Heat-Associated Deaths in Maricopa County, AZ
Multiyear Report for 2006-2013

Photograph by Dan Sorensen:
http://www.dansorensenphotography.com/

Maricopa County Department of Public Health
http://www.maricopa.gov/publichealth/

Multiyear Heat Report| 2006-2013

Table of Contents
I. Acknowledgements __________________________________________________________ 2
II. Introduction _______________________________________________________________ 3
III. Methodology ______________________________________________________________ 4
IV. Results ___________________________________________________________________ 6
Heat Associated Deaths by Year ______________________________________________________ 6
Heat Associated Deaths by Month ____________________________________________________ 7
Heat-Associated Deaths by Residency _________________________________________________ 8
Heat-Associated Death by Years of Life Spent in Arizona___________________________________ 9
Demographic Characteristics of Heat-Associated Deaths _________________________________ 10
Heat-Associated Deaths Rates _______________________________________________________ 12
Heat-Associated Deaths by Place of Injury _____________________________________________ 19
Air Conditioning Use for Indoor Deaths _______________________________________________ 23
Homelessness among Heat-Associated Deaths _________________________________________ 24
Substance Use among Heat-Associated Deaths _________________________________________ 25

V. Conclusions _______________________________________________________________ 26
VI. Future Plans _____________________________________________________________ 27
VII. Appendix _______________________________________________________________ 28

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Multiyear Heat Report| 2006-2013

I. 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’s findings:
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)

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Multiyear Heat Report| 2006-2013

II. Introduction
This report gives an overview of heat-associated deaths in Maricopa County from 2006 to 2013.
Mortality from environmental heat is a significant public health problem, as 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 and the risk factors for mortality. Sharing this
information helps community stakeholders to design interventions in an effort to prevent heatassociated 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.

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Multiyear Heat Report| 2006-2013

III. 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:
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.

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Multiyear Heat Report| 2006-2013

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
2
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.

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Multiyear Heat Report| 2006-2013

IV. Results
Heat Associated Deaths by Year

• Of the 1,049 cases investigated between 2006 and 2013, 632 (60%) were confirmed as heatassociated deaths.
• The number of heat associated-deaths peaked in 2012, when 110 deaths were recorded.
•There has been an average of 79 heat-associated deaths each year during this period.
•See Appendix, Table A for more information on investigation status.

Graph 1. Heat-Associated Deaths by Year (n=632), Maricopa County, 2006-2013*
120
106

110

100

Number of Deaths

85

82

80

75

74

60

51

49

2007

2008

40

20

0
2006

2009

2010

2011

2012

2013

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 1/26/2015
† One case from 2013 still
pendingby
a final
cause of death
Heat-Associated
Deaths
Month

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Multiyear Heat Report| 2006-2013

Heat Associated Deaths by Month

• Most heat-associated deaths occurred between June and August.
• The month with the highest number of deaths was July (n=294).
• The majority of deaths were classified as heat caused (61%); the remainder was classified as heat
related (39%).

Graph 2. Heat-Associated Deaths by Month and Classification (n=632), Maricopa County, 2006-2013*
300
275
250

Number of Deaths

225
200
175
150
125
100
75
50
25
0

Jan
*

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov
*

Dec

Total (n=632)

1

0

2

2

15

110

294

148

49

8

3

0

Heat Related (n=247)

0

0

1

0

7

40

124

56

16

1

2

0

Heat Caused (n=385)

1

0

1

2

8

70

170

92

33

7

1

0

Month of Death
*The deaths that occurred in January and November were results of heat-associated injuries that occurred over the summer.

• The National Weather Service (NWS) issues excessive heat warnings for days with higher than
normal temperatures.
• Over this 8-year period, 43 excessive heat warnings were issued; 183 (29%) of the deaths occurred
during an excessive heat warning day.
• See Appendix, Table C for more information on excessive heat warnings and deaths.

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Multiyear Heat Report| 2006-2013

Heat-Associated Deaths by Residency

• Maricopa County residents accounted for 78% (n=491) of all heat-associated deaths from 20062013.
• There were 57 residents of Arizona who lived outside of Maricopa County.
• Non-Arizona residents included 43 U.S residents and 24 non-U.S. residents.
• See Appendix, Table D for more information on residency status.
Graph 3. Heat-Associated Deaths by Residency (n=615)*, Maricopa County, 2006-2013
600

Number of Deaths

500
400
300
200
100
0
Maricopa Co.

