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Cold-related illness and injury is a large category of health concerns related to cold exposure and phases of hypothermia. Common complaints from patients included frostbite, foot and hand pain and swelling, general weakness, and shortness of breath. Changing climate conditions in Oregon are expected to create more extreme weather events in the future, likely in the form of floods, heatwaves, wildfires, and summer and winter storms[1]. Cold weather and ice events have brought more emergency department visits related to falls and carbon monoxide poisoning.
Falls due to icy surfaces disproportionately affect older adults and those with mobility challenges. The tri-county region experienced severe freezing rain and ice during winter storms in February 2023 and January 2024.
Carbon monoxide (CO) poisoning is a health concern, particularly during colder months when the use of heating systems, generators, and other fuel-burning appliances increases. CO is an odorless, colorless gas produced by incomplete combustion of carbon-based fuels, and exposure can lead to symptoms ranging from headaches and dizziness to unconsciousness and death. Climate-related extreme weather events, such as winter storms and power outages exacerbate risks as people turn to alternative heating sources.
Elevating Equity
Climate change-driven extreme weather can have greater impacts on some people and communities based on their ability to prepare for, withstand, and recover from events. Learning from previous extreme weather events [2][3] the following groups face higher risks:
Older adults, children, people who use mobility devices, and people with disabilities who are unable to find protection from a storm or have limited access to transportation.
People who have less capacity or fewer resources to gather supplies for extreme weather events, as well as to cover costs related to post-storm recovery.
Communities who are isolated culturally, linguistically, or by technology barriers, like limited internet, may not have access to appropriate emergency communications.
People who are experiencing houselessness and do not have means to shelter.
Communities of color that have experienced historic redlining, structural exclusion, or lived in areas that have not been prioritized for public works enhancements.
Communities that are geographically isolated or do not have backup systems for essential services like water, power, or travel routes damaged by extreme weather.
References
[1] Haggerty B, York E, Early-Alberts J, Cude C. Oregon Climate and Health Profile Report. Oregon Health Authority. September 2014: Portland, OR ↩︎
[2] McGill, N. (2016). Vulnerable populations at risk from effects of climate change: Public health working to find solutions. The Nation’s Health. 46(9) p. 1-14. ↩︎
[3] Gamble, J.L., J. Balbus, M. Berger, K. Bouye, V. Campbell, K. Chief, K. Conlon, A. Crimmins, B. Flanagan, C. Gonzalez-Maddux, E. Hallisey, S. Hutchins, L. Jantarasami, S. Khoury, M. Kiefer, J. Kolling, K. Lynn, A. Manangan, M. McDonald, R. Morello-Frosch, M.H. Redsteer, P. Sheffield, K. Thigpen Tart, J. Watson, K.P. Whyte, and A.F. Wolkin, 2016: Ch. 9: Populations of Concern. The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. U.S. Global Change Research Program, Washington, DC, 247–286. http://dx.doi.org/10.7930/J0Q81B0T. ↩︎
Trends
This section looks at Emergency Department and Urgent Care (ED/UC) visits, hospitalizations, and deaths due to cold-related illness. There is also an analysis of hospitalizations for falls due to slips on ice and unintentional carbon monoxide poisoning.
These data look at the months of October – March, referred to as the “cold months.” Data is summed by calendar year.
The rates of cold-related illness ED/UC visits per 100,000 ED/UC visits have steadily declined since a peak in 2019 across all counties and the region.
Number of cold-related illness ED/UC visits per 100,000 total ED/UC visits by county and year.
The rates of cold-related illness hospitalizations per 100,000 all-cause hospitalizations have risen sharply in Multnomah County since 2019, driving a slight regional increase. Clackamas County has seen a decline since a peak in 2021. Rates in Washington County have steadily increased since 2016.
Rate of cold-related illness hospitalizations per 100,000 total hospitalizations by county and year.
Rates of cold-related illness deaths per 100,000 all-cause deaths saw a peak in 2021 and have steadily declined in all counties and regionally.
Rate of cold-related illness deaths per 100,000 total deaths by county and year.
ED/UC visits for unintentional carbon monoxide poisoning remained steady until 2023, when there was a large increase in Multnomah County that drove a regional increase.
Number of ED/UC visits for unintentional carbon monoxide poisoning during the 2019 – 2024 cold months by county and year of admission.
