Extreme heat and mortality rates in Las

Vegas, Nevada: inter-annual variations

and thresholds

E. R. Bandala, K. Kebede, N. Jonsson,

R. Murray, D. Green, J. F. Mejia &
P. F. Martinez-Austria

International Journal of
Environmental Science and
Technology

ISSN 1735-1472

Int. J. Environ. Sci. Technol.

DOI 10.1007/s13762-019-02357-9

1 23
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 Author's personal copy
International Journal of Environmental Science and Technology
https://doi.org/10.1007/s13762-019-02357-9

ORIGINAL PAPER

Extreme heat and mortality rates in Las Vegas, Nevada: inter‑annual

variations and thresholds
E. R. Bandala1   · K. Kebede2 · N. Jonsson2 · R. Murray2 · D. Green2 · J. F. Mejia1 · P. F. Martinez‑Austria3

Received: 12 June 2018 / Revised: 4 February 2019 / Accepted: 26 March 2019

© Islamic Azad University (IAU) 2019

Abstract
Hourly temperature and dew point from Las Vegas were collected and used to estimate the heat index and excess heat
factor. The indices were used with data of heat-related deaths to assess the effect of extreme heat on the population. The
trends of the heat indices were analyzed for 2007–2016, and the correlation between heat wave episodes and the number of
heat-related deaths was estimated. Both indices showed a clear increase over the last ten years in the severity and number
of heat wave events per year. The number of heat wave episodes increased, while their duration decreased. The number of
heat-related deaths was also found to increase, with 2016 having the highest number of heat-related deaths. For the period,
437 heat-related deaths were registered in Las Vegas. The most vulnerable subpopulation was people over 50 years old, for
which 76% of the heat-related deaths were associated with preexisting heart disease.

Keywords  Heat waves · Heat index · Excess heat factor · Heat-related deaths · Las Vegas

Introduction population in urban locations—where heat island effect

Over the last few decades, the relationship between extreme
heat and increased mortality rates has been consistently
reported (Kingsley et  al. 2016; Basu and Samet, 2002;
Petkova et al. 2014). Extreme heat poses a significant pub-
lic health risk because it may produce heat-related deaths
resulting from exacerbated preexisting health conditions,
or because of the use of drug treatment that affect the heat
regulatory system of the organism (Berko et al. 2014). It has
been proposed that the combined effects of high tempera-
ture, and the aging U.S. population along with the increasing
Editorial Responsibiility: Zhenyao Shen.
Electronic supplementary material  The online version of this
article (https​://doi.org/10.1007/s1376​2-019-02357​-9) contains
supplementary material, which is available to authorized users.
* E. R. Bandala
erick.bandala@dri.edu
1
Desert Research Institute, 755 E. Flamingo Road, Las Vegas,
NV 89119‑7363, USA
2
Nevada State College, 130 Nevada State Dr., Henderson,
NV 89002, USA
3
Universidad de Las Americas Puebla, Sta. Catarina Martir,
Cholula, Puebla, Mexico
exacerbates high temperature—will generate an increased
number of heat-related deaths (Luber and McGeehin 2008).
Because the frequency of extreme heat events is expected
to increase in the near future (Schubert et al. 2014; Fischer
and Schar 2009), understanding their relationship, identi-
fying the major trends, and vulnerable subpopulations will
be critical in helping to prevent or minimize heat-related
deaths (Gubernot et al. 2015; Guirguis et al. 2014; Meehl
and Tebaldi 2004).
Some regions are expected to experience more intense,
frequent, and long-lasting extreme heat events by the sec-
ond half of the twenty-first century, as well as the corre-
sponding health-related consequences (Martinez-Austria
et al. 2016). Specifically, southwestern USA is a region
where a significant increase in the frequency of extreme
heat events is expected (Jones et al. 2015). Clark County
is located in the southern part of Nevada and includes the
Las Vegas Metropolitan Area (LVMA), a city where the
hottest daytime temperatures are reported to frequently
exceed 40 °C during the summer (June–August) with an
exacerbated urban heat island (UHI) effect because of the
type of land cover (Myint et al. 2015; Batson and Monnat
2015). The LVMA has led population growth rate in the
USA since the 1990s with a growth rate of 66.3%, and
estimates suggest that the LVMA population will double