Non-Maricopa
Co.

Non-Arizona

Total

491

57

67

Heat Related (n=238)

215

14

9

Heat Caused (n=377)

276

43

58

Residency
*Excludes 17 case s with unknown residency status

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Multiyear Heat Report| 2006-2013

Heat-Associated Death by Years of Life Spent in Arizona

• Of the 500 decedents for whom time spent in Arizona was known, 59% (n=293) resided in Arizona
for 20 years or more.
• Overall, the majority of decedents had lived in Arizona for 3 years or longer.

Graph 4. Heat-Associated Deaths by Years of Life Spent in Arizona and Age Group (n=500)*, Maricopa
County, 2006-2013
100
90

Number of Deaths

80
70
60
50
40
30
20
10
0

<3

3-9

10-19

20 +

0-4 (n=10)

9

1

0

0

5-19 (n=12)

8

1

1

0

20-34 (n=40)

10

9

6

7

35-49 (n=134)

16

16

15

58

50-64 (n=199)

13

19

23

89

65-74 (n=17)

4

14

6

45

75+ (n=145)

7

7

22

94

All Ages* (n=500)

67

67

73

293

Years Spent in Arizona
*Excludes 126 cases for which time spent in Arizona was unknown and 6 cases for which age was unknown

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Multiyear Heat Report| 2006-2013

Demographic Characteristics of Heat-Associated Deaths
• The majority of deaths were male (73%, n=459).
• Twenty-two deaths occurred in people 19 years old or younger.
• Most deaths occurred in the 50-64 years old age group (31%, n=199).
•Most cases were White (63%, n=399).
• See Appendix, Table B for more information on the characteristics of heat-associated deaths.

Table 1. Heat-Associated Deaths by Gender, Age, and Race/Ethnicity; Maricopa County, 2006-2013

TOTAL
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
Unknown
Total
RACE/ETHNICITY
White
Hispanic
African American
Native American
Asian/Pacific Islander
Multiple/Other
Unknown
Total

%
459
173
632

73%
27%
100%

10
12
40
134
199
86
145
6
632

2%
2%
6%
21%
31%
14%
23%
1%
100%

399
132
50
26
6
3
16
632

63%
21%
8%
4%
1%
0%
3%
100%

10

Multiyear Heat Report| 2006-2013

Heat-Associated Deaths by Age Group and Gender

• The highest incidence of heat-associated death occurred among individuals 50-64 years old (32%)
followed by those 35-49 years old (21%).
• Female cases were generally older than male cases; 44% (n=76) of all females who died were aged
75 or older.
• There were seventeen pediatric (i.e., 0-17 years old) deaths during this eight-year period.
• See Appendix, Table E for more information on deaths by age and gender.

Graph 5. Heat-Associated Deaths by Age Group and Gender (n=626)*, Maricopa County, 2006-2013
180
160

Number of Deaths

140
120
100
80
60
40
20
0

0-4

5-19

20-34

35-49

50-64

65-74

75 +

Male (n=453)

4

11

37

111

163

58

69

Female (n=173)

6

1

3

23

36

28

76

Total* (n=626)

10

12

40

134

199

86

145

Age Group (in Years)
*Excludes 6 cases for which age was unknown
* Based on Census population estimates for Maricopa County; excludes 141 cases that were not Maricopa County residents.

11

Multiyear Heat Report| 2006-2013

Heat-Associated Deaths Rates
Heat-Associated Death Rates by Year

• The graph below and all other graphs involving death rates only include Maricopa County residents.
• The years that had the highest death rate among Maricopa County residents was 2011 and 2012.
The years with the lowest death rate were 2007 and 2008.
• The overall death rate from 2006-2013 was 1.6 per 100,000 Maricopa County residents.

Graph 6. Heat-Associated Crude Death Rate per 100,000 Maricopa County Residents by Year (n=491)*,
Maricopa County, 2006-2013

Rate of Death (per 100,000 Residents)

3
2.5
2
1.5
1
0.5
0

2006

2007

2008

2009

2010

2011

2012

2013

Rate per 100,000 MC residents

1.8

1.1

1.1

1.2

1.6

2.2

2.2

1.5

Number of deaths among MC
residents

66

42

42

49

60

84

87

61

Year
*Based on Census population estimates for Maricopa County. Excludes 141 cases that were not Maricopa County residents.

