Heat-Associated Deaths in Maricopa County, AZ Final Report for 2018 Photograph by Dan Sorensen: http://www.dansorensenphotography.com/ Heat Death Report | 2018 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 ................................................................................................................... 7 HEAT-ASSOCIATED DEATHS BY TIME RESIDING IN ARIZONA*.................................................. 7 Demographic Characteristics of Heat-Associated Deaths ....................................................................................... 8 Heat-Associated Death Rates* ............................................................................................................................. 10 Heat-Associated Deaths by Place of Injury ........................................................................................................... 12 Air Conditioning Use for Indoor Deaths* .............................................................................................................. 14 Substance Use among Heat-Associated Deaths ................................................................................................... 15 Living Situation among Heat-Associated Deaths .................................................................................................. 17 CONCLUSIONS ..................................................................................................................... 18 APPENDIX............................................................................................................................ 19 Background.......................................................................................................................................................... 19 Methodology ....................................................................................................................................................... 19 Tables .................................................................................................................................................................. 21 1 Heat Death Report | 2018 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 | 2018 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. Heat related 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 | 2018 Results Heat-Associated Deaths by Year Graph 1. There were 182 heat-associated deaths reported in 2018. 179 182 154 106 85 82 74 75 49 38 51 42 110 84 75 61 49 21 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Data Sources: Maricopa County, Office of Vital Registration and Office of Medical Examiner; Arizona Department of Health Services, Office of Vital Registration  See Methodology in the Appendix for more information about the number of confirmed, ruled-out, and pending cases by year. 4 Heat Death Report | 2018 Heat-Associated Deaths by Month Graph 2. Fifty-nine percent of heat-associated deaths since 2006 have been classified as heat-caused. 63 89 66 47 49 27 34 27 13 2006 28 17 58 38 32 2007 2008 39 33 47 48 57 2009 2010 2011 119 88 90 2016 2017 63 42 2012 Heat-Caused 2013 45 33 2014 2015 2018 Heat-Related Graph 3. Eighty-six percent of all heat-associated deaths occurred in the months of July, August, and September (N=156). 54 32 23 5 4 May 21 10 5 June 18 8 July Heat-Related (N=63) August Heat-Caused (N=119) September 5 Heat Death Report| 2016 Heat-Associated Deaths and Temperatures  The National Weather Service issued seven excessive heat warnings for a total of thirteen days in 2018.  