The 2006 California heat wave: Impacts on hospitalizations and emergency department visits

Kim Knowlton, Mirian Rotkin-Ellman, Galatea King, Helene G Margolis, Daniel Smith, Gina Solomon, Roger Trent, Paul English

Research output: Contribution to journalArticlepeer-review

472 Scopus citations


Background: Climate models project that heat waves will increase in frequency and severity. Despite many studies of mortality from heat waves, few studies have examined morbidity. Objectives: In this study we investigated whether any age or race/ ethnicity groups experienced increased hospitalizations and emergency department (ED) visits overall or for selected illnesses during the 2006 California heat wave. Methods: We aggregated county-level hospitalizations and ED visits for all causes and for 10 cause groups into six geographic regions of California. We calculated excess morbidity and rate ratios (RRs) during the heat wave (15 July to 1 August 2006) and compared these data with those of a reference period (8-14 July and 12-22 August 2006). Results: During the heat wave, 16,166 excess ED visits and 1,182 excess hospitalizations occurred statewide. ED visits for heat-related causes increased across the state [RR = 6.30; 95% confidence interval (CI), 5.67-7.01], especially in the Central Coast region, which includes San Francisco. Children (0-4 years of age) and the elderly (≥ 65 years of age) were at greatest risk. ED visits also showed significant increases for acute renal failure, cardiovascular diseases, diabetes, electrolyte imbalance, and nephritis. We observed significantly elevated RRs for hospitalizations for heat-related illnesses (RR = 10.15; 95% CI, 7.79-13.43), acute renal failure, electrolyte imbalance, and nephritis. Conclusions: The 2006 California heat wave had a substantial effect on morbidity, including regions with relatively modest temperatures. This suggests that population acclimatization and adaptive capacity influenced risk. By better understanding these impacts and population vulnerabilities, local communities can improve heat wave preparedness to cope with a globally warming future.

Original languageEnglish (US)
Pages (from-to)61-67
Number of pages7
JournalEnvironmental Health Perspectives
Issue number1
StatePublished - 2009


  • Climate change
  • Electrolyte imbalance
  • Emergency department
  • Global warming
  • Heat stroke
  • Heat wave
  • Hospitalization
  • Morbidity
  • Renal failure
  • Temperature

ASJC Scopus subject areas

  • Health, Toxicology and Mutagenesis
  • Public Health, Environmental and Occupational Health


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