12

Multiyear Heat Report| 2006-2013

Heat-Associated Death Rates by Gender

• The majority (69%) of deaths among Maricopa County residents occurred among males.
• The mortality rate for males was 2.2 times greater than the rate for females.
• See Appendix, Table F and Table H for more information on death rates by gender.

Graph 7. Heat-Associated Crude Death Rate per 100,000 Maricopa County Residents by Gender
(n=491)*, Maricopa County, 2006-2013
2.5

Rate of Death (per 100,000 Residents)

2.2
2

1.5

1.0
1

0.5

0
Male (n=337)

Female (n=154)

Gender
* Based on Census population estimates for Maricopa County; excludes 141 cases that were not Maricopa County residents.

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Multiyear Heat Report| 2006-2013

Heat-Associated Death Rates by Age Group and Gender

• The heat-associated mortality rate increases with age.
• People ages 75 and older had the highest mortality rate, at 8.1 per 100,000 residents.
• The mortality rate for males was higher than that of females for all age group except for the 0-4
year old age group.
• See Appendix, Table F and Table G for more information on death rates by age.

Graph 8. Heat-Associated Death Rate per 100,000 Maricopa County Residents by Gender and Age
Group (n=491)*, Maricopa County, 2006-2013
18
16

Rate of Death
(per 100,000 Residents)

14
12
10
8
6
4
2
0

0-4

5-19

20-34

35-49

50-64

65-74

75 +

Female (n=154)

0.5

0

0

0.5

1.3

2.2

7.4

Male (n=337)

0.3

0.1

0.5

2.6

4.8

5.5

9.1

Total (n=491)

0.4

0.1

0.3

1.6

2.9

3.7

8.1

Age Groups (in Years)
* Based on Census population estimates for Maricopa County; excludes 141 cases that were not Maricopa County residents.

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Multiyear Heat Report| 2006-2013

Heat-Associated Death Rates by Age Group and Year

• For every year between 2006 and 2013, adults aged 75 years and older consistently had the highest
heat-associated death rate. The death rate for this age group peaked in 2012, when it was 13.0 per
100,000 Maricopa County residents.

Graph 9. Heat-Associated Crude Death Rate per 100,000 Maricopa County Residents by Age Group
and Year (n=491)*, Maricopa County, 2006-2013

Rate of Death (per 100,000 Residents)

14.0
12.0
10.0

0-4 years
5-19 years

8.0

20-34 years
35-49 years

6.0

50-64 years
4.0

65-74 years
75+ years

2.0
0.0
2006

2007

2008

2009

2010

2011

2012

2013

Year
* Based on Census population estimates for Maricopa County; excludes 141 cases that were not Maricopa County residents.

15

Multiyear Heat Report| 2006-2013

Heat-Associated Death Rates by Race

• For Maricopa County residents, most of the deaths occurred among Whites.
• However, Native Americans had the highest rate of death of all races (4.1 per 100,000 Maricopa
County residents).
• See Appendix, Table G and Table H for more information on death rates by race.

Graph 10. Heat-Associated Crude Death Rate per 100,000 Maricopa County Residents by
Race/Ethnicity (n=482)*, Maricopa County, 2006-2013

Rate of Death (per 100,000 Residents)

6
5
4
3
2
1
0
White

African
American

Native
American

Hispanic

Asian/
Pacific
Islander

Rate of death

1.8

3.1

4.1

1.0

0.4

Number of deaths

325

41

20

92

4

Race/Ethnicity
* Based on Census population estimates for Maricopa County. Excludes 141 cases that were not Maricopa County residents and 9
additional cases with unknown/ multiple races.

16

Multiyear Heat Report| 2006-2013

Heat-Associated Death Rates by Race and Age

• The highest death rate of any age and race/ethnicity group is seen in African Americans aged 75+
years, at 37.4 per 100,000 residents.
• Native Americans aged 65-74 years and 75+ years also have high rates of heat-associated death.