13
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again by 2040 (Jones et al. 2015). In addition to the overall
population growth, the proportion of residents aged 55 and
older has also continuously increased over the past decade
(Pharr et al. 2015).
The two meters surface temperature in Clark County was
analyzed previously to analyze the influence of urbanization
on the LVMA climate using a numerical model and found
that urbanization in the area creates a UHI effect at night
but minor cooling during the day (Kamal et al. 2015). Nev-
ertheless, extreme heat weather episodes are still among the
most frequently observed weather-related health hazard for
households in the LVMA (Sokolowsky et al. 2017). A con-
tinuous analysis of extreme heat trends and their relationship
to health hazards is necessary and remains a high priority
because current climate change models project an increase
in the likelihood of extreme temperature episodes in the area
(Tong et al. 2016; Thakali et al. 2016).
The goals of this study are to assess the trends for extreme
heat—measured as the heat index (HI) and excess heat factor
(EHF)—and correlate them to heat-related mortality records
from 2007 to 2016 in Clark County, as well as to identify
the most vulnerable subpopulation groups and the specific
trends related to preexisting health conditions that may affect
extreme heat-related mortality rates in the area.
Materials and methods
Surface temperature observations
Hourly two meters surface maximum temperature and
dew point temperature data for June, July, and August
(2007–2016) were obtained from the National Centers for
Environmental Information of the National Oceanic and
Atmospheric Administration (NOAA) for the Las Vegas
McCarran International Airport station (KLAS; WBAN:
23169; ISSN#: 0198-3318) (Lat: 36°4′N; Long:115°9′W,
Elev: 664.5 m) (NOAA 2017). Data from this station have
been widely used in the past for extreme temperature
analysis (Martinez-Austria and Bandala 2017; Black and
Stephen 2014), and they are considered reliable and rep-
resentative of the city (Allen and Sheridan 2016, 2018).
The time between June and August was selected for this
study as historically reported the months with the highest
temperature along the year (Reich et al. 2014). Because
the dataset was obtained from a reliable source, the only
quality assurance/quality control (QA/QC) analysis carried
out for the information was for the statistical estimation
of outliers. For outliers treatment, the Oklahoma Mesonet
approach was followed, in which suspicious values (less
than 5%) were not deleted but flagged and stored alongside
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International Journal of Environmental Science and Technology
the rest of the data to ultimately decide their suitability
(Warren et al. 2016).
Calculation of heat index and excessive heat factor
Hourly maximum surface temperature and dew point tem-
perature were used to estimate the HI using the NOAA
National Weather Service methodology (NOAA 2016),
which is used internationally to estimate heat wave epi-
sodes and thermal comfort thresholds (Opitz-Stapleton
et  al. 2016; Wehner et  al. 2015). This methodology is
one of the most popular indices for environmental health
research and is provided to heat advisories in many U.S.
communities (Anderson et al. 2013; Jones et al. 2016).
Also known as the Steadman’s apparent temperature index,
the HI method takes into account the reaction of the human
body to surface temperature and relative humidity by con-
sidering its thermal comfort response and expresses the
physiological reaction as an apparent temperature. The
U.S. National Weather Service (USNWS) adopted the HI
method by developing its own HI estimation algorithm,
which is available online (Lee et al. 2016; Ramirez-Beltran
et al. 2017). HI was calculated using the online available
algorithm by the USNWS.
The EHF is a relatively new heat wave intensity metric
that measures heat wave intensity and extreme heat stress,
which makes it an ideal metric for assessing the effects of
future climate change on public health (NOAA 2017). It
measures three-day periods of heat in relation to an annual
temperature threshold for a particular location and how hot
the three-day period is with respect to the previous 30 years
to account for the population’s degree of acclimatization.
The EHF can be estimated by combining two factors, also
called excess heat indices, proposed by Nairn and Fawcett
(2015) and defined for day i as follows:
( )
Ti + Ti+1 + Ti+2
EHIsig = − T95 (1)
3
( ) ( )
Ti + Ti+1 + Ti+2 Ti−1 + ⋯ + Ti−30
EHIaccl = −
3 30
(2)
where Ti, Ti+1, and Ti+2 are the daily maximum temperatures
(°C) during three consecutive days; T95 is the 95th percen-
tile of the daily mean temperature; and Ti−1 and Ti−30 are
the daily maximum temperatures during the 30-day period
preceding the three-day period (Nairn and Fawcett 2015).
The EHF, with units °C2, is calculated using Eq. (3) as the
product of the two excess heat indices:
(3)
( )
EHF = EHIsig × max 1, EHIaccl
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International Journal of Environmental Science and Technology
