title: Characterizing the Impact of Extreme Heat on Mortality, Karachi, Pakistan, June 2015.
abstract: Introduction Karachi, Pakistan was affected by a heat wave in June 2015 during the Muslim holy month of Ramadan. Many media reports attributed the excess deaths in part to the practice of daylight fasting during Ramadan. As much of the published research reports on heat-related mortality in Europe and the United States, an exploration of the effects of extreme heat on residents of a South Asian mega-city address a gap in current disaster research. Hypothesis/Problem This report investigated potential risk factors for excess mortality associated with the June 2015 heat wave in Karachi, Pakistan.
  
  
  METHODS
  Data were obtained through manual review of death certificates at public hospitals and private clinics in Karachi, Pakistan, conducted from July 1 through July 31, 2015 by a trained physician. Demographic data for any deaths with a primary cause of death of heat-related illness were recorded in Microsoft Excel (Microsoft Corp.; Redmond, Washington USA). EpiSheet (2012; Rothman. Modern Epidemiology. Lippincott Williams & Wilkins; Philadelphia, Pennsylvania USA) was used to calculate risk differences (RD), rate ratios (RR), and 95% confidence intervals (95% CI).
  
  
  RESULTS
  Overall, residents of Karachi were approximately 17 times as likely to die of a heat-related cause of death during June 2015 (RR=17.68; 95% CI, 13.87-22.53) when compared with the reference period of June 2014. Residents with a monthly income lower than 20,000 Pakistani Rupees (US $196; RD=0.03; 95% CI, 0.01-0.05) and those with less than a fifth grade education (RD=0.03; 95% CI, 0.00-0.05) were at significantly higher risk of death during the 2015 heat wave compared to the reference period.
  
  
  CONCLUSIONS
  Fasting during Ramadan was not a significant risk factor for mortality from heat-related causes during the Karachi heat wave of June 2015. A large number of excess deaths were reported across all demographic groups, which due to the burden of record keeping in an under-resourced health system during a public health emergency, are almost certainly an underestimate. Ghumman U , Horney J . Characterizing the impact of extreme heat on mortality, Karachi, Pakistan, June 2015. Prehosp Disaster Med. 2016;31(3):263-266.
authors.affiliation: Department of Epidemiology and Biostatistics,Texas A&M School of Public Health,College Station,TexasUSA.
authors.forename: Usman
authors.initials: U
authors.lastname: Ghumman
authors.affiliation: Department of Epidemiology and Biostatistics,Texas A&M School of Public Health,College Station,TexasUSA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Horney
mesh_terms: D003644:Death Certificates; D004190:Disasters; D055874:Extreme Heat / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010154:Pakistan / Q000453:epidemiology; D012307:Risk Factors
keywords: RD risk difference; RR rate ratio; disasters; global health; hot temperature; mortality