Graph 11. Heat-Associated Crude Death Rate per 100,000 Maricopa County Residents by
Race/Ethnicity and Age Group (n=482)*, Maricopa County, 2006-2013
40.0
35.0

Rate of Death
(per 100,000 Residents)

30.0
25.0
20.0
15.0
10.0
5.0
0.0

0-4

5-19

20-34

35-49

50-64

65-74

75+

White (n=325)

0.3

0.1

0.4

1.7

2.4

3.3

6.5

African American (n=41)

0.9

0.0

0.0

3.0

9.2

5.9

37.4

Native American (n=20)

4.3

0.9

0.7

4.0

9.0

21.4

33.7

Hispanic (n=92)

0.2

0.0

0.1

1.3

4.1

6.0

15.0

Asian/ Pacific Islander (n=4)

0.0

0.0

0.0

0.0

0.6

2.0

7.7

Age Group (in Years)
* Based on Census population estimates for Maricopa County. Excludes 141 cases that were not Maricopa County residents and nine
additional cases with unknown/multiple races.

17

Multiyear Heat Report| 2006-2013

18

Heat-Associated Death Rates by Race and Year

• Although the heat-associated death rates by race fluctuated between 2006 and 2013, Native
Americans and African Americans generally had the highest rates of death compared to other groups.

Graph 12. Heat-Associated Crude Death Rate per 100,000 Maricopa County Residents by Race and
Year (n=482)*, Maricopa County, 2006-2013

Rate of Death (per 100,000 Residents)

6.0

5.0

White (n=325)
African American
(n=41)

4.0

Native American
(n=20)

3.0

Hispanics (n=92)
2.0
Asian/ Pacific
Islander (n=4)

1.0

0.0
2006

2007

2008

2009

2010

2011

2012

2013

Year
* Based on Census population estimates for Maricopa County. Excludes 141 cases that were not Maricopa County residents and nine
additional cases with unknown/multiple races.

Multiyear Heat Report| 2006-2013

Heat-Associated Deaths by Place of Injury

• In general, most heat injuries occurred outdoors.
• The majority of males were injured outdoors (69%). In contrast, the majority of females were
injured indoors (59%).
• See Appendix, Table I for more information on place of injury.
Graph 13. Outdoor Heat-Associated Deaths by Place of Injury (n=630)*, Maricopa County, 2006-2013

Outdoor (n=388)

38%

Indoor (n=242)

62%

*Two cases excluded due to unknown place of injury occurrence

Graph 14. Heat-Associated Deaths by Gender and Place of Injury, Maricopa County, 2006-2013

19

Multiyear Heat Report| 2006-2013

Heat-Associated Death Rates by Place of Injury and Age

• Individuals 64 years old or younger were more likely to be injured outdoors.
• In contrast, individuals 65 years old or older were more likely to be injured indoors.

Graph 15. Heat-Associated Deaths by Age Group and Place of Injury (n=626)*, Maricopa County,
2006-2013
140
120

Number of Deaths

100
80
60
40
20
0

0-4

5-19

20-34

35-49

50-64

65-74

75+

Indoor
(n=243)

1

0

4

22

69

53

93

Outdoor
(n=381)

9

12

35

112

129

33

52

Unknown
(n=2)

0

0

1

0

1

0

0

Age Group (in Years)
*6 cases excluded due to unknown age

20

Multiyear Heat Report| 2006-2013

Heat-Associated Death Rates by Place of Injury and Year
Graph 16. Heat-Associated Deaths by Year and Place of Injury (n=630)*, Maricopa County, 2006-2013

• For every year except for 2011, a higher proportion of decedents were injured outdoors as opposed
to indoors.

Percentage of heat-associated deaths

80%
70%
60%
50%
40%

% Indoor
%Outdoor

30%
20%
10%
0%
2006

2007

2008

2009

2010

Year
*Excludes 2 cases with unknown place of injury

2011

2012

2013

21

Multiyear Heat Report| 2006-2013

Specific Place of Injury for Indoor and Outdoor Deaths

• Most outdoor deaths were injured in an urban area (45%, n=173).
• Forty-four decedents were injured in a car. See Appendix, Table J for more information on injuries
that occurred in a car.
• Most indoor deaths were injured in a house (53%, n=128).