In the case of the EHF, the higher the value, the higher
the severity of the heat wave being registered.
Most extreme surface temperature indices are highly cor-
related in space and time (Anderson et al. 2013) because
they are partly driven by large-scale “blocking” atmospheric
systems. However, the EHF index is constructed using the
local climatological distribution, which allows for nor-
malization in space and makes it useful in diverse climatic
regimes.
The EHF values are of great interest because they incor-
porate both the maximum and the minimum daily tem-
perature, which represent the extent of heat that is actually
dissipated overnight after very hot days and provide infor-
mation on the accumulated thermal load that might affect the
health of the exposed population (Nairn and Fawcett 2015).
Therefore, the higher the EHF value, the greater the potential
effect on the exposed population’s health, with the worst
effects occurring as the severity of the heat wave increases
(Nairn and Fawcett 2015). The frequency of events with con-
ditions indicative of a heat wave episode is also a significant
value to keep in mind because it is directly related to the
exhaustion that extreme heat causes in organisms (Nairn and
Fawcett 2015).
Heat‑related deaths
The number and characteristics of deaths from heat
because of weather conditions were obtained from the
Clark County Coroner/Medical Examiner Office. The
dataset used was the total amount of information avail-
able which was registered during the 2007–2016 period.
In agreement with the Medical Examiners’ and Coroners’
Handbook on Death Registration and Fetal Death Report-
ing (2003), the causes of death in death reports must be
classified on the basis of the World Health Organization’s
tenth revision of International Classification of Diseases
(ICD-10) codes (WHO 2011). Therefore, this study only
considered heat-related deaths for which the ICD-10 code
was reported as X30 (i.e., exposure to excessive natural
heat) (Taylor et al. 2018). Deaths owing to ICD-10 code
W92 (i.e., exposure to excessive heat of human-made ori-
gin), neither general number of deaths, were not consid-
ered in order to avoid bias in the trends by including other
causes of death indirectly related to heat but also poten-
tially related to other health conditions (e.g., circulatory
and/or respiratory distress) (Riley et al. 2018). The data
provided include the case number, date of death, decedent
age, cause of death, and decedent residence state. Only
deaths occurring in June, July, or August during this time
period were considered for this study.
Analysis of heat index trends
The nonparametric estimation method based on the Spear-
man’s rho test was used to estimate trends in index values.
This test is robust and provides consistent results compared
with other approaches, and its application for extreme tem-
perature analysis is explained elsewhere (Martinez-Austria
and Bandala 2017).
Estimation of heat wave episodes
Two different methods were used to determine heat wave
episodes. The first method is based on the heat wave defini-
tion previously proposed by Martinez-Austria and Bandala
(2017), which defines each event to last for two or more
days with HI values equal to or higher than the 90th percen-
tile threshold. The second method implements the approach
proposed by Meehl and Tebaldi (2004): Threshold 1 (T1) is
defined as the 97.5th percentile of the distribution of maxi-
mum temperatures in the observations and in the simulated
present-day climate (seasonal climatology at the given loca-
tion), and threshold 2 (T2) is defined as the 81st percentile.
A heat wave is then defined as the longest period of con-
secutive days satisfying the following conditions: (1) The
daily maximum temperature must be above T1 for at least
3 days, and (2) the average daily maximum temperature must
be above T2 for every day of the entire period (Tong et al.
2016). A recent study (Nairn and Fawcett 2015) suggested
using the 85th percentile of positive EHF values from 1958
to 2011 ­(EHF85) to classify extreme heat wave events as
low intensity, severe, or extreme with implications for the
different EHF values depending on the risk being studied.
These authors established EHF severity as: no heat wave
occurring for negative EHF values; a low-intensity heat wave
for zero EHF, a severe heat wave for 0 ≤ EHF ≤ 3 × EHF85,
and an extreme heat wave if EHF ≥ 3 × EHF85 (Nairn and
Fawcett 2015). In this work, E­ HF85 was estimated using the
2007–2016 data.
Using the HI and EHF criteria, heat wave episodes were
also analyzed for two time periods: from 1980 to 2016,
which was used as the historical data, and from 2007 to
2016, which was compared with the mortality data.
Results and discussion
Heat index recent trend
Figure 1 shows the monthly average HI values for June,
July, and August during 2007–2016 in Las Vegas. Overall,
there is an observed slight increase in average HI intensity
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International Journal of Environmental Science and Technology

