Jordana Jampel

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In a cohort study of more than 3 million hospitalizations of patients with Alzheimer disease and related dementias (ADRD), researchers investigated the link between extreme heat and risk for hospitalization. The researchers specifically addressed where, when, and for whom extreme heat increases the risk for hospitalization in this ADRD cohort; results were published in JAMA Internal Medicine. 
The main outcome was an individual’s first hospitalization with an ADRD diagnosis code; other measures were county-level climates (arid, continental, temperate, or tropical). 
The researchers used a time-stratified case-crossover design implemented with distributed lag nonlinear models using conditional logistic regression to analyze Medicare fee-for-service (Part A) claims from 2000 to 2018 among beneficiaries aged 65 years or older in the contiguous United States. They also converted daily maximum heat indices to percentiles of climate-specific warm season heat index distributions. 
The dataset included 3,329,977 individuals (63.9% female, 85% White, and 26.8% with dual eligibility for Medicaid). The odds ratio (OR) of hospitalization with ADRD when comparing days in the 99th versus the 50th percentile of the heat index distribution was 1.02 (95% CI, 1.01-1.02), which corresponds to 0.8 (95% CI, 0.5-1.1) additional hospitalizations with ADRD per 1,000 individuals. The cumulative OR of hospitalization with ADRD after four days of continuous exposure to heat indices at the 99th versus the 50th percentiles was 1.04 (95% CI, 1.03-1.04), or 1.7 (95% CI, 1.3-2.0) additional hospitalizations with ADRD per 1,000 individuals. 
Effects estimates in temperate and continental climates were similar. Arid and tropical climate estimates were somewhat similar but more uncertain. OR point estimates for hospitalization from four days of continuous extreme heat exposure for individuals who identified as Asian (OR, 1.09; 95% CI, 1.02-1.17), Black (OR, 10.7; 95% CI, 1.05-1.10), and Hispanic (OR, 1.08; 95% CI, 1.03-1.13) were 2.6 to 3.2 times greater than for White individuals (OR, 1.03; 95% CI, 1.02-1.04). 
“This study found that extreme heat may pose a growing threat to older adults living with ADRD. This threat may be larger among Asian, Black, and Hispanic racial and ethnic groups. Clinicians should consider counseling patients living with ADRD on extreme heat risks, and policymakers should devise risk mitigation programs,” the researchers concluded.

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Researchers investigated the link between extreme heat and risk for hospitalization in patients with Alzheimer disease.

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