Deaths related to cold weather have risen steadily nationwide in recent decades, new research shows, underscoring the continued risks of cold exposure even as average temperatures continue to climb.
The study, which examined data from the Centers for Disease Control and Prevention, found that the rate of deaths in which cold was an underlying or contributing cause more than doubled between 1999 and 2022, with the highest mortality rates recorded in the Midwest. In 2022, 3,571 people died of causes linked to cold weather, the study’s authors said.
“Even though we are in this warming world, cold-related deaths are still a public health issue in the U.S.,” said Michael Liu, a student at Harvard Medical School and the lead author of the study.
Winters in much of America are now, on average, 4 degrees warmer than they were a half-century ago, according to Climate Central, an independent research group. But climate change has also led to more bursts of extremely cold winter weather, including polar vortexes, which occur when Arctic air blows into the United States.
This “winter whiplash,” as Victor Gensini, a professor of meteorology at Northern Illinois University, describes it, can make people more vulnerable to cold snaps.
“We are less accustomed to experiencing those cold temperatures,” he said, “so that when they do occur, it is much more of a shock to the system.”
Most Vulnerable to Cold
The cold weather can lead to serious health effects, including frostbite and hypothermia, a condition in which the body’s core temperature drops below 95 degrees. Prolonged hypothermia can affect the cardiac and respiratory systems and is sometimes fatal.
The study found that the death rate was highest among people 75 or older. The body’s ability to regulate temperatures declines with age, making people more susceptible to sudden spikes or drops in body temperature. Older people are also more likely to have chronic conditions like diabetes or thyroid problems that, if not properly treated, can make it harder to stay warm.
The authors said other factors could also be at play, including social isolation, substance abuse and an increase in homelessness. Dr. Neha Raukar, an emergency room doctor at Mayo Clinic in Rochester, Minn., said that in recent years she had seen more patients with cold-related injuries who were intoxicated. People who are drinking alcohol may not realize how cold it is outside, she added.
The rise in cold-related deaths was most pronounced from 2017 through 2022, a period when more people experienced homelessness, according to federal data. The study also found that the cold-related death rates were highest among American Indian, Alaska Native and Black people, groups that federal data shows are also disproportionately affected by homelessness.
Dr. James Miner, an emergency physician at Hennepin County Medical Center in Minneapolis, said that he had seen this firsthand in recent years. On cold nights, he said, more people without shelter now crowd into the hospital’s waiting room in search of warmth.
How to Prevent and Treat Injuries From the Cold
Dr. Raukar said preventing cold-related injuries started with dressing right. She recommended piling on several layers of loosefitting, lightweight clothing to trap the heat. She also advised always wearing a hat, gloves and scarf, and not lingering in wet socks.
She also said that it was important to stay hydrated — she recommended drinking warm fluids — and to avoid alcohol in extreme cold. This type of weather can be dehydrating: We lose fluids in winter simply by breathing in cold, dry air that the body must warm and moisten before it reaches the lungs, Dr. Raukar explained. Physical activity like shoveling snow causes heavier, deeper breathing, which takes more fluid.
A mild injury from cold exposure is frost nip, when toes or fingers turn painful and purple. Mild hypothermia can cause uncontrollable shivering. People with these symptoms can warm themselves up at home, using lukewarm water and blankets to restore feeling and heat.
But if any part of the body looks bruised or blistered, experts said, people may need to see a doctor to be treated for frostbite. If patients have hypothermia and can’t quickly warm up, they could become confused or exhibit strange behavior, Dr. Miner said. People often stop shivering and may even take off their clothes, convinced that they are too warm. Some patients go into cardiac arrest.
In the hospital, doctors treat severe hypothermia by covering a patient in blankets and blasting the person with warm air. If the patient doesn’t improve, doctors may insert catheters or even use a bypass machine to warm up the blood. Dr. Raukar said, “We see a lot of frostbite and hypothermia in people who don’t realize that they’re getting really cold, that they’ve been outside too long, and just how dangerous it is.”
Experts said that the best way to take care of a homeless person on a cold night was to help the person find a shelter, a library, a subway or anywhere else insulated from the cold.
“A blanket wouldn’t hurt,” Dr. Miner said, “but what we really need is to get people inside.”
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