Arnab K. Ghosh

Background: The development of clinical tools to combat extreme heat events (EHEs) is urgently needed. However, the collection, linkage, and application of data and technology required to address the health consequences of EHEs—through individualized decision-making, population-focused interventions, and health system planning—remain in its infancy despite the wealth of data infrastructure in health care systems. Methods: In this paper, we describe a use case for data-intensive system architecture that can enable best practices for addressing EHE-related health risks in older adults with cardiovascular disease (CVD), a population uniquely vulnerable to EHEs. Results: Descriptions of various data sources integrated into a modular approach are discussed that allows multilevel (ie, individual-level, population-level) evaluation of EHE-related risk. Individual data streams include batched data from personal digital health devices such as wearables, indoor temperature sensors, and electronic medical record data linked through unique identifiers. Data collection, processing, and analysis as well as related challenges (eg, data quality, processing requirements, and health care system attribution) are also discussed. How this data architecture can then address important preclinical, clinical, and related questions are then described, including: (1) which physiological signals (including cardiovascular and sleep measures) may best anticipate EHE-related health care utilization in older adults with CVD; (2) how do heat thresholds that increase EHE-related health care utilization differ by medication use and type, and comorbidities; and (3) how does indoor versus outdoor temperature measures influence these associations—all understudied aspects of EHE risk in older adults. Conclusions: With considered effort and expertise, a modular data architecture that allows the combination of different elements will enable the development of clinical tools to address EHE-related health risk among older adults with CVD at multilevel scales.

Highlights• Climate vulnerability was associated with higher CHD and stroke prevalence.• Highest-risk counties clustered in the Southeastern United States.• Spatial error models outperformed spatial lag models for model fit.• Climate vulnerability may identify counties for targeted CVD prevention.• Findings support climate-informed cardiovascular public health planning.

This cohort study assesses the convergence of the rising threat of extreme weather events and increasing use of home health care through the lens of Hurricane Sandy.

Urban trees can protect city residents from extreme heat, but tree planting programs seldom provide sufficient shade where it is most needed. We synthesize evidence highlighting three rarely fulfilled prerequisites for the effective use of trees in heat adaptation.

Objectives: Examine the association between dementia and all-cause 5-year mortality among skilled nursing facility (SNF) residents exposed to Hurricane Sandy flooding. Methods: This study analyzed Medicare fee-for-service (FFS) beneficiaries aged ≥65 receiving care in SNFs located in flooded ZIP codes in New York, New Jersey, and Connecticut (October 2012). A 20% Medicare FFS sample was linked to Minimum Data Set assessments, LTCFocus, Care Compare, and American Community Survey data. Flooding exposure was defined using 2012 U.S. Geological Survey flood shapefiles. Follow-up extended 5 years. Analysis included Kaplan-Meier curves, multivariable Cox models, and propensity-score matching. Results: Of 1,627 SNF residents, 767 (47%) had dementia. Compared with those without dementia, they were older (≥85y: 52% vs 38%; P < 0.001), less often non-Hispanic White (67% vs 75%; P < 0.001), and more frequently dually eligible for Medicare/Medicaid (63% vs 40%; P < 0.001); Charlson comorbidity burden was similar (mean 4.9; P = 0.95.). Dementia was associated with higher 5-year mortality after full adjustment (HR 1.20, 95% CI 1.05-1.37), and propensity-score matching (HR 1.24, 95% CI 1.08-1.44). Median survival was 1.68 years vs 2.61 years. Conclusions: SNF residents with dementia in flooded areas had higher 5-year mortality, underscoring the need for dementia-specific disaster plans.

Importance: Hurricanes are associated with increased cardiovascular disease (CVD) risk, yet little is known about whether these risks extend into the long term and for how long.Objective: To examine the association between hurricane-related flooding and CVD risk up to 5 years after landfall.Design, Setting, and Participants: This cohort study included a 20% national sample of continuously enrolled Medicare fee-for-service beneficiaries from New Jersey, New York City, and Connecticut from January 1, 2010, to December 31, 2017. Data were analyzed from December 14, 2023, to June 20, 2025.Exposure: Residence in zip code tabulation areas (ZCTAs) impacted by flooding from Hurricane Sandy throughout the study period.Main Outcomes and Measures: The primary outcome was the rate of ZCTA-level adjusted CVD events (including myocardial infarction [MI], heart failure [HF], and stroke), defined per 1000 beneficiary-years, with associated 95% bayesian credible intervals (bCrIs). Secondary outcomes included the rate of events for each CVD subtype (MI, HF, and stroke).Results: In the matched cohort, 121 395 beneficiaries resided in 690 ZCTAs, of which 441 (63.9%) flooded. In nonflooded vs flooded ZCTAs, mean (SD) age (74.2 [1.4] vs 74.1 [1.2] years; P = .16), proportion of female beneficiaries (61.4% [8.4%] vs 61.3% [6.6%]; P = .89), and proportion of White beneficiaries (74.3% [28.7%] vs 76.7% [26.8%]; P = .27) were similar, but ZCTA-level median income ($81 168 [$33 410] vs $69 650 [$27 594]; P < .001) and median National Area Deprivation Index rank (17.1 [IQR, 10.2-27.6] vs 21.0 [IQR, 10.9-32.5]; P = .02) differed; prevalence of CVD and CVD subtypes was similar at baseline. Flooding was associated with an increase in adjusted 5-year CVD risk post landfall (relative risk, 1.05; 95% bCrI, 1.01-1.08) and HF rates overall (relative risk, 1.03; 95% bCrI, 1.00-1.08). No significant difference was found in rates of MI or stroke in adjusted analyses.Conclusions and Relevance: In this cohort study of Medicare fee-for-service beneficiaries, hurricane-related flooding was associated with increases in CVD event rates as long as 5 years after landfall and increased HF rates in New Jersey. These findings highlight the importance of place-based vulnerability from hurricane exposure to mitigate longer-term CVD risk and the need to consider long-term outcomes in hurricane mitigation efforts.