Spatial and intraseasonal variation in changing susceptibility to extreme heat in the United States

Exposure to excessive heat is associated with a higher risk of death. Although the relative risk of death on extreme-heat days has decreased over the past several decades in the United States, the drivers of this decline have not been fully characterized. In particular, while extreme heat earlier in the warm season has been shown to confer greater risk of mortality than exposure later in the season, it is unknown whether this within-season variability in susceptibility has changed over time and whether it is modified by region, climatic changes, or social vulnerability. METHODS: We used distributed-lag nonlinear models and meta-regression to estimate the association between ambient maximum daily temperature during the early, late, and overall warm seasons and the relative risk of mortality for two decades, 1973–1982 and 1997–2006, in 186 metropolitan areas in the United States. We assessed changes in relative risk nationally, regionally, and between places with differential changes in early-season relative extreme heat and indicators of social vulnerability. RESULTS: Most of the reduction in heat-related mortality nationally between the two decades is driven by decreases in late-season mortality, while substantial early-season risk remains. This difference is most apparent in the Northeast, in cities with greater increases in early-season relative extreme heat, and in places that have become more socially vulnerable. CONCLUSIONS: Early-season heat mortality risks have persisted despite overall adaptations, particularly in places with greater warming and increasing social vulnerability. Interventions to reduce heat mortality may need to consider greater applicability to the early warm season.