Graph 17. Outdoor Heat-Associated Deaths by Place of Injury (n=388)
1%

1%
Shed (n=5)

11%

Urban Area (n=173)
Desert Area/Trail (n=89)

19%

45%

Private Residence (n=72)
Car (n=44)
Unknown (n=5)

23%

Graph 18. Indoor Heat-Associated Deaths by Place of Injury (n=242)
1% 2%
11%

4%

Apartment (n=28)
Condominium (n=9)
RV/ Trailer (n=71)

53%

29%

House (n=128)
Business (n=2)
Unknown (n=4)

22

Multiyear Heat Report| 2006-2013

Air Conditioning Use for Indoor Deaths
• The air conditioning (AC) status was unknown for 13% of indoor deaths.
• Eighty-seven percent of indoor deaths were injured in an indoor environment not cooled by AC:
-Eighteen percent did not have AC physically present when they were injured. .
-Twenty-four percent had AC present but it was turned off for unknown reasons.
-Forty-five percent of indoor deaths had AC present but were unable to use it. The most common
reason why AC was not available for use was that it was non-functioning (graph 17).

Graph 19. Indoor Heat-Associated Deaths by Use of Air Conditioning Maricopa County, 2006-2013*

31, 13%

AC not present*

44, 18%

AC present but turned off
AC present but not available for use

58, 24%

109, 45%

AC status unknown

*6 of the cases that did not have AC present had a swamp cooler.

Graph 20. Reasons why AC was not available for use (n=109), Maricopa County, 2006-2013
1, 1%

22, 20%

No Electricity
Non-Functioning
Unknown

86, 79%

23

Multiyear Heat Report| 2006-2013

Homelessness among Heat-Associated Deaths

• From 2006-2013, there were a total of 144 cases (23%) who were homeless.
• The highest number of deaths among the homeless was reported in 2006 with 32 heatassociated deaths (38% of the 2006 total).
• See Appendix, Table K for more information on homelessness.

Graph 21. Homeless Heat-Associated Deaths by Year (n=632), Maricopa County, 2006-2013
120

Number of Deaths

100

80

60

40

20

0

2006

2007

2008

2009

2010

2011

2012

2013

Non-Homeless

53

45

46

53

60

86

90

55

Homeless

32

6

3

21

22

20

20

20

24

Multiyear Heat Report| 2006-2013

Substance Use among Heat-Associated Deaths

• There were a total of 187 cases (30%) where drug and/or alcohol use was mentioned on the death
certificate.

Graph 22. Drug and Alcohol Use, as Mentioned on the Death Certificate for Heat-Associated Death
(n=632), Maricopa County, 2006-2013

0%

30%

Drug and/or Alcohol
Use (n=187)
No Drug and/or
Alcohol Use (n=443)
Unknown (n=2)

70%

25

Multiyear Heat Report| 2006-2013

V. Conclusions
•There were 632 confirmed heat-associated deaths between 2006 and 2013. The highest number of
deaths occurred in 2012 and the fewest number of deaths occurred in 2008.
•The majority of heat-associated deaths were classfied as heat-caused.
•Most deaths occurred between the months of June and August.
•Between 2006 and 2013, 43 excessive heat warnings were issued in Maricopa County—29% if all heatassociated deaths occurred during the days when an warning was issued.
•The majority of cases were Maricopa County residents. In addition, the vast majority of cases had lived
in Arizona for at least 3 years.
•There were many more deaths among males than among females.
•Among Maricopa County residents, the rate of heat-associated deaths was highest for males, those 75
and older, and Native Americans. African Americans 75 or older had the highest rate of death of any
combined race and age group.
•The majority of cases were injured outdoors. Most outdoor deaths were injured in urban area and
most indoor deaths were injured in a house.
•Males were more likely to die outdoors and females were more likely to die indoors. Those who died
indoors were generally older than those who died outdoors.
• Eighty-seven percent of indoor deaths were injured in an environment not cooled by air-conditioning.
• Appriximately one in five heat-associated deaths occurred among the homeless.
•Thirty percent of cases had drug or alcohol use mentioned in the death certificate.

26

Multiyear Heat Report| 2006-2013

VI. Future Plans
Expand heat morbidity surveillance by analyzing hospital discharge data, data from BioSense (a CDC
syndromic surveillance system) , and data from the Arizona Prehospital Information and EMS Registry
System (AZ-PIERS).
Provide community stakeholders with information related to heat mortality and morbidity that can be
used for prevention efforts
Incorporate Geographic Information System (GIS) maps in future heat reports
Analyze the relationship between environmental temperatures and heat-associated mortality and
morbidity

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/

27

Multiyear Heat Report| 2006-2013

28

VII. Appendix
Table A. Heat-Associated Deaths Reported by Investigation Status, Maricopa County, 2006-2013

Total Reported
n

Year
2006
2007
2008
2009
2010
2011
2012
2013
Total

104
131
96
114
142
144
173
145
1,049

Confirmed
n (%)