The highest daily maximum temperature in 2018 was 116°F and occurred on July 24th and 25th. Graph 4. Twenty-three percent of heat-associated deaths occurred on days for which an excessive heat warning has been issued. (N=41) 8 120°F 7 100°F 80°F 5 60°F 4 3 40°F 2 20°F 1 0°F 0 Excessive Heat Warning Heat-Associated Deaths High Temperature Low Temperature *Two deaths which occurred outside of the MCDPH enhanced heat surveillance season (May 1 – September 30) excluded from graph. Number of Deaths 6 6 Heat Death Report| 2016 Heat-Associated Deaths by Residency Graph 5. Maricopa County residents accounted for eighty-eight percent of all heat-associated deaths with known county of residence. 137 Maricopa County Resident 11 7 Non-Maricopa County Arizona Resident† Non-Arizona Resident‡ † Non-Maricopa County Arizona Resident cases include residents from Apache, Gila, Navajo, Pima, and Pinal, Counties and one case with unknown county of residency. ‡ Non-Arizona Resident cases include residents of California, Illinois, Iowa, Missouri, New Jersey, and Ohio. Heat-Associated Deaths by Time Residing in Arizona* Graph 6. Sixty-four percent of heat-associated deaths with known residency history had lived in Arizona for 20 or more years at time of death. 84 19 17 3-9 Years 10-19 Years 12 <3 Years *Fifty cases for which time spent in Arizona was unknown were excluded from analysis. 20+ Years 7 Heat Death Report | 2018 Demographic Characteristics of Heat-Associated Deaths Graph 7. The majority of heat-associated deaths occurred among males. Female 23% Male 77% Graph 8. The largest proportion of deaths in males occurred in thoe under 65, while the largest proportion of deaths in females occurred in those over 65. 17 20 to 34 27 35 to 49 56 50 to 64 27 14 * 10 65 to 74 14 75+ 11 Male (N=141) * Indicates suppressed value of ≤ 5. * Female (N=41) 8 Heat Death Report | 2018 Graph 9. Seventy-three percent of heat-associated deaths were among those 50 and older. (N=132) 66 41 32 25 18 0 0 0-4 5-19 20-34 35-49 50-64 65-74 75+ Age Range Graph 10. Fifty-nine percent of heat-associated deaths for which race and ethnicity are known occurred among whites. (N=107) 1% 4% 8% Asian/Pacific Islander Native American 15% African American Hispanic White 59% 9 Heat Death Report | 2018 Heat-Associated Death Rates* *Death rate graphs below include rates per 100,000 residents. Non-Maricopa County residents were excluded. Rates calculated using census population estimates for 2017. Graph 11. The heat-associated death rate for males was more than three times greater than the rate for females. 4.8 1.5 Males Females Graph 12. For both male and female residents, the heat-associated death rate was highest in those over the age of 65. 13.4 Male Female 10.6 9.8 5.7 5.7 4.0 2.7 1.2 0.0 0.0 0-4 0.0 0.0 5-19 1.7 0.0 20-34 35-49 50-64 65-74 75+ 10 Heat Death Report | 2018 Graph 13. The heat-associated death rate increases with age. 9.3 7.8 5.7 2.6 1.4 0.0 0.0 0-4 5-19 20-34 35-49 50-64 65-74 75+ Age Group Graph 14. African Americans and Native Americans had the highest rates of heat-associated deaths per 100,000 residents. 6.6 5.4 3.7 1.7 0.5 0.0 Multiple Asian/Pacific Islander Hispanic White Native American African American 11 Heat Death Report | 2018 Heat-Associated Deaths by Place of Injury Graph 15. A lower proportion of deaths occurred indoors than in previous years. 2011 Outdoor 46% Indoor 54% 2012 58% 42% 2013 59% 41% 72% 2014 28% 2015 61% 39% 2016 61% 39% 2017 60% 40% 72% 2018 28% Graph 16. A higher proportion of male deaths than female deaths occurred outdoors. Indoor 24% Outdoor 76% Males Indoor 43% Outdoor 58% Females 12 Heat Death Report | 2018 Graph 17. Sixty percent of outdoor deaths with a known location of injury occurred in an urban area. Urban Area 76 Private Residence 24 Desert Area/Trail 19 Car Care Facility 7 * * Indicates suppressed value of ≤ 5. Graph 18. Seventy-three percent of indoor deaths occurred in a house or apartment. House 27 Trailer/RV/Mobile Home 12 Apartment/Condo 10 Care Facility * Business * * Indicates suppressed value of ≤ 5. 