40 developed during the last decade—which had a higher com-

38 mitment to including green spaces—where the decrease in
36
temperature was found to be greater (Stephen et al. 2014).
Another land cover change that can potentially have a
Average Heat index, °C

34
significant effect on warming temperature trends may be
32 related to outdoor irrigation and the change in trees and
30 greenery coverage. A recent report (Hass et al. 2016) sug-
28 gested that trees and greenery may provide relief from some
26 of the urban heat, but they are also associated with higher
humidity. As a result, HI values for locations with more trees
24
may be significantly higher than areas with less greenery
22
(Hass et al. 2016). Over the past 20 years, water usage in the
20 LVMA has increased with the growth in population despite
2007 2009 2011 2013 2015 the successful implementation of water saving programs by
Year the Southern Nevada Water Authority (SNWA) (Brelsford
and Abbott 2017). Outdoor water used to maintain green-
Fig. 1  Heat index intensity trend during 2007–2016 ery and trees in Clark County is a major component of the
monthly water budget in the city. Because the Las Vegas area
during the study period. The entire dataset used to create is located in a region with low dew point values, there is a
Fig. 1 is included in Table S1 of the supplemental material. significantly high demand for irrigation water to account for
The light trend to increase shown in average HI values in the evapotranspiration process (Huntra and Keener 2017).
Fig. 1 was confirmed by the application of the Spearman’s This excess water use increases the surface dew point, which
rho test, and the results are shown in Table 1 where a trend
to increase was found for the HI values estimated in the
June–August period from 2007 to 2016. July was identified
as the month with the most significant increase, followed by 40
June and August, while the overall trend showed the lowest
35
significance. This trend could be associated with UHI in Las
Vegas Metropolitan area (LVMA). Myint et al. (2015) com- 30
pared the effects of UHI in Las Vegas, Nevada, and Phoenix,
EHF severity, °C2

25
Arizona, and found that impervious surfaces in Las Vegas
had a greater effect on surface temperatures than grass or 20
trees, which significantly affected daytime temperatures in
15
the area. They also found that most of the trees and green-
ery in the LVMA were located near hotels and commercial 10
buildings with close proximity to or surrounded by paved
5
surfaces, and therefore, they determined that vegetated land
had little or no effect on decreasing the effect of the impervi- 0
ous surfaces (Myint et al. 2015). 2007 2009 2011 2013 2015 2017
However, other reports (Stephen et al. 2014) found a Year
decreasing trend of daily maximum temperatures in Las
Vegas related to an increase in vegetation cover during Fig. 2  Excess heat factor severity index for Las Vegas from 2007 to
the 2000–2010 period. This trend of decreasing tempera- 2016. Horizontal colored lines represent EHF thresholds proposed in
Nairn and Fawcett (2015) and characterize the severity thresholds for
tures was found to be lower in older urban developments— low-intensity (0–11.5 °C2, green line), severe (11.5–34.0 °C2, orange
which had less space for green areas—than in urban areas line), and extreme heat waves (> 34.0 °C2, red line)

Table 1  Spearman’s rho test Month ZSR D t(n − 2, 1 − (𝛼∕2)) R p Trend

results for heat index trends in
Clark County for the 2007–2016 June 2.49 0.15 1.65 0.223 9 × 10−5 Increase
period
July 2.96 0.17 1.65 0.222 1 × 10−4 Increase
August 1.80 0.11 1.65 0.106 6.7 × 10−4 Increase
Overall 8.52 0.271 1.65 0.253 4.7 × 10−3 Increase

