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May 7, 2026Health Affairs0 citationsOpen Access

Cold-Related Illness In An Era Of Extreme Climate Events: US Trends, 1998–2022

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DPDhara PatelCambridge Health AllianceSWSteffie WoolhandlerCambridge Health AllianceLALenore S. AzaroffCommunity Health Center

Key Points

  • To assess trends in cold-related illness hospitalizations and associated factors in the US from 1998 to 2022.
  • Analyzed data from the National Inpatient Sample over 25 years
  • Identified trends in cold-related illness hospitalizations
  • Examined association with alcohol and substance use, mental health, and housing insecurity.
  • Identified 345,314 cold-related illness hospitalizations
  • Age- and sex-adjusted rates tripled from 42.0 to 122.5 per 100,000
  • CRI inpatients had higher mortality rates and were more likely to live in high-poverty areas.

Abstract

Cold-related illnesses (CRIs) are preventable yet often deadly. Using twenty-five years of data from the National Inpatient Sample (1998-2022), we assessed nationwide trends in CRI hospitalizations and concomitant alcohol use, substance use, and mental health disorders and housing insecurity. We identified 345,314 (weighted) CRI hospitalizations and found that age- and sex-adjusted rates tripled from 42.0 to 122.5 per 100,000 hospitalizations. CRI inpatients were more likely than others to die during hospitalization, live in high-poverty ZIP codes, be publicly insured or uninsured, and have behavioral health conditions and housing instability. These findings highlight the rising and unequal toll of CRIs in the context of social instability and increasingly severe cold events associated with climate change. Expanded access to behavioral health treatments, increased subsidies for home heating, investments in affordable and supportive housing and shelter capacity, and public health measures to increase resilience to extreme weather events could reduce CRI morbidity and mortality.

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Cite This Study

Patel et al. (2026) studied this question.

synapsesocial.com/papers/69fbe2b3164b5133a91a20e8https://doi.org/10.1377/hlthaff.2025.01557
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