title: Identifying heat-related deaths by using medical examiner and vital statistics data: Surveillance analysis and descriptive epidemiology - Oklahoma, 1990-2011.
abstract: Approximately 660 deaths occur annually in the United States associated with excess natural heat. A record heat wave in Oklahoma during 2011 generated increased interest concerning heat-related mortality among public health preparedness partners. We aimed to improve surveillance for heat-related mortality and better characterize heat-related deaths in Oklahoma during 1990-2011, and to enhance public health messaging during future heat emergencies.
  
  
  
  Heat-related deaths were identified by querying vital statistics (VS) and medical examiner (ME) data during 1990-2011. Case inclusion criteria were developed by using heat-related International Classification of Diseases codes, cause-of-death nomenclature, and ME investigation narrative. We calculated sensitivity and predictive value positive (PVP) for heat-related mortality surveillance by using VS and ME data and performed a descriptive analysis.
  
  
  
  During the study period, 364 confirmed and probable heat-related deaths were identified when utilizing both data sets. ME reports had 87% sensitivity and 74% PVP; VS reports had 80% sensitivity and 52% PVP. Compared to Oklahoma's general population, decedents were disproportionately male (67% vs. 49%), aged ≥65 years (46% vs. 14%), and unmarried (78% vs. 47%). Higher rates of heat-related mortality were observed among Blacks. Of 95 decedents with available information, 91 (96%) did not use air conditioning.
  
  
  
  Linking ME and VS data sources together and using narrative description for case classification allows for improved case ascertainment and surveillance data quality. Males, Blacks, persons aged ≥65 years, unmarried persons, and those without air conditioning carry a disproportionate burden of the heat-related deaths in Oklahoma.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; Acute Disease Service, Oklahoma State Department of Health, Oklahoma City, OK, USA. Electronic address: mgjohnson33@gmail.com.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Johnson
authors.affiliation: Injury Prevention Service, Oklahoma State Department of Health, Oklahoma City, OK, USA.
authors.forename: Sheryll
authors.initials: S
authors.lastname: Brown
authors.affiliation: Injury Prevention Service, Oklahoma State Department of Health, Oklahoma City, OK, USA.
authors.forename: Pam
authors.initials: P
authors.lastname: Archer
authors.affiliation: College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Wendelboe
authors.affiliation: College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Magzamen
authors.affiliation: Office of the State Epidemiologist, Oklahoma State Department of Health, Oklahoma City, OK, USA.
authors.forename: Kristy K
authors.initials: KK
authors.lastname: Bradley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009825:Oklahoma / Q000453:epidemiology; D011159:Population Surveillance; D055815:Young Adult
keywords: Heat; Medical examiner; Mortality; Oklahoma; Vital statistics