13
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then affects the HI and enhances thermal discomfort at lower
temperatures (Williams et al. 2015).
Excess heat factor recent trend
Figure 2 shows the EHF severity index (in °C2; Eqs. 1–3)
from 2007 to 2016 which was analyzed using the Kendall
rank correlation coefficient to determine the overall trend.
The trend showed that there was an increase in the frequency
of low-intensity (Kendall tau 0.22; p = 0.007) and severe
(Kendall tau 0.51; p = 0.0002) heat wave events over time,
with most EHF episodes below 10 °C2 during 2007–2009
and more intense events over the last 8 years of records. As
shown in Fig. 2, 77% of the total heat wave events identi-
fied during 2007–2016 fell within the low-intensity range
and the remaining 22% fell within the severe range. No
extreme events were identified during 2007–2016. However,
the trend of the EHF intensity data reveals an increase in
the number of severe heat wave events over time because
only one was observed between 2007 and 2009, whereas
six severe heat wave events were observed from 2010 and
after. Related to heat wave event frequency, Fig. 3 shows
the 2007–2016 trend in the number of events with a positive
EHF value for Las Vegas. As shown, the number of events
per year has changed from an annual average of 3.3 in the
2007–2009 period to 4.7 in the 2010–2016 period, which
is significantly higher than the values estimated previously
for other locations with similar climates such as Australia
where annual rates are rarely above 1.0 (Nairn and Fawcett
2015). The frequency of severe heat wave events shows also
an interesting trend because at least one severe events occurs
per year in almost all the cases (exceptions were observed
6 August (3 times) (data not shown). The shift in the mean
Low intensity
5 Severe
Heatwave events/year
4
3 Using global climate model projections for areas rep-
2 estimated a late twenty-first century increase in heat wave
1 to 2.17 for Paris. In their work, they suggested that an
0 increase in the effect of heat waves on the population.
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Year
Fig. 3  2007–2016 Las Vegas EHF low-intensity (black dots) and
severe (red squares) heat wave events. Excess heat factor heat wave
episodes in Las Vegas were calculated using the methodology pro-
posed by Meehl and Tebaldi (2004)
during 2008 and 2014 when no severe event was recorded)
suggesting that the severity of excess heat has risen over
the last 10 years and that the frequency of these events has
increased to show at least one severe event per year. Perkins
et al. (2012) have reported significant trends in the USA of
longer and more intense heat wave episodes, particularly for
years with a very strong El Niño. The climate of the south-
western USA is affected by large interannual to multidecadal
variability (Seager and Vecchi 2010; Raymond et al. 2017).
It could be the case that some of the reported trends in this
study are related to slow modes of variability, but assessing
this is out of the scope of this study.
Based on the EHF index, we also analyzed tempera-
ture data from 1980 to 2016 (See Figure S2) and found
that the number of heat wave events that occur per year
has increased from an annual average of 1.85 during the
1980–1989 period to 1.9 during the 1990–1999 period,
and 3.2 during the 2000–2009 period. The average annual
number of heat wave events during the 2010–2016 period
is currently 3 events per year. When only severe heat wave
events are considered, the situation is entirely different. No
severe heat wave events occurred from 1980 to 1989, only
two (0.2 events per year) severe heat wave events occurred
from 1990 to 1999, nine (average 0.9 per year) severe heat
wave events occurred from 2000 to 2009, and five (aver-
age 0.83 per year) severe heat wave events occurred from
2010 to 2016. These data show that the severity as well as
the frequency of excess heat has risen significantly over
the last 35 years.
Mean occurrence of heat waves increased from 2.5 per
year during the 1980–2006 period to 3.3 per year during
the 2007–2016 period. Heat wave episodes that occurred
during the 1980–2006 period were significantly more fre-
quent in June and July (14 times in both cases) than in
occurrence of heat waves per year in Las Vegas was 0.2
heat wave events per year. This increasing trend describes
the overall tendency for the phenomenon in the area fairly
well, and it agrees with the results obtained using the HI
values.
resenting Chicago and Paris, Meehl and Tebaldi (2004)
frequency from 1.09 to 2.14 for Chicago and from 1.18
increase in the frequency of heat waves also means an
More consecutive days without relief from warmer mini-
mum temperatures can exacerbate preexisting chronic con-
ditions, which increase the risk of heat-related illnesses
or deaths (Berko et al. 2014). Such occurrences have been
identified in other areas of the southwestern USA and the
Mediterranean region in Europe (Taylor et al. 2018).
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From the 1980–2016 dataset, the trend is not the same
for the mean heat wave duration. The mean heat wave dura-
tion per event was 21.5 days during the 1998–2006 period,
whereas it was 18.1 days during the 2007–2016 period.
Although the heat wave episodes are increasing in frequency,
they tend to become shorter over time. This trend seems to
be in opposition to tendencies identified by other authors
for the eastern USA and Europe, where heat wave duration
has been found to increase at both locations (Meehl and
Tebaldi 2004). These authors found that longer-lived heat
waves last a maximum of 12.7 and 17 days for Chicago and
Paris, respectively. Heat waves have been associated with
highly specific atmospheric circulation patterns related to
semistationary 500 hPa positive height anomalies producing
subsidence, clear skies, light winds, warm air advection, and
prolonged hot conditions at the surface (Palecki et al. 2001).
Meehl and Tebaldi (2004) found that variations among dif-
ferent geographic locations may lead to changes in the pat-
tern and characteristics of heat waves. They found that the
increase in 500 hPa height over the western USA is leading
to more intense heat waves, which is in agreement with the
findings of this work.
Heat‑related deaths in Las Vegas
Figure 4 shows the overall number of deaths per year from
2007 to 2016 in Las Vegas, with the highest number of
deaths occurring in the summer of 2016. The number of
deaths in the June–August period per year correlated with
100 Heat Index
90 Number of Deaths
80
Number of Deaths
70
60
50
40
30
20
10
0 33
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Year
Fig. 4  Behavior of the average number of heat-related deaths with HI
during June–August in Clark County for the 2007–2016 period
Table 2  Number of heat wave Year
events and average event
duration (in days) during the Number of heat wave events
2007–2016 period using HI
Average event last, days
values
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International Journal of Environmental Science and Technology
the average heat index obtained for June to August in the
same year, as shown in Fig. 4, because both lines increase
and decrease at the same time along the ten-year period.
When the Spearman’s rho was calculated for the two param-
eters—the number of deaths from June to August and June
to August heat index—the two-tailed value of p was found
to be 0.009 with a rho value 0.45, which suggests that the
association between the two variables would be considered
statistically significant.
The number of heat wave events, during which the HI
reached 40 °C or higher for two or more days, increased in
frequency and duration from 2007 to 2016 (red boxes in
Table S1) as shown in Table 2. As shown in Table 2, two
heat wave events occurred in 2007, and none occurred dur-
ing 2008 or 2009. Four events occurred during 2010, two
occurred between 2012 and 2014, one occurred in 2015, and
four occurred in 2016. The average duration of each event
showed an increase from 2 days for the 2007–2010 period to
4.5 for the 2011–2016 period, which is also shown in Table 2.
Of note is that multiple deaths occurred during each heat wave
event (see Table S1, red boxes).
Figure 5 shows the relationship between the daily HI and
the number of deaths in Clark County for June, July, and
August during the 2007–2016 period. The three HI categories
suggested by NOAA’s National Weather Service (i.e., cau-
tion, extreme caution, and danger) were included as a refer-
ence of intensity. Except for two points, all the HI values are
included in the colored area. Most of the heat wave estimates
for 2007–2016 fall within the caution threshold (83%), and
the reminding estimates fall within the extreme caution (7.8%)
and danger (8.5%) categories. The overall trend in HI values
37.5 suggests a bell-shaped seasonal distribution with peak values
37 by late July and early August. Of note is that the number of
deaths shows a similar trend.
36.5
Table S1 shows (in red boxes) the heat wave events detected
36
based on the definition provided previously (i.e., two or more
Heat Index, °C
35.5 days with the HI reaching 40 °C or higher). Based on the data,
35 a significant number of deaths occur even at lower HI val-
34.5 ues. Considering the number of reported deaths that occurred
34
below the 90th percentile value (deaths start being registered
once the HI reaches 33 °C), using a new threshold HI value
33.5
instead of waiting two or more days for the HI to reach 40 °C
or higher may save some lives because the warning will be sent
out earlier. For example, using an HI value of 36 °C for two
or more consecutive days as the threshold to identify a heat
wave in Las Vegas may prevent a greater number of deaths.
The green boxes in Table S1 show that the number of deaths
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
2 Null Null 4 1 2 2 2 1 4
2 0 0 2 3 5 5.5 2.5 8 3
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International Journal of Environmental Science and Technology

