (7%) 9th through 12th grade; no diploma 9 (11%) High school graduate or GED completed 34 (40%) Some college credit, but no degree 11 (13%) Associate degree (e.g.AA,AS) 5 (6%) Bachelor’s degree (e.g.BA,BS) 4 (5%) Master’s degree (e.g.MA,MS,MEng,MEd,MSW,MBA) 2 (2%) Doctorate (e.g.PhD,EdD) or Professional degree (e.g.MD,DDS,DVM,LLB,JD) 0 (0%) Unknown Total 13 (15%) 84 (100%) 32 Heat Death Report| 2015 Poster 1. The Effects of Maximum and Minimum Temperatures on Deaths Attributed to Environmental Heat in Maricopa County, 2006-2013 33