Evidence map›Paper›PMID 35982292›Full record

ArticleCanadian journal of public health = Revue canadienne de sante publique2022

Impact of Ontario's Harmonized Heat Warning and Information System on emergency department visits for heat-related illness in Ontario, Canada: a population-based time series analysis.

Kristin K Clemens, Alexandra M Ouédraogo, Britney Le, James Voogt, Melissa MacDonald, Rebecca Stranberg, Justin W Yan, E Scott Krayenhoff, Jason Gilliland, Cheryl Forchuk and 2 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Canadian journal of public health = Revue canadienne de sante publique, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 2 pooled it
0.5field-weighted citation impact, top 37% of its field
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 2 syntheses or guidelines pooled it, 6 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Heat-Related Health Risks for People Experiencing Homelessness: A Rapid Review.Journal of urban health : bulletin of the New York Academy of Medicine · 2025
    Review
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 6 institutions in 1 country.

Kristin K ClemensDepartment of Medicine, Western University, London, Ontario, Canada. kristin.clemens@sjhc.london.on.ca.ORCID 0000-0001-9636-5597
Alexandra M OuédraogoICES, Toronto, Ontario, Canada.
Britney LeICES, Toronto, Ontario, Canada.
James VoogtDepartment of Geography and Environment, Western University, London, Ontario, Canada.
Melissa MacDonaldEnvironment and Climate Change Canada, Dartmouth, Nova Scotia, Canada.
Rebecca StranbergConsumer and Hazardous Products Safety Directorate, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, Ontario, Canada.
Justin W YanDivision of Emergency Medicine, Western University, London, Ontario, Canada.
E Scott KrayenhoffSchool of Environmental Sciences, University of Guelph, Guelph, Ontario, Canada.
Jason GillilandDepartment of Geography and Environment, Western University, London, Ontario, Canada.
Cheryl ForchukSchool of Health Studies, Western University, London, Ontario, Canada.
Rafique Van UumDepartment of Science, University of Toronto, Toronto, Ontario, Canada.
Salimah Z ShariffICES, Toronto, Ontario, Canada.
Western University · CAInstitute for Clinical Evaluative Sciences · CAEnvironment and Climate Change Canada · CAHealth Canada · CAUniversity of Guelph · CAUniversity of Toronto · CA

Funding

CIHR
6 · The paper itself

Abstract

interventionOntario's Harmonized Heat Warning and Information System (HWIS) brings harmonized, regional heat warnings and standard heat-health messaging to provincial public health units prior to periods of extreme heat. RESEARCH QUESTION: Was implementation of the harmonized HWIS in May 2016 associated with a reduction in emergency department (ED) visits for heat-related illness in urban locations across Ontario, Canada?

methodsWe conducted a population-based interrupted time series analysis from April 30 to September 30, 2012-2018, using administrative health and outdoor temperature data. We used autoregressive integrated moving average models to examine whether ED rates changed following implementation of the harmonized HWIS, adjusted for maximum daily temperature. We also examined whether effects differed in heat-vulnerable groups (≥65 years or <18 years, those with comorbidities, those with a recent history of homelessness), and by heat warning region.

resultsOver the study period, heat alerts became more frequent in urban areas (6 events triggered between 2013 and 2015 and 14 events between 2016 and 2018 in Toronto, for example). The mean rate of ED visits was 47.5 per 100,000 Ontarians (range 39.7-60.1) per 2-week study interval, with peaks from June to July each year. ED rates were particularly high in those with a recent history of homelessness (mean rate 337.0 per 100,000). Although rates appeared to decline following implementation of HWIS in some subpopulations, the change was not statistically significant at a population level (rate 0.04, 95% CI: -0.03 to 0.1, p=0.278).

conclusionIn urban areas across Ontario, ED encounters for heat-related illness may have declined in some subpopulations following HWIS, but the change was not statistically significant. Efforts to continually improve HWIS processes are important given our changing Canadian climate.

Indexed as

Heat Stress DisordersHot TemperatureEmergency Service, HospitalHumansInformation SystemsOntarioTime FactorsEnvironmentExtreme heatPopulation healthPublic healthTemperature

Identifiers

PMID35982292
PMCPMC9481795
OpenAlexW4293829919

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.