Rates of ED/UC visits for unintentional carbon monoxide poisoning per 100,000 total ED/UC visits remained steady in Multnomah county until 2023. Clackamas County saw increases in 2016 and 2019.
Rate of ED/UC visits for unintentional carbon monoxide poisoning per 100,000 total ED/UC visits by county and year.
Demographics
This section looks at demographic information for the region through Emergency Department and Urgent Care (ED/UC) visits, hospitalizations, and deaths. Percentage of visits during the cold season (October 1-March 31) from 2021 – 2024 are presented by age, sex, and race.
The percentage of men was higher for cold-related illness ED/UC visits compared with total visits for men. Younger adults (18-44) saw lower percentages as compared with total visits for this age group. Black people saw a higher percentage of ED/UC visits compared to total visits for Black people.
Demographic comparison of cold-related ED/UC visits and all ED/UC in the tri-county region during the 2021 – 2024 cold months.
Men, people 45 - 64 years old, and white and black people made up a higher percentage of cold-related hospitalizations compared with all hospitalizations. Women and Hispanic people made up a lower percentage of cold-related hospitalizations compared with all hospitalizations.
Demographic comparison of cold-related hospitalizations and all hospitalizations during the 2021 – 2024 cold months in the tri-counties.
The percentage of men, adults under 74 years old, and Black people was higher for cold-related deaths compared to all deaths. Women and people over 75 years old saw much lower percentages of cold-related deaths as compared to all deaths.
Demographic comparison of cold-related deaths and all deaths during the 2021 – 2024 cold months in the tri-counties.
The rate of cold-related ED/UC visits for all ages has declined when comparing 2019-2022 to 2023-2024, with the exception of preschool (0 – 4) aged people who saw a large increase between the two time frames. Visits by race have declined or remained steady, except for Native Hawaiian or Pacific Islander people, who saw a large increase in visits. Visits by sex have remained steady.
Rate of cold-related ED/UC visits per 100,000 total visits for 2019-2022 and 2023-2024, by patient age, race/ethnicity and sex in the tri-counties
The rate of hospitalizations for cold-related illness for young adults increased while other age groups remained steady when comparing visits in 2019–2022 and visits in 2023–2024. Hospitalizations for men and women have remained steady. Hospitalizations have increased across all racial groups.
Rates of cold-related hospitalizations per 100,000 total hospitalizations for 2019-2022 and 2023-2024 cold months by patient age, race and ethnicity, and sex in the tri-counties.
The percentage of cold-related deaths in younger adults, older adults, and older seniors have gone down when comparing deaths in 2019–2022 with deaths in 2023–2024 , while seniors saw a slight increase. Deaths for Asian people have increased, while other races have remained steady. Deaths for men and women have gone down.
Rates of cold-related deaths per 100,000 total deaths for the 2019-2022 and 2023-2024 cold months by patient age, race/ethnicity, and sex in the tri-counties.
The percentage of hospitalizations for falls caused by slips on ice for men, people over age 45, and white was higher than visits for all hospitalizations. Other age groups, races, and women saw a smaller percentage compared with all hospitalizations.
Demographic comparison of hospitalizations for falls caused by slips on ice and all hospitalizations during the 2021 – 2024 cold months in the tri-counties.
The rate of hospitalizations per 100,000 for falls caused by slips on ice saw large increases across most age groups when comparing 2019–2022 to 2023–2024. Both men and women saw increases in hospitalizations. All racial and ethnic categories saw increases in hospitalizations when comparing 2019-2022 to 2023-2024.
Rates of hospitalizations for falls caused by slips on ice per 100,000 total hospitalizations in the tri-counties during the cold season of 2019-2022 vs. 2023-2024, by patient age, sex and race/ ethnicity in the tri-counties
Younger adults aged 18 to 44 saw a large increase in ED/UC visits for unintentional carbon-monoxide poisoning when compared to all visits. Black people also saw a large increase in ED/UC visits when compared to all visits.
Demographic comparison of ED/UC visits for accidental carbon monoxide poisoning and all visits during the 2021 – 2024 cold months in the tri-counties.
Older adults ages 45 – 64 saw a decreased rate in ED/UC visits for unintentional carbon monoxide poisoning while all other ages saw increased rates when comparing visits in 2019–2022 to 2023–2024. Black, Hispanic, Native Hawaiian and Pacific Islanders saw increased rates, while Asian and American Indian and Alaska Natives groups saw decreased rates. Men saw a large increase in the rate of ED/UC visits for unintentional carbon monoxide poisoning.
