Who’s most at risk during extreme heat?

Tegwyn Hughes, Reporter, Local News Initiative

Nearly two years after 619 people died from extreme heat during the 2021 BC heat dome, a new study suggests that people with schizophrenia and other mental illnesses are most at risk.

The British Columbia Center for Disease Control compared deaths recorded from June 25 to July 2, 2021, with the same eight-day period from 2012 to 2020, to see how mortality rates for people with chronic conditions differed.

The highest mortality rate is among patients with schizophrenia. During the 2021 hot dome, the risk of death among people with schizophrenia was three times higher than the average death rate for this population in previous years.

Sarah Henderson, scientific director of environmental health services at the center, co-authored the study.

“Schizophrenia was really higher” than other comorbidities her team studied, she said.

“Public health information about extreme heat [has] Specific callouts for individuals with cardiovascular disease, respiratory disease, or diabetes.We expect all of these to be risk factors, but you don’t necessarily [see] Appeal to people with schizophrenia or severe mental illness,” she added.

Henderson’s team noted that there are a number of aggravating factors that people with schizophrenia may face during a hot dome.

These factors include social isolation and economic marginalization, and an inability to perceive the threat of heat. Of the 309 schizophrenic patients who died in the heat dome, 47% also reported using illicit substances, which may have increased their vulnerability to extreme heat.

Antipsychotics used to treat schizophrenia can negatively affect the body’s ability to regulate heat, though Henderson cautions that people taking antipsychotics should not stop taking them during periods of extreme heat.

Instead, she said, the public health focus should be on “reaching out to people if we know a heat event is coming and helping them find ways to stay cool during that event.”

In addition to uncovering startling data on schizophrenia, Henderson’s team learned how other chronic diseases affect mortality in extreme heat.

People with depression were slightly more likely to die during extreme heat events.

People with substance use disorders, asthma, chronic kidney disease and diabetes also had higher mortality rates. Having three or more chronic diseases was also associated with increased odds of dying during extreme heat events.

Surprisingly, people with angina, dementia, and other medical conditions, such as heart disease, had lower mortality rates during the hot dome. The researchers speculate that this may be because these individuals were known to be at risk for heat events and received enhanced care, such as more health checks and use of air conditioning.

The researchers also found that overall daily death rates increased by 95 percent during extreme heat emergencies.

Overlapping mental health and poverty play role in mortality

Rowan Burdge, provincial director of the British Columbia Coalition to Reduce Poverty, said the groups her organization serves are not only severely impacted by the heat dome, but also unable to defend themselves at the provincial level.

The coalition primarily serves low-income populations as well as intersectional populations such as Black, Indigenous and other racialized populations, seniors, people with disabilities, and drug users.

Birch, who represents B.C.’s Poverty Reduction Coalition on the province’s extreme heat death review panel, said risk factors such as mental health, disability, drug use and poverty often go hand in hand.

“I’ve worked with a lot of people who are living in poverty, living in poor physical conditions…they have bugs and mold in their apartments, or don’t have access to enough food…these things have a serious impact on people’s mental health,” they said.

The Extreme Heat Deaths Review Group report released last year found that 39 percent of heat dome deaths occurred in multi-unit buildings, while social or supportive housing and senior or long-term care homes accounted for 10 percent and 7 percent, respectively.

The report also makes recommendations regarding cooling, including encouraging building retrofits to encourage active and passive cooling, and requiring new developments to meet specific cooling standards. However, Burdge said the changes are unlikely to benefit those living in existing multi-unit low-income housing anytime soon.

“There were thousands of people living in BC Housing buildings before any new adjustments to the building code — we needed to transform these spaces,” Burdge said.

In addition to working with vulnerable populations most affected by heated domes, Burdge has seen first-hand the impact of extreme heat on chronic disease, as she has type 1 diabetes and lives in a non-air-conditioned multi-unit apartment building.

People with diabetes can have more difficulty regulating their body temperature and staying hydrated. In addition to the physiological effects of hot weather, extreme heat can damage diabetes medications and equipment.

“Because my blood sugar was so high, I had headaches, dizziness, confusion — I didn’t actually have enough cognitive capacity to realize how bad the impact was,” Burdge said.

The BCCDC study found that during extreme heat events, the death rate of diabetic patients who died from heat-related causes was 1.10 times that of the same period in previous years.

“It wasn’t until the heat passed that I started to regain my cognition and realize how severe the impact was,” Birch said.

The BCCDC is still working to fully understand how extreme heat events in 2021 will affect British Columbia’s most vulnerable residents — not just those who died.

“We’re still only looking at mortality during the event,” Henderson said. “We haven’t looked at all the people who went to the emergency room and all the people who called 911. My team hasn’t even touched on the broader health implications of that event.”

Both projects are also taking a closer look at those with schizophrenia who died during the heat dome, and the broader risk factors for schizophrenia during rising temperatures.

Future Security in Hot Topics

Environmental experts are tentatively predicting another hot summer for British Columbia, especially as climate change increases overall temperatures.

The Death from Extreme Heat Review Group report includes several recommendations for short- and long-term extreme heat mitigation strategies. The first proposal is to introduce a coordinated provincial heat alert response system, which the province has begun implementing through its BC Heat Alert and Response System.

Other recommendations include identifying and supporting vulnerable groups at risk of death during an extreme heat emergency, and expect the Department of Health to review the possibility of distributing cooling equipment such as fans and air conditioners to at-risk residents during extreme heat events.

The results of that review were supposed to be announced on Dec. 1. But the health department still hasn’t released its findings, telling CBC News earlier this month that it needs more time to ensure the report is finalized “before full analysis and appropriate engagement.” “

The delay is disappointing as the province enters its second summer since the heat dome, Burdge said.

“For those who are low-income or experience poverty, there are indeed insufficient measures to change these outcomes,” they said.

“If we had another heat dome this summer, I don’t think we’re going to see a huge reduction in the kind of death and suffering we’re seeing starting in 2021.”

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