Fig. 5  Daily heat index (black 45

dots) and number of heat- Danger 14
related deaths (red squares) in 40
Clark County for June, July, and 12
August during the 2007–2016 35
period. NOAA’s National Extreme Caution
Weather Service HI categories 30 10

Number of Deaths
Heat Index, ˚C
are shaded as caution (yellow), Caution
25 8
extreme caution (orange), and
danger (red)
20
6
15
4
10
2
5

0 0
0 20 40 60 80
June July August

50 which suggests that the relationship between the two variables

50 would be considered statistically significant. From Fig. 6, it
48 is also easy to note that the trend in both cases (HI and the
Heat Index number of deaths) is to increase for the last few years of the
40
46
analyzed period, being 2016 the year with the higher number
Number of Deaths

of deaths and also one of the highest HI values assessed. The

30 trends found for July and August show similar results (Spear-
44
HI, ˚C

man’s rho = 0.24 and 0.1 for July and August, respectively;

42
40
38
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Year
Fig. 6  Behavior of the average monthly (June) heat index and heat-
related deaths in Las Vegas over the 2007–2016 period
outside the heat wave event decreases significantly using this
slightly lower threshold.
Social and health implications
As shown in Fig. 4, a significant increase in the overall num-
ber of heat-related deaths has occurred over the last three
years, which may correlate with the increase in temperature.
For example, Fig. 6 shows the number of deaths in Las Vegas
compared with HI values in June (2007–2016).
It is interesting to observe how both curves (the HI is shown
as a solid line, and the number of deaths is shown as a dotted
line) behave in a similar way by going up and down at the
same time. When the Spearman’s rho analysis was performed,
the resulting rho value was found to be 0.79 with p = 0.003,
20
p = 0.002 and 0.004 for July and August, respectively), which
are shown in Figure S1 of the supplemental material. The same
trend has been observed for other location in the Southwestern
10 U.S. like San Diego, CA, where a number of health impacts
have been observed associated with increasing daily maximum
0 temperature threshold levels (Guirguis et al. 2018). In the case
of San Diego, temperature thresholds for health effects were
found highly depending on the geographic location of the dif-
ferent analysis (coastal, inland and desert regions) suggested
to be related to the adaptation of the inhabitants of the differ-
ent regions to high temperatures. In our case, the significance
of the temperature data obtained is clear as shown in Fig. 5
where most of the HI values obtained were located within
the extreme caution and danger indices, meaning that peo-
ple exposed to these conditions are expected to experience
effects on the body such as heat stroke, cramps, exhaustion,
heat cramps, and/or heat exhaustion leading to susceptible
individuals to death (Abdullahi et al. 2016).
Figure 7 compares the trend of the number of deaths with
the EHF values and the results agree with those shown in
Fig. 4, which shows that the highest mortality rates occur
in the later years and are related to the highest values of
the HI. In the case of HEF, the trend described in Figure
S2—which showed a sustained increase in the severity of
excess heat events—can be related to the increased num-
ber of deaths during the 2007–2016 period. This trend was
confirmed by analyzing the dataset using the Spearman’s