13 Heat Death Report | 2018 Graph 19. Sixty-three percent of indoor deaths were discovered during a welfare check, compared to just seven percent of outdoor deaths.* 31 7 Indoor Deaths Outdoor Deaths *Excludes forty cases for which welfare check status was not reported and one case for which place of injury is unknown. Air Conditioning Use for Indoor Deaths* *Evaporative coolers were not considered as A/C units as their ability to cool becomes inadequate in extreme Maricopa County temperatures. Graph 20. Eighty-two percent of indoor deaths had an air conditioning unit present at time of death. (N=42) A/C Not Present 18% A/C Present 82% 14 Heat Death Report | 2018 Graph 21. Among deaths where an A/C unit was present, a nonfunctioning A/C unit was the most common reason for not having a cooled environment at the time of death. 9% 8% Non-Functioning Functioning but Not In Use 11% No Electricity Other/Unknown 72% Substance Use among Heat-Associated Deaths Graph 22. Half of all cases involved substance use as a cause of death or a contributing factor. (N=91) No Substance Use 50% Substance Use 50% 15 Heat Death Report | 2018 16 Graph 23. In thirty-seven percent of cases, drug use was listed as either cause of death or a contributing factor. (N=68) 61 23 7 Drugs only Alcohol only Drugs and alcohol Graph 24. The proportion of heat-associated deaths involving drug use increased seventeen percent from the previous year.* 50% 40% Drugs 30% 20% Alcohol 10% 0% 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 *Cases involving both drug and alcohol use are represented uniquely on each line. 2016 2017 2018 Heat Death Report | 2018 Living Situation among Heat-Associated Deaths Graph 25. Thirty-four percent of cases were homeless at time of death. Homeless 61 Living Independently 58 Co-Habitating/Roommate 35 Unknown 28 Graph 26. More heat-associated deaths occurred among homeless individuals than any previous year on record. 122 121 54 57 61 2016 2017 2018 100 86 53 53 45 46 6 * 2007 2008 32 2006 90 60 55 76 54 21 22 20 20 20 2009 2010 2011 2012 2013 Homeless * Indicates suppressed value of ≤ 5. 7 8 2014 2015 Non-Homeless 17 Heat Death Report | 2018 Conclusions  There was only a 1% increase in heat-associated deaths between 2017 and 2018.  Seven excessive heat warnings were issued in 2018, and ranged in duration from 1 to 3 days. On those days, 23% of all heat-associated deaths occurred.  For the first time on record, more heat deaths occurred in September than in June.  There were 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, African Americans, Native Americans, and those 65 years of age or older.  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 a private residence.  While 82% of indoor deaths had an A/C unit present at the time of death, in all cases the environment was not being adequately cooled. Reasons for lack of cooling in the presence of an A/C unit include a malfunctioning unit, a lack of electricity, the unit being turned off due to cost, forgetfulness, or other reasons, and the unit being set to a high temperature. A total of 18% of indoor cases did not have an A/C unit present.  Drugs or alcohol were mentioned on the death certificate in half of all cases.  Individuals experiencing homelessness accounted for 34% of heat-associated deaths.  The average years of life lost for those with heat-related deaths was 23 years, with a median age at death of 60 years. 18 Heat Death Report | 2018 Appendix Background 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. 