Characterizing Adaptive Capacity for the Future Heat-Related Cardiovascular Morbidity Burden in U.S. Metropolitan Areas

Exposure to excess heat is linked to increased risks of cardiovascular diseases (CVD). With the projections of rising temperature globally, it is crucial to understand the health risks of excess heat-related CVD (xHEAT-CVD) burden to inform strategies for adaptation. This study aimed to identify the contextual factors associated with future xHEAT-CVD burden among older adults across eighty U.S. metropolitan statistical areas (MSAs). MSA-specific xHEAT-CVD risk for age ≥65 was estimated for 2000–2017 at temperatures above the minimum hospitalization percentile (TMHP). Future xHEAT-CVD hospitalizations ≥TMHP were estimated using temperature projections for 2025-2054, 2045-2074, and 2070-2099 under three climate scenarios. Demographic and economic status, health, environment, and infrastructure contexts were identified to derive Urban Heat Health Risk (UHHR) scores using confirmatory factor analysis. UHHR scores were examined using xHEAT-CVD burden. In 2070-2099 under the mildest climate scenario, approximately 36 more days were projected to be ≥TMHP, and xHEAT-CVD burden was projected to increase by at least 20.4-fold. Overall UHHR scores were associated with greater increases in future xHEAT-CVD burden (beta: 9.1, 95% Confidence Intervals: 2.8–15.4). xHEAT-CVD burden was largely driven by the health context at the baseline, whereas environment played a more important role in the future. Our findings suggest that drivers of the xHEAT-CVD burden may vary across time. Targeting the areas most associated with xHEAT-CVD burden at varying timeframes can help mitigate xHEAT-CVD burden more effectively.

Impact/Purpose

Exposure to excess heat is linked to increased risks of cardiovascular diseases (CVD). With the projections of rising temperature globally, it is crucial to understand the health risks of excess heat-related CVD (xHEAT-CVD) burden to inform strategies for adaptation. This study aimed to identify the contextual factors associated with future xHEAT-CVD burden among older adults across eighty U.S. metropolitan statistical areas (MSAs). MSA-specific xHEAT-CVD risk for age ≥65 was estimated for 2000–2017 at temperatures above the minimum hospitalization percentile (TMHP). Future xHEAT-CVD hospitalizations ≥TMHP were estimated using temperature projections for 2025-2054, 2045-2074, and 2070-2099 under three climate scenarios. Demographic and economic status, health, environment, and infrastructure contexts were identified to derive Urban Heat Health Risk (UHHR) scores using confirmatory factor analysis. UHHR scores were examined using xHEAT-CVD burden. In 2070-2099 under the mildest climate scenario, approximately 36 more days were projected to be ≥TMHP, and xHEAT-CVD burden was projected to increase by at least 20.4-fold. Overall UHHR scores were associated with greater increases in future xHEAT-CVD burden (beta: 9.1, 95% Confidence Intervals: 2.8–15.4). xHEAT-CVD burden was largely driven by the health context at the baseline, whereas environment played a more important role in the future. Our findings suggest that drivers of the xHEAT-CVD burden may vary across time. Targeting the areas most associated with xHEAT-CVD burden at varying timeframes can help mitigate xHEAT-CVD burden more effectively.

Citation

Tsai, W., Melissa Mcinroe, A. Jalowska, C. Keeler, S. Cleland, Cassie O'Lenick, T. Spero, A. Schneider, AND A. Rappold. Characterizing Adaptive Capacity for the Future Heat-Related Cardiovascular Morbidity Burden in U.S. Metropolitan Areas. Elsevier B.V., Amsterdam, NETHERLANDS, 207:110022, (2026). [DOI: 10.1016/j.envint.2025.110022]

DOI: Characterizing Adaptive Capacity for the Future Heat-Related Cardiovascular Morbidity Burden in U.S. Metropolitan Areas