Impact of Extreme Heat on Emergency Department Admissions for Childhood and Adult Asthma: An Evaluation of Earth Observations and Heat Wave Definitions

Extreme heat has been associated with adverse health outcomes, yet its impact on asthma exacerbations remains understudied. This is, in part, due to data limitations: research that relies on weather station records and aggregated health statistics cannot resolve fine-scale differences in heat impacts. This study investigates the association between heat wave definitions and summertime asthma-related emergency department visits in Baltimore, Maryland from 2016 to 2022, including 819 adult and 695 pediatric exacerbations. Using geocoded electronic health records and air temperature measurements at several spatial resolutions, we applied a case-crossover design with conditional logistic regressions at the census block group and tract levels. We found strong associations between asthma exacerbations and nighttime heat wave definitions based on relative thresholds of minimum temperatures when census block group or tract level temperature estimates were used. These relationships were significant for both age groups and showed elevated risks in socially vulnerable areas. In contrast, heat wave definitions derived from the city's primary National Weather Service synoptic weather station show associations between asthma and daytime heat extremes, suggesting that the character of the heat hazard depends on the scale at which it is defined. The extreme heat event definition used by Baltimore City's Code Red system showed no significant association with exacerbations. These findings highlight the importance of data resolution in shaping health inferences related to extreme heat in urban environments. Further, this study demonstrates that, regardless of spatial scale, extreme heat is associated with asthma exacerbations in both age groups.