title: Heat effects among migrant and seasonal farmworkers: a case study in Colorado.
abstract: BACKGROUND
  Although migrant and seasonal farmworkers are highly vulnerable to ambient heat because of their working conditions, heat effects in this population have been rarely studied.
  
  
  OBJECTIVE
  We estimated effects of heat on mean daily counts of clinic visits among migrant and seasonal farmworkers by taking advantage of a unique longitudinal medical records database in the USA.
  
  
  METHODS
  We compiled a daily weather and clinic visit data set based on data from a health centre in Colorado for the summer of 2013. A total of 14 481 patients were included in our analysis, including 150 migrant farmworkers and 231 seasonal farmworkers with an average of 3 and 4 visits per day. We used Poisson regression to estimate the associations between heat and daily all-cause or cardiovascular-specific clinic visits among migrant or seasonal farmworkers or other stratified patients. We defined heat effects as the percentage difference in average daily counts of clinic visits, comparing 90-50th centiles of daily mean apparent temperature, a composite index accounting for both temperature and humidity. We conducted a sensitivity analysis to evaluate the impact of adjustment for ozone levels and different heat definitions.
  
  
  RESULTS
  Estimates of heat effects on average daily clinic visits among migrant farmworkers were positive (88.0%, 95% CI: 26.2% to 180.0%). We did not observe statistically significant associations between heat and clinic visits among other stratified groups.
  
  
  CONCLUSIONS
  Our study appears to be the first to link heat effects with clinic data among migrant and seasonal farmworkers. This research suggests possible significant impact of heat on migrant farmworkers and provides justifications for further studies.
authors.affiliation: Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Texas, USA Southwest Center for Occupational and Environmental Health, University of Texas School of Public Health.
authors.forename: Kai
authors.initials: K
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Texas, USA.
authors.forename: Rony F
authors.initials: RF
authors.lastname: Arauz
authors.affiliation: Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Texas, USA.
authors.forename: Tsun-Hsuan
authors.initials: TH
authors.lastname: Chen
authors.affiliation: University of Texas School of Public Health, San Antonio Regional Campus, San Antonio, Texas, USA.
authors.forename: Sharon P
authors.initials: SP
authors.lastname: Cooper
mesh_terms: D000383:Agriculture; D000554:Ambulatory Care Facilities; D002318:Cardiovascular Diseases / Q000209:etiology / Q000628:therapy; D003120:Colorado; D000067565:Farmers; D005260:Female; D006358:Hot Temperature; D006801:Humans; D008297:Male; D016273:Occupational Exposure / Q000009:adverse effects*; D010342:Patient Acceptance of Health Care; D014171:Transients and Migrants; D014887:Weather
keywords: Heat; Migrant farmworker; Poisson regression; Seasonal farmworker; Temperature