13
 Author's personal copy
30
25 EHF severity, °C2
Number of Deaths
20
EHF severity, ˚C2
15
10
5 10
0 0
2006 2008 2010 2012 2014 2016
Year
Fig. 7  Comparison between the severity of the excess heat factor and
the number of heat-related deaths during 2007–2016 in Las Vegas
rho correlation and the rho value calculated was 0.55 with
p = 0.004, which suggests that the association between the
two variables would be considered statistically significant.
The total number of heat-related deaths registered by the
Clark County Coroner/Medical Examiner Office during the
2007–2016 period was 437, with 90 deaths occurring in
June (20%), 229 deaths occurring in July (52%), 79 deaths
occurring in August (18%), and 39 deaths occurring in other
months (9%). The overall number of deaths that occurred in
the summer for the 2007–2016 period was as high as 398
(over 90%). In recent studies, EHF has been used to corre-
late heat wave episodes and their effect on the population’s
health (Loridan et al. 2016), as well as the total number
of fatalities reported in accumulated EHF episodes (Lan-
glois et al. 2013). In the case of Las Vegas, the correlation
between EHF and the number of deaths for the 2007–2016
period does not seem to be as clear as the trend observed
for the number of deaths and HI values. This is probably
because EHF is more closely related to morbidity as a prime
measure of heat-related negative outcomes than fatal cases
(Hatvani-Kovacs et al. 2015), for which other health-related
impacts are not considered. However, other authors consider
EHF to be a better indicator of excess mortality (Luber and
McGeehin 2008). These authors found that a peak EHF
value (144  °C2) needed to be reached before observing
deaths, whereas in this study, the occurrence of heat-related
deaths was observed for significantly lower EHF values.
The most vulnerable subpopulations can be identi-
fied using the available data and sorting by the ages of the
deceased people. For this study, the death information was
arbitrarily divided into three age-related population seg-
ments (i.e., less than 20 years old, 20–50 years old, and older
13
International Journal of Environmental Science and Technology
60 than 50 years old) to identify the vulnerability of children
and young people, economically active populations, and the
50 elderly to extreme heat. Based on the available information,
approximately 1% of the deaths occurred among people less
than 20 years old, 23% of the deaths occurred among people
Number of Deaths
40
20–50 years old, and 76% of the deaths occurred among peo-
ple older than 50 years old. These results are highly signifi-
30 cant considering the increase in retirees who choose Clark
County as a destination for retirement (Pharr et al. 2015).
20 When the cause of death was reviewed for each case, it
was noteworthy that almost all of the deaths for the subpopu-
lation older than 50 years old were described to be related
to heart disease, with arteriosclerotic cardiovascular com-
plications being the most common preexisting health con-
dition among the people registered for heat-related deaths.
Intense heat stimulates the sympathetic nervous system that
increases heart rate, which increases blood pressure, and has
a significant impact on those with preexisting hypertension
caused by cardiovascular problems. The high rate of per-
spiration usually associated with extreme heat also causes
dehydration, which leads to increased resistance to blood
flow that in turn is caused by elevated blood viscosity (Luber
and McGeehin 2008).
Interestingly, the most common preexisting condition for
the subpopulation of 20–50 years old was related to ethanol
intoxication and/or illegal drug intoxication (e.g., heroin
and methamphetamine). Alcohol contributes to dehydration
and electrolyte imbalance, which can result in irreversible
complications.
Figure 8 shows the relationship between the number of
deaths and the duration of the heat waves for both the HI and
EHF indices, which suggests that for both cases longer heat
wave increases heat-related deaths, with correlation values
on the same order of magnitude (R2 = 0.46 and 0.42 for HI
and EHF, respectively). It has been proposed that increased
heat wave severity is significantly associated with its poten-
tial for fatalities (Loridan et al. 2016) and that the combina-
tion of large mean maximum heat index value and sustained
period of the heat wave produces an increased number of
fatalities. Li et al. (2015) suggested that heat waves tend to
have a short lag effect, with some deaths occurring even after
seven days of the event. Figure 8 shows these lag effects as
well as the death counts during the seven days after the heat
wave event. Similarly, Fig. 9 relates the number of deaths to
the HI and EHF severity values based on the same lag effect
described by Li et al. (2015). Of note is that the relation-
ship between the number of deaths and the maximum HI is
rather weak (R2 = 0.3), whereas the relationship between the
number of deaths and EHF severity is moderately stronger
(R2 = 0.68). In agreement with data shown in Figs. 2 and 3
and Table 2, heat wave episodes in the study area trend to
increase in frequency, duration, and severity meaning that
an increase in the number of deaths should be also expected
 Author's personal copy
International Journal of Environmental Science and Technology