Ruled-Out
n(%)

Pending
n(%)

85 (82%)
51 (39%)
49 (51%)
74 (65%)
82 (58%)
106 (74%)
110 (64%)
75 (52%)
632 (60%)

19 (18%)
80 (61%)
47 (49%)
40 (35%)
60 (42%)
38 (26%)
63 (36%)
69 (48%)
416 (40%)

0 (0%)
0 (0%)
0 (0%)
0 (0%)
0 (0%)
0 (0%)
0 (0%)
1*(0%)
1 (0%)

Table B. Characteristics of Heat-Associated Deaths by Year, Maricopa County, 2006-2013
Year of Death

Month of Death

Residence
Status

Gender

2006

2007

2008

2009

2010

2011

2012

2013

Total

January

0

0

0

0

0

1

0

0

1

February

0

0

0

0

0

0

0

0

0

March

0

0

0

0

0

1

0

1

2

April

0

0

0

1

0

1

0

0

2

May

2

1

0

4

1

2

4

1

15

June

16

11

12

4

18

15

18

16

110

July

62

22

20

42

44

32

33

39

294

August

5

11

12

16

12

39

42

11

148

September

0

5

3

6

6

15

7

7

49

October

0

1

2

1

1

0

3

0

8

Novermber

0

0

0

0

0

0

3

0

3

December

0

0

0

0

0

0

0

0

0

Total

85

51

49

74

82

106

110

75

632

Maricopa

66

42

42

49

61

83

89

59

491

Non-Maricopa

3

3

2

9

13

11

11

5

57

Non-Arizona

9

6

5

14

8

9

9

7

67

Unknown

7

0

0

2

0

3

1

4

17

Total

85

51

49

74

82

106

110

75

632

Male

65

34

34

55

62

77

71

61

459

Female

20

17

15

19

20

29

39

14

173

Total

85

51

49

74

82

106

110

75

632

Multiyear Heat Report| 2006-2013

29

Table B (continued)
Year of Death

Age Group

Years of Life
Spent in
Arizona

Race/Ethnicity

Place of Injury

Homelessness

0-4
5-19
20-34
35-49
50-64
65-74
75+
Unknown
Total
< 3 years
3-9 years
10-19 years
20 years
Unknown
Total
White
African
American
American
Indian
Hispanic
Asian/Pacific
Islander
Multiple
Unknown
Total
Indoor
Outdoor
Unknown
Total
Homeless
NonHomeless
Total

2006
0
1
5
24
29
9
14
3
85
9
10
8
35
23
85
53

2007
2
1
3
7
15
9
14
0
51
4
9
8
20
10
51
32

2008
2
2
2
7
15
5
16
0
49
8
5
7
24
5
49
32

2009
0
2
5
15
20
13
18
1
74
4
7
4
27
32
74
46

2010
2
2
7
18
24
7
21
1
82
11
9
10
38
14
82
54

2011
0
1
7
22
37
16
23
0
106
11
9
13
52
21
106
68

2012
2
1
4
22
36
16
29
0
110
8
9
18
61
14
110
71

2013
2
2
7
19
23
11
10
1
75
12
9
5
36
13
75
43

Total
10
12
40
134
199
86
145
6
632
67
67
73
293
132
632
399

9

2

3

2

9

10

5

10

50

2
20

4
12

5
9

5
19

1
14

0
23

7
18

2
17

26
132

0
0
1

0
0
1

0
0
0

1
0
1

0
1
3

1
1
3

4
0
5

0
1
2

6
3
16

85
26
58
1
85
32

51
21
30
0
51
6

49
17
32
0
49
3

74
25
49
0
74
21

82
24
58
0
82
22

106
54
52
0
106
20

110
46
63
1
110
20

75
29
46
0
75
20

632
242
388
2
632
144

53
85

45
51

46
49

53
74

60
82

86
106

90
110

55
75

488
632

Multiyear Heat Report| 2006-2013

Table C. Heat- Associated Deaths by Excessive Heat Warnings, Maricopa County, 2006-2013
Year