19 Heat Death Report | 2018 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 indicated in Part I1 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 II2 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. For the purposes of this report, reasons for not having a cooled environment at the time of death in indoor cases where an A/C unit was present were grouped into three categories: non-functioning, functioning but turned off, and no electricity. “Non-functioning” is defined as an A/C unit that was not operating properly, was broken, or could not be turned on despite the presence of electricity. Cases categorized as having a “functioning but turned off” A/C unit indicate that the unit worked properly but was the A/C was turned off for some reason at the time of the OME scene inspection. In cases where the unit could not be turned on due to a lack of electricity, regardless of whether it was functioning or non-functioning, were counted in the “no electricity” category. 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 20 Heat Death Report | 2018 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. Tables Table A. Heat-Associated Deaths Reported by Investigation Status, Maricopa County, 2006-2018 YEAR TOTAL CASES REPORTED CONFIRMED CASES (%) RULED-OUT CASES (%) PENDING CASES (%) 2006 104 85 (82%) 19 (18%) 0 (0%) 2007 131 51 (39%) 80 (61%) 0 (0%) 2008 97 49 (51%) 48 (49%) 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 75 (52%) 70 (48%) 0 (0%) 2014 115 61 (53%) 54 (47%) 0 (0%) 2015 144 84 (58%) 59 (42%) 0 (0%) 2016 240 154 (64%) 86 (36%) 0 (0%) 2017 264 179 (68%) 85 (32%) 0 (0%) 2018 242 182 (75%) 60 (25%) 0 (0%) TOTAL 1,549 931 (60%) 617 (40%) 0 (0%) 21 Heat Death Report | 2018 Table B. Heat-Associated Deaths by Gender and Age Group, Maricopa County, 2018 AGE GROUP MALE CASES (%) FEMALE CASES (%) TOTAL CASES (%) 0-4 0 (0%) 0 (0%) 0 (0%) 5-19 0 (0%) 0 (0%) 0 (0%) 20-34 17 (9%) * * 35-49 27 (15%) * * 50-64 56 (31%) 10 (5%) 66 (36%) 65-74 27 (15%) 14 (8%) 41 (23%) 75+ 14 (8%) 11 (6%) 25 (14%) TOTAL 141 (100%) 41 (100%) 182 (100%) * Indicates suppressed value of ≤ 5 or a value that would facilitate calculation of a suppressed value. Table C. Heat-Associated Deaths Rates per 100,000 Residents** by Gender and Age Group, Maricopa County, 2018 AGE GROUP MALE RATE (N) FEMALE RATE (N) TOTAL RATE (N) 0-4 0.0 (0) 0.0 (0) 0.0 (0) 5-19 0.0 (0) 0.0 (0) 0.0 (0) 20-34 2.7 (13) 0.0 (0) 1.4 (13) 35-49 4.0 (17) 1.2 (*) 2.6 (*) 50-64 9.8 (37) 1.7 (7) 5.7 (44) 65-74 13.4 (24) 5.7 (12) 9.3 (36) 75+ 10.6 (13) 5.7 (9) 7.8 (22) TOTAL 4.8 (104) 1.5 (*) 3.1 (137) * Indicates suppressed value of ≤ 5 or a value that would facilitate calculation of a suppressed value. **Based on 2018 census population estimates for Maricopa County. Forty-five cases that were not Maricopa County residents or had an unknown county of residence excluded. 22 Heat Death Report | 2018 Table D. Heat-Associated Deaths Rates per 100,000 Residents** by Age Group and Race/Ethnicity, Maricopa County, 2018 AGE GROUP RATE (N) RACE/ETHNICITY 0-4 5-19 20-34 35-49 50-64 65-74 WHITE 0.0 (0) 0.0 (0) 0.7 (*) 3.7 (17) 5.6 (29) 7.9 (24) 7.2 (17) 3.7 (90) HISPANIC 0.0 (0) 0.0 (0) 1.5 (*) 1.1 (*) 7.5 (*) 1.7 (23) BLACK 0.0 (0) 0.0 (0) 5.0 (*) 4.1 (*) 12.9 (*) 21.3 (*) 13.5 (*) 5.8 (14) ASIAN/PACIFIC ISLANDER 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 13.0 (*) 0.5 (1) 4.7 (8) 10.0 (*) 75+ TOTAL NATIVE AMERICAN 0.0 (0) 0.0 (0) 9.5 (*) 0.0 (0) 9.9 (*) 31.3 (*) 0.0 (0) 5.4 (*) MULTIPLE 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) 0.0 (0) TOTAL 0.0 (0) 0.0 (0) 1.4 (13) 2.6 (22) 5.7 (44) 9.3 (36) 7.8 (22) 3.1 (137) 0.0 (0) * Indicates suppressed value of ≤ 5 or a value that would facilitate calculation of a suppressed value. **Based on 2018 census population estimates for Maricopa County. Forty-five cases that were not Maricopa County residents or had an unknown county of residence excluded. Total includes five cases with unknown race/ethnicity. Table E. Heat-Associated Deaths Rates per 100,000 Residents** by Gender and Race/Ethnicity, Maricopa County, 2018 