Rates of ED/UC visits for unintentional carbon monoxide poisoning per 100,000 total visits for 2019-2022 and 2023-2024, by patient age, race/ethnicity and sex.
Notes
Data details
Data for Cold-Related Illness, falls, and carbon monoxide poisoning came from the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) in Oregon. The number of hospitalizations was obtained by request from the Office of Health Analytics at Oregon Health Authority Health Policy and Analytics Division. This data was October-March 2016-2024. Data on deaths came from death certificates from Oregon Vital Statistics. See table of winter weather health indicators for more details.
Vital records data captures information on the cause and manner of death, and demographic information about the decedent. Deaths have one underlying cause and up to twenty contributing causes that are recorded by a medical professional or the county medical examiner. The underlying cause is the disease or injury that initiated the chain of events leading to death. Contributing causes contribute to death but are not to the ultimate direct cause. All causes of death are translated into codes (ICD-10, or International Statistical Classification of Disease, 10th revision) which can then be queried to find heat related deaths.
These data were for the months of October-March from 2016-2024.
Each query looks for ICD-9 and ICD-10 codes related to the specific health outcome of interest. Query details and sources are presented in the table of winter weather health indicators below.
Methods
We obtain data on ED/UC visits of county residents, hospitalization of county residents, and deaths occurring within each county that indicate cold-related illness, falls from slips on ice, and carbon monoxide poisoning (See table of Winter Extreme health indicators). We aggregate indicators per cold season and present annual number of visits for each county and the entire tri-county region in bar graphs. We calculate annual rates of each indicator. Rates for ED/UC visits, hospitalizations, and deaths are among all ED/UC visits, hospitalizations, and deaths for the same time period and region.
We do not calculate visit percent or rates by census population data because some visits and hospitalizations can be by the same person. Urgent care facilities reporting to ESSENCE can also change over time. Therefore, the percentage of indicators is among all ED/UC visits and hospitalizations provides a consistent way to track changes in the burden of climate-related care over time and identify differences between who typically seek care. Rates for deaths are among all deaths in the region for the same time period, since we count the deaths by place of injury and not by place of residence.
Winter Weather Health Indicators
Health Outcome
Data Source
Query Details
Cold-related illness (ED/UC Visits) (Cold-related illness refers to illness or injury related to weather, such as hypothermia and frostbite)
Oregon ESSENCE (Electronic Surveillance System for the Early Notification of Community-Based Epidemics) https://knowledgerepository.syndromicsurveillance.org/cold-related-illness-cste
Keywords in patient records that suggest cold-related illness:
• 'Cold exposure' or similar phrases like:
- 'exposure to cold'
- 'environmental exposure'
- 'cold-exp'
- 'out in the cold'
• Specific cold-related conditions:
- 'frostbite'
- 'frost nip' or 'frostnip'
- 'hypothermia'
- 'frozen fingers,' 'frozen hands,' 'frozen toes,' or 'frozen feet'
Excludes mentions that are clearly unrelated to weather or cold injury:
• Food or meat references (e.g., 'frozen meat,' 'frozen burger,' 'pork')
• Common unrelated body issues (e.g., 'wart,' 'growth,' 'shoulder,' 'knee')
• Routine care or non-urgent check-ups (e.g., 'recheck,' 'history of frostbite,' 'dressing change')
• Respiratory symptoms or infections (e.g., 'cough,' 'chest congestion,' 'infection')
• Codes or notes that point to unrelated conditions (e.g., fever, rashes, other ICD codes like R68.0, 780.65)
Terms and Codes That Suggest Carbon Monoxide Exposure
The query includes: Words or abbreviations that indicate CO poisoning:
• 'monox' (short for monoxide)
• 'carbon monoxide'
• 'carbon oxid' or 'carbonoxid'
• 'CO inh' (short for CO inhalation)
• 'CO pois,' 'CO tox,' 'CO exp' (abbreviated forms of CO poisoning, toxicity, or exposure, including common misspellings or substitutions like zero for O)
ICD or SNOMED diagnosis codes that specifically match CO poisoning:
• Codes starting with T58, which refer to toxic effects of carbon monoxide
• ICD-9 code 986 (toxic effect of carbon monoxide)
• External cause codes like E868.2, E868.3, E868.9 (e.g., exposure to carbon monoxide from a furnace, motor vehicle, or other source)
• SNOMED codes for carbon monoxide poisoning (e.g., 95875007, 17383000)
Terms That Are Excluded (Not Carbon Monoxide Related)
To avoid false matches, the search filters out: Other toxic substances:
• 'Mycotox' (mycotoxins)
• 'Vanco tox' or 'vancotox' (vancomycin toxicity)
• 'Alco tox' or 'alcotox' (alcohol toxicity)
• 'Tobacco exposure' or similar terms
ICD codes for different conditions that look similar to carbon monoxide codes but are not the correct subtypes or stages
Falls (ED/UC Visits) This query looked for free text terms related to falls, including 'slipped,' 'tripped,' and 'stumbled.' Importantly, this subsyndrome does not look for diagnosis codes among ED/UC visits.