Events

Consecutive Days

Date

Number of deaths

2006

1

3

6/3-6/5

3

2006

2

2

7/14-7/15

6

2006

3

3

7/21-7/23

20

2007

1

1

6/21

1

2007

2

2

7/4-7/5

3

2007

3

2

8/12-8/13

2

2008

1

2

5/19-5/20

0

2008

2

8

6/15-6/22

5

2008

3

3

7/1-7/3

5

2008

4

2

8/1-8/2

3

2009

1

4

7/11-7/14

0

2009

2

4

7/17-7/20

16

2009

3

3

7/26-7/28

3

2009

4

6

8/1-8/6

6

2009

5

4

8/27-8/30

1

2010

1

2

6/6-6/7

1

2010

2

3

6/30-7/2

3

2010

3

3

7/8-7/10

2

2010

4

5

7/13-7/17

11

2010

5

2

7/19-7/20

8

2010

6

1

8/5

1

2010

7

3

8/13-8/15

1

2010

8

2

8/23-8/24

0

2011

1

1

6/22

1

2011

2

3

6/27-6/29

6

2011

3

3

7/1-7/3

3

2011

4

2

8/2-8/3

1

2011

5

1

8/18

3

2011

6

11

8/22-9/1

16

2011

7

1

9/4

1

2012

1

2

5/21-5/22

1

2012

2

2

5/31-6/1

1

2012

3

1

6/18

0

2012

4

4

6/27-6/30

4

2012

5

2

7/9-7/10

4

2012

6

9

8/6-8/14

22

Total deaths
29

6

13

26

27

31

32

30

Multiyear Heat Report| 2006-2013

Table C (Continued)
2013

1

1

6/2

1

2013

2

1

6/7

0

2013

3

1

6/12

1

2013

4

6

6/28-7/3

12

2013

5

1

8/1

1

2013

6

4

8/16-8/19

3

2013

7

2

8/20-8/21

1

Total

43

128

183

19

183

Table D. Heat-Associated Deaths by Residency Status, Maricopa County, 2006-2013

Residency Status
Non-Arizona (n=67)
Non-Maricopa (n=57)
Apache (1)
Cochise (2)
Coconino (1)
Gila (1)
Mohave (1)
Navajo (2)
Pima (2)
Pinal (7)
La Paz (2)
Yuma (1)
Unknown (37)

Total (57)

U.S. Residents
(n=43)
AK (1)
AR(1)
CA (7)
CO (2)
IA (1)
IL (1)
IN (1)
MN(1)
NC (1)
ND (1)
NM (1)
OR (1)
PA (1)
TX (3)
UT (1)
WA (1)
WV (1)
Unknown (17)
Total (43)

Non-U.S.
Residents (n=24)
Austria (1)
Canada (1)
Honduras (1)
Guatemala (1)
Mexico (19)
Scotland (1)

Total (24)

31

Multiyear Heat Report| 2006-2013

Table E. Heat- Associated Deaths by Gender and Age Group, Maricopa County, 2006-2013

Deaths by Gender
Age Group
Male n (%)

Female n (%)

Total n (%)

0-4

4 (1%)

6 (3%)

10 (2%)

5-19

11 (2%)

1 (1%)

12 (2%)

20-34

37 (8%)

3 (2%)

40 (6%)

35-49

111 (24%)

23 (13%)

134 (21%)

50-64

163 (36%)

36 (21%)

199 (31%)

65-74

58 (13%)

28 (16%)

86 (14%)

75 +

69 (15%)

76 (44%)

145 (23%)

Unknown

6 (1%)

0 (0%)

6 (1%)

All

459 (73%)

173 (27%)

632 (100%)

Table F. Heat-Associated Death Rates per 100,000 Resident* by Gender and Age Group, Maricopa
County, 2006-2013

Gender
Rate per 100,000 (n)

Age Group
Male

Female

Total

0-4

0.3 (4)

0.5 (6)

0.4 (10)

5-19

0.1 (3)

0 (1)

0.1 (4)

20-34

0.5 (18)

0 (1)

0.3 (19)

35-49

2.6 (82)

0.5 (17)

1.6 (99)

50-64

4.8 (115)

1.3 (33)

2.9 (148)

65-74

5.5 (52)

2.2 (24)

3.7 (76)

75+

9.1 (63)

7.4 (72)

8.1 (135)

All Ages

2.2 (337)

1.0 (154)

1.6 (491)

*Based on Census population estimates for Maricopa County. Excludes 141 cases who were not Maricopa County residents.