RACE/ETHNICITY MALE RATE (N) FEMALE RATE (N) TOTAL RATE (N) White 5.4 (64) 2.1 (26) 3.7 (90) Hispanic 3.0 (21) 0.3 (*) 1.7 (23) Black 4.9 (6) 2.5 (*) 3.7 (9) Asian/Pacific Islander 1.1 (*) 0.0 (0) 0.5 (*) Native American 23.1 (8) 0.0 (0) 10.9 (8) Multiple 4.2 (*) 0.0 (0) 2.1 (*) TOTAL 4.8 (104) 1.5 (33) 3.1 (137) * Indicates suppressed value of ≤ 5 or a value that would facilitate calculation of a suppressed value. *Based on 2018 census population estimates for Maricopa County. Forty-five cases that were not Maricopa County residents or had an unknown county of residence excluded. Total includes five cases with unknown race/ethnicity. 23 Heat Death Report | 2018 Table F. Indoor Heat-Associated Deaths* by Place of Injury and Age Group, Maricopa County, 2018 PLACE OF INJURY TYPE AGE GROUP HOUSE APARTMENT TRAILER/RV/ MOBILE HOME BUSINESS CARE FACILITY TOTAL 0-4 0% 0% 0% 0% 0% 0% 5-19 0% 0% 0% 0% 0% 0% 20-34 0% 4% 2% 0% 0% 6% 35-49 0% 2% 2% 0% 0% 4% 50-64 16% 4% 8% 0% 0% 27% 65-74 27% 8% 8% 2% 2% 47% 75+ 10% 2% 4% 0% 0% 16% TOTAL 53% 20% 24% 2% 2% 100% Table G. Outdoor Heat-Associated Deaths* by Place of Injury and Age Group, Maricopa County, 2018 PLACE OF INJURY TYPE AGE GROUP CAR DESERT AREA RESIDENCE URBAN AREA CARE FACILITY TOTAL 0-4 0% 0% 0% 0% 0% 0% 5-19 0% 0% 0% 0% 0% 0% 20-34 1% 4% 2% 6% 0% 12% 35-49 2% 5% 2% 15% 0% 23% 50-64 0% 4% 2% 33% 0% 39% 65-74 2% 1% 5% 6% 0% 13% 75+ 2% 2% 9% 0% 1% 13% TOTAL 6% 15% 19% 60% 1% 100% *Two cases with unknown place of injury excluded from analysis. Outdoor total excludes two outdoor cases with unknown location type. 24 Heat Death Report | 2018 Table H. Heat-Associated Deaths* by Place of Injury, Age Group, and Gender, Maricopa County, 2018 INDOOR OUTDOOR AGE GROUP MALE FEMALE TOTAL MALE FEMALE TOTAL 0-4 0% 0% 0% 0% 0% 0% 5-19 0% 0% 0% 0% 0% 0% 20-34 6% 0% 6% 11% <1% 12% 35-49 4% 0% 4% 19% 3% 22% 50-64 20% 8% 27% 35% 5% 40% 65-74 29% 18% 47% 9% 4% 13% 75+ 8% 8% 16% 8% 5% 13% TOTAL 67% 33% 100% 82% 18% 100% *Total excludes two cases with unknown place of injury. Table I. Indoor Heat-Associated Deaths by Presence of an Air Conditioning (A/C) Unit and Age Group, Maricopa County, 2018 AGE GROUP AC UNIT PRESENT (%) AC UNIT NOT PRESENT OR UNKNOWN (%) TOTAL 0-4 0% 0% 0% 5-19 0% 0% 0% 20-34 4% 2% 6% 35-49 4% 0% 4% 50-64 22% 6% 27% 65-74 39% 8% 47% 75+ 14% 2% 16% TOTAL 82% 18% 100% 25 Heat Death Report | 2018 Table J. Indoor Heat-Associated Deaths with AC Unit Present by Air Conditioning (A/C) Status and Age Group, Maricopa County, 2018 A/C STATUS (%) AGE NO NONNOT IN USE GROUP ELECTRICITY FUNCTIONING OTHER UNKNOWN TOTAL 0-4 0% 0% 0% 0% 0% 0% 5-19 0% 0% 0% 0% 0% 0% 20-34 0% 4% 2% 0% 0% 7% 35-49 0% 4% 0% 0% 0% 4% 50-64 2% 17% 2% 0% 2% 24% 65-74 7% 35% 4% 0% 2% 48% 75+ 0% 11% 2% 2% 2% 17% TOTAL 9% 72% 11% 2% 7% 100% Table K. Heat-Associated Deaths by Substance Use at Time of Death, Maricopa County, 2018 SUBSTANCE USE (%) AGE GROUP ALCOHOL DRUG BOTH NEITHER TOTAL 0-4 0% 0% 0% 0% 0% 5-19 0% 0% 0% 0% 0% 20-34 2% 5% 2% 1% 10% 35-49 3% 11% <1% 3% 18% 50-64 5% 16% <1% 15% 36% 65-74 2% 2% <1% 18% 23% 75+ 1% 0% 0% 13% 14% TOTAL 13% 34% 4% 50% 100% Heat Death Report | 2018 Table L. Heat-Associated Deaths among Homeless Individuals, Maricopa County, 2018 AGE GROUP MALE FEMALE TOTAL 0-4 0% 0% 0% 5-19 0% 0% 0% 20-34 8% 2% 10% 35-49 25% 5% 30% 50-64 43% 7% 49% 65-74 11% 0% 11% 75+ 0% 0% 0% TOTAL 87% 13% 61% Table M. Heat-Associated Deaths by Education Level, Maricopa County, 2018 EDUCATION CASES (%) 8th grade or less 12 (7%) 9th through 12th grade; no diploma 18 (10%) High school graduate or GED completed 51 (28%) Some college credit, but no degree 24 (13%) Associate degree (e.g.AA,AS) 15 (8%) Bachelor’s degree (e.g.BA,BS) 17 (9%) 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) 6 (3%) 0 (0%) Unknown 39 (21%) TOTAL 182 (100%) 27