SynthesisEnvironment international2018
Effectiveness of National Weather Service heat alerts in preventing mortality in 20 US cities.
Synthesis in Environment international, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
36 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- A Systematic Review of Heat Health Warning Systems: Enhancing the Framework Towards Effective Health Outcomes.Current environmental health reports · 2025Pooled it
- Assessing the causal effects of a stochastic intervention in time series data: are heat alerts effective in preventing deaths and hospitalizations?Biostatistics (Oxford, England) · 2023Pooled it
- A healthy cities agenda for extreme heat adaptation in urban settings.Bulletin of the World Health Organization · 2026Article
- Excess risk of heat-related hospitalization associated with temperature and PMEnvironmental epidemiology (Philadelphia, Pa.) · 2026Article
- Global Warming and the Elderly: A Socio-Ecological Framework.International journal of environmental research and public health · 2026Review
- Regular Medicaid Home Visits and Emergency Department Use Among Older Adults During Extreme Heat.JAMA network open · 2026Article
- Climate resilience adaptation and psychiatric emergency services utilization during extreme heat in Boston, MA: a difference-in-differences analysis.Environment international · 2026Article
- Temporal changes in the high-temperature-mortality association in the Netherlands and the potential impact of the implementation of the national heat plan.Environmental epidemiology (Philadelphia, Pa.) · 2025Article
- Heat Wave Beliefs and Behaviors in Southern Spain.International journal of environmental research and public health · 2025Article
- Extreme heat and pediatric health in a warming world: a space-time stratified case-crossover investigation in Ontario, Canada.Environmental health : a global access science source · 2025Article
- Heat-health messaging in Canada: A review and content analysis of public health authority webpages and resources.Public health in practice (Oxford, England) · 2025Article
- Reconceiving Domestic Burning Controls: Air Quality Alerts, Behavioural Responsive Regulation, and Designing for Compliance.Environmental management · 2025Article
- Evaluating the socioeconomic benefits of heat-health warning systems.European journal of public health · 2025Article
- Evaluation of community-based heat adaptation interventions: a systematic review.BMJ public health · 2025Article
- Comprehensive evaluation framework for intervention on health effects of ambient temperature.Eco-Environment & Health · 2024Review
- Beliefs and behaviors associated with the first named heat wave in Seville Spain 2022.Scientific reports · 2024Article
- A century of exercise physiology: concepts that ignited the study of human thermoregulation. Part 3: Heat and cold tolerance during exercise.European journal of applied physiology · 2024Review
- Climate change is a health crisis with opportunities for health care action: A focus on health care providers, patients with asthma and allergic immune diseases, and their families and neighbors.The Journal of allergy and clinical immunology · 2023Review
- Human Health and Well-being in a Warming World.The Milbank quarterly · 2023Article
- Explorative Assessment of the Temperature-Mortality Association to Support Health-Based Heat-Warning Thresholds: A National Case-Crossover Study in Switzerland.International journal of environmental research and public health · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors.
Funding
Abstract
backgroundExtreme heat is a well-documented public health threat. The US National Weather Service (NWS) issues heat advisories and warnings (collectively, "heat alerts") in advance of forecast extreme heat events. The effectiveness of these alerts in preventing deaths remains largely unknown.
objectivesTo quantify the change in mortality rates associated with heat alerts in 20 US cities between 2001 and 2006.
methodsBecause NWS heat alerts are issued based on forecast weather and these forecasts are imperfect, in any given location there exists a set of days of similar observed heat index in which heat alerts have been issued for some days but not others. We used a case-crossover design and conditional logistic regression to compare mortality rates on days with versus without heat alerts among such eligible days, adjusting for maximum daily heat index and temporal factors. We combined city-specific estimates into a summary measure using standard random-effects meta-analytic techniques.
resultsOverall, NWS heat alerts were not associated with lower mortality rates (percent change in rate: -0.5% [95% CI: -2.8, 1.9]). In Philadelphia, heat alerts were associated with a 4.4% (95% CI: -8.3, -0.3) lower mortality rate or an estimated 45.1 (95% empirical CI: 3.1, 84.1) deaths averted per year if this association is assumed to be causal. No statistically significant beneficial association was observed in other individual cities.
conclusionsOur results suggest that between 2001 and 2006, NWS heat alerts were not associated with lower mortality in most cities studied, potentially missing a valuable opportunity to avert a substantial number of heat-related deaths. These results highlight the need to better link alerts to effective communication and intervention strategies to reduce heat-related mortality.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.