32

Multiyear Heat Report| 2006-2013

33

Table G. Heat-Associated Death Rates per 100,000 Residents* by Race/Ethnicity and Age Group,
Maricopa County, 2006-2013

Race/ Ethnicity
Rate per 100,000 (n)

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

White
0.3 (3)
0.1 (2)
0.4 (14)
1.7 (67)
2.4 (89)
3.3 (54)
6.5 (96)
1.8 (325)

African
American
0.9 (1)
0.0 (0)
0.0 (0)
3.0 (8)
9.2 (16)
5.9 (3)
37.4 (13)
3.1 (41)

Native
American
4.3 (2)
0.9 (1)
0.7 (1)
4.0 (4)
9.0 (5)
21.4 (3)
33.7 (4)
4.1 (20)

Hispanic
0.2 (2)
0.0 (1)
0.1 (3)
1.3 (20)
4.1 (34)
6.0 (13)
15.0 (19)
1.0 (92)

Asian/ Pacific
Islander
0.0 (0)
0.0 (0)
0.0 (0)
0.0 (0)
0.6 (1)
2.0 (1)
7.7 (2)
0.4 (4)

* Based on Census population estimates for Maricopa County. Excludes 141 cases that were not Maricopa County residents and nine
additional cases with unknown/multiple races.

Table H. Heat-Associated Death Rates per 100,000 Residents* by Gender and Race/Ethnicity,
Maricopa County, 2006-2013

Gender
Rate per 100,000 (n)

Race/Ethnicity
White
African American
Native American
Hispanic
Asian/Pacific Islander
All Races

Male
2.5 (221)
3.9 (28)
5.3 (12)
1.5 (67)
0.8 (4)
2.2 (337)

Female
1.1 (104)
0.7 (13)
3.2 (8)
0.6 (25)
0.0 (0)
1.0 (154)

Total
1.8 (325)
1.7 (41)
4.2 (20)
1.1 (92)
0.4 (4)
1.6 (491)

*Based on Census population estimates for Maricopa County. Excludes 141 cases that were not Maricopa County residents.

Multiyear Heat Report| 2006-2013

34

Table I. Heat-Associated Deaths by Indoor or Outdoor Occurrence, Age Group, and Gender, Maricopa
County, 2006-2013

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

Indoor
Male

Outdoor

Female
0
0
4
15
49
35
37
0
140

Total
1
0
0
7
20
18
56
0
102

Male
1
0
4
22
69
53
93
0
242

4
11
32
96
114
23
32
6
318

Female

Total
5
1
3
16
15
10
20
0
70

*Excludes 2 cases for which place of injury was unknown

Table J. Heat-Associated Deaths that Occurred in a Car by Age-Group, Maricopa County, 2006-2013

Age Group

Number of Deaths

0-4

9 (20%)

5-19

1 (2%)

20-34

4 (9%)

35-49

9 (20%)

50-64

16 (36%)

65-74

4 (9%)

75+

1 (2%)

All Ages

44 (100%)

9
12
35
112
129
33
52
6
388

Multiyear Heat Report| 2006-2013

Table K. Homeless Heat-Associated Deaths by Age-Group and Gender, Maricopa County, 2006-2013

Gender

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

Female

Total

0 (0%)
4 (3%)
16 (11%)
41 (28%)
65 (45%)
7 (5%)
1 (1%)
5 (3%)
139 (97%)

0 (0%)
0 (0%)
0 (0%)
2 (1%)
2 (1%)
1 (1%)
0 (0%)
0 (0%)
5 (3%)

0 (0%)
4 (3%)
16 (11%)
43 (30%)
67 (47%)
8 (6%)
1 (1%)
5 (3%)
144 (100%)

Table L. Heat-Associated Deaths by Education Category, Maricopa County, 2006-2013

Education Category

n

(%)

8th grade or less

35

6%

9th through 12th grade; no diploma

43

7%

134

21%

Some college credit, but no degree

60

9%

Associate degree (e.g.AA,AS)

13

2%

Bachelor’s degree (e.g.BA,BS)
Master’s degree
(e.g.MA,MS,MEng,MEd,MSW,MBA
Doctorate (e.g.PhD,EdD) or
Professional degree
(e.g.MD,DDS,DVM,LLB,JD)
Not Classifiable
Unknown
Total

20

3%

7

1%

0
3
317
632

0%
0%
50%
100%

High school graduate or GED
completed

35