Heat Waves and Adverse Health Events among Dually Eligible Individuals 65 Years and Older

Importance: Extensive research has found the detrimental health effects of heat waves. However, a critical gap exists in understanding their association with adverse health events among older dually eligible individuals, who may be particularly susceptible to heat waves. Objective: To assess the association between heat waves and adverse health events among dually eligible individuals 65 years and older. Design, Setting, and Participants: This retrospective time-series study assessed the association between heat waves in warm months from 2016 to 2019 and zip code tabulation area (ZCTA)-day level adverse health events. Dually eligible individuals 65 years and older who were continuously enrolled in either a Medicare fee-for-service plan or a Medicare Advantage plan with full Medicaid benefits from May to September in any given year were identified. All ZCTAs in the US with at least 1 dually eligible individual in each study year were included. Data were analyzed from September 2023 to August 2024. Exposure: Heat waves, defined as 3 or more consecutive extreme heat days (ie, days with a maximum temperature of at least 90 °F [32.2 °C] and in the 97th percentile of daily maximum temperatures for each ZCTA during the study period). Main Outcomes and Measures: Daily counts of heat-related emergency department visits and heat-related hospitalizations for each ZCTA. Results: The study sample included 5448499 beneficiaries 65 years and older in 28404 ZCTAs across 50 states and Washington, DC; the mean (SD) proportion of female beneficiaries and beneficiaries 85 years and older in each ZCTA was 66% (7%) and 20% (8%), respectively. The incidence rate for heat-related emergency department visits was 10% higher during heat wave days compared to non-heat wave days (incidence rate ratio [IRR], 1.10; 95% CI, 1.08-1.12), and the incidence rate of heat-related hospitalizations was 7% higher during heat wave days (IRR, 1.07; 95% CI, 1.04-1.09). There were similar patterns in other adverse health events, including a 4% higher incidence rate of death during heat wave days (IRR, 1.04; 95% CI, 1.01-1.07). The magnitude of these associations varied across some subgroups. For example, the association between heat waves and heat-related emergency department visits was statistically significant only for individuals in 3 of 9 US climate regions: The Northwest, Ohio Valley, and the West. Conclusions and Relevance: In this time-series study, heat waves were associated with increased adverse health events among dually eligible individuals 65 years and older. Without adaptation strategies to address the health-related impacts of heat, dually eligible individuals are increasingly likely to face adverse outcomes.