(a) 40 (a) 50
35 45

Extreme caution
30 40

Danger
Number of deaths

25 35

Number of deaths
20 30
15 25
10 20
5 15
0 10
0 2 4 6 8 10
HI heatwave duration, days 5

(b) 40 0
39 40 41 42 43
35
HI severity, °C
30
(b) 160
Number of deaths

25

20
140
15
120 Low intensity Severe Extreme
10

5
100
Number of deaths

0
4 9 14 19
80
EHF heatwave duration, days

60
Fig. 8  Relationship between the number of heat-related deaths and
the heat wave duration (in days) for a HI and b EHF during the 2007–
2016 period in Las Vegas 40

correlated with the trends shown in Figs. 8 and 9. Despite 20

the differences, both indices suggested that the number of

deaths increases as the heat wave intensity increases, as it 0
0 10 20 30 40
has been found for other geographic locations (Loridan et al.
2016). In a recent paper, Meehl et al. (2016) found that the EHF severity, °C2
general trend for distinct geographic locations shows that
future heat wave events will become more intense, more fre- Fig. 9  Relationship between the number of heat-related deaths and
quent and longer lasting in Europe and North America. The the severity of heat wave events for the two indices analyzed. The
severities of a heat wave events were classified as a caution (26–
trend was suggested related to a specific atmospheric circu- 32 °C), extreme caution (32–40 °C), and danger (> 40 °C) for HI and
lation patter which is intensified by increases in greenhouse b low-intensity (0–11.5  °C2), severe (11.5–34.0  °C2), and extreme
gas concentration with the consequent increase in heat wave (> 34.0 °C2) heat wave for EHF
severity. It is believed that, if the trend is confirmed, the
results shown in Figs. 8 and 9 becomes of great significance
as the effects on populations health remain closely linked Conclusion
to the duration and severity of the heat wave events in the
study area. Furthermore, all these trends should be of use for An analysis of two extreme heat indices related to the
local decision making related to protect the most vulnerable number of heat-related deaths in Las Vegas during the
population segments. 2007–2016 period was performed. The following are the
main findings:

13
 Author's personal copy
The nonparametric Spearman’s rho analysis of the data
showed that the HI in Clark County was increasing, with
June being the month with the highest warming trend fol-
lowed by August and July.
The EHF showed significant increase in severity with
values from 10 °C2 in the 1980s to 25 °C2 in the last five
years. The annual average of heat wave episodes also
increased from 1.3 to 6 per year over the same period.
The mean heat wave frequency for summer in Las Vegas
increased from 1.4 per year during the 1980–2006 period
to 1.66 per year for the 2007–2016 period, and heat waves
were more frequent in June and July than in August. Nev-
ertheless, the mean heat wave duration decreased from
20.4 days during the 1980–2006 period to 18.1 days dur-
ing the 2007–2016 period, which means that there was an
increased frequency and intensity of heat waves but the
events lasted for a shorter time.
A statistically significant correlation was found between
the number of deaths and the values of the two heat indices
(e.g., HI and EHF) used in this study, as well as heat wave
event duration and severity, although heat wave severity
had a lower correlation. For all the cases, the higher the
index (either HI or EHF) value, duration, or severity, the
higher the number of extreme heat-related deaths.
Heat-related deaths in Clark County were found to
significantly increase over the last few years of the study
period, and 2016 was the year with the highest number of
deaths. The number of heat-related deaths was found to fit
fairly well using either HI or EHF values.
Most of the heat-related deaths were registered in July
(52%), followed by June (20%) and August (18%). The
most vulnerable subpopulation was found to be individu-
als over 50 years old (76%) with preexisting conditions
of heart disease followed by young adults (20–50 years
old), whose deaths were usually associated with drug or
alcohol abuse.
Acknowledgements  This material is based upon work supported in
part by the National Science Foundation (Grant IIA-1301726). The
authors thank the Clark County Coroner/Medical Examiner Office for
providing information for heat-related deaths. J. Mejia thanks NASA
(Grant NNX12AF57G) and DRI for their support in developing this
manuscript. The authors also thank Ms. Nicole Damon (DRI) for her
editorial review.
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