Increasing extreme heat events have more of a risk for at-risk populations as the number of hospital beds in Tennessee decline. (Photo: Getty Images)
Shrinking hospital capacity in Tennessee can leave at-risk communities more vulnerable than initially thought to an increasing number of extreme heat events, according to a new study published in the Journal of the American Medical Association.
The tools government officials use to gauge a region’s vulnerability to heat-related illnesses don’t always take access to healthcare into account, instead focusing on heat indices and other vulnerability metrics like age, according to the study.
The study found that including healthcare system capacity — the number of staffed beds per capita — in vulnerability calculations revealed a “major increase” in magnitude and a change in which parts of the U.S. are most vulnerable to extreme heat events. Tennessee was no exception.
Researchers combined data and models for summertime extreme heat days, population aged 65 or older and counties’ number of hospital beds per capita to create a new measure of vulnerability.
Roughly half of Tennessee’s 95 counties have a higher extreme heat vulnerability index for people aged 65 or older when hospital capacity is considered in calculations, according to the study. Twenty counties saw their vulnerability indices for extreme heat projected in 2035 more than double, with Bradley, Decatur, Cocke, Lake and Grainger counties seeing the highest increases.
Vulnerability indices improved slightly in 48 Tennessee counties when hospital capacity was included in calculations, with Meigs County seeing the greatest improvement from a score of 0.19 out of 1 to 0.13.
Hussam Mahmoud, the study’s main researcher and a professor at Colorado State University’s Department of Civil and Environmental Engineering, said it was “low-hanging fruit” to question modeling approaches that “dismiss the importance of having healthcare to begin with.”
While the report explores hospital capacity’s impact on extreme heat vulnerability across the United States, Mahmoud provided Tennessee Lookout with county-level data for Tennessee.
It’s an “obvious argument,” Mahmoud said: areas where healthcare is more readily accessible are more likely to be able to handle the expected increase in the number of people seeking care for heat-related illnesses. Places where staffed beds are more scarce are more vulnerable to the impact of heat waves.
Before taking hospital capacity into consideration, heat vulnerability models looked like one might expect, Mahmoud said, with the most vulnerable areas concentrated on the west coast, in Florida and in mountain regions.
“Once we put in the (hospital beds per capita data), then you ended up with many (more vulnerable) counties across the country,” he said.
Data from the National Centers for Environmental Information show that on average, the past 10 years in Tennessee have been 2.4 degrees Fahrenheit hotter than temperatures 40 years ago. Tennessee’s hospital capacity has also taken a hit in recent years, with 15 rural hospital closures since 2010, the second-most of any state in that period.
Those trends are on track with the rest of the country — the average number of extreme heat days and heat-related emergency department visits in the U.S. has increased in recent years as the country has continued to see a decline in hospital capacity, according to the study.
The study has its limitations — it only looks at the population of people aged 65 and older to gauge individual heat vulnerability, not taking other risk factors or at-risk groups into consideration. Mahmoud said this study served as a sort of proof of concept: “once you put the number of beds per capita on top of the heat and social metrics, whether it’s age 65 (plus) or more metrics than that, then the math completely changes.”
The study also “overlooks key dimensions of true health system capacity like public health, primary care and emergency services,” it states. The model also assumes the number of hospital beds per 100,000 people will remain constant through 2035, “which may be optimistic given current trends.”
Mahmoud said he hopes this study encourages elected officials and policy makers to consider healthcare accessibility and hospital capacity as one of the main factors of heat vulnerability and ask how their constituencies can be better prepared.
“Maybe that will push them toward the direction looking more into how many beds we have per capita there, and how we can change that,” he said.
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