Oregon ESSENCE
ChiefComplaintSubSyndrome: Falls SubSyndrome
Cold-related hospitalization among Tricounty residents
and deaths that occurred in the Tricounty region
Office of Health Analytics: Hospital Reporting Program Oregon Vital Statistics
ICD 10 Codes: T33, T34, T68, T69, and X31
Ice Fall hospitalization among Tricounty residents
Office of Health Analytics: Hospital Reporting Program
ICD code: W00
Note: All queries were conducted for the period October to March, 2016-2024
Extreme Cold Overview
Cold-related illness and injury is a large category of health concerns related to cold exposure and phases of hypothermia. Common complaints from patients included frostbite, foot and hand pain and swelling, general weakness, and shortness of breath. Changing climate conditions in Oregon are expected to create more extreme weather events in the future, likely in the form of floods, heatwaves, wildfires, and summer and winter storms.(1) Cold weather and ice events have brought more emergency department visits related to falls and carbon monoxide poisoning.
Falls due to icy surfaces disproportionately affect older adults and those with mobility challenges. The tri-county region experienced severe freezing rain and ice during winter storms in February 2023 and January 2024.
Carbon monoxide (CO) poisoning is a health concern, particularly during colder months when the use of heating systems, generators, and other fuel-burning appliances increases. CO is an odorless, colorless gas produced by incomplete combustion of carbon-based fuels, and exposure can lead to symptoms ranging from headaches and dizziness to unconsciousness and death. Climate-related extreme weather events, such as winter storms and power outages exacerbate risks as people turn to alternative heating sources.
Elevating Equity
Climate change-driven extreme weather can have greater impacts on some people and communities based on their ability to prepare for, withstand, and recover from events. Learning from previous extreme weather events (2, 3), the following groups face higher risks:
Older adults, children, people who use mobility devices, and people with disabilities who are unable to find protection from a storm or have limited access to transportation.
People who have less capacity or fewer resources to gather supplies for extreme weather events, as well as to cover costs related to post-storm recovery.
Communities who are isolated culturally, linguistically, or by technology barriers, like limited internet, may not have access to appropriate emergency communications.
People who are experiencing houselessness and do not have means to shelter.
Communities of color that have experienced historic redlining, structural exclusion, or lived in areas that have not been prioritized for public works enhancements.
Communities that are geographically isolated or do not have backup systems for essential services like water, power, or travel routes damaged by extreme weather.
Trends
This section looks at Emergency Department and Urgent Care (ED/UC) visits, hospitalizations, and deaths due to cold-related illness. There is also an analysis of hospitalizations for ice falls and unintentional carbon monoxide poisoning.
These data look at the months of October – March, referred to as the “cold season.”
Cold-Related Illness
Cold-Related Illness Annual Counts
Cold-Related Illness Emergency Department and Urgent Care Visits
Key Takeaway: “The number of ED/UC visits for cold-related illness has been steady for the last few years, with a decrease in 2024.”
Alt Text: “Vertical bar chart showing the number of cold-related illness ED/UC visits for each county and the region from the 2019 to 2024 cold months.”
Cold-Related Illness Hospitalizations
Key Takeaway: “The number of cold-related illness hospitalizations have steadily increased in Washington and Multnomah counties, driving a regional increase.”
Alt Text: “Vertical bar chart showing the number of cold-related illness hospitalizations from the 2019 to 2024 cold months for each county and the region.”
Cold-Related Illness Deaths
Key Takeaway: “The number of cold-related illness deaths increased in 2021 and have declined since.”
Alt Text: “Vertical bar graph showing the number of cold-related illness deaths from 2019 to 2024 cold months for each county and the region.”
Cold-Related Illness Rates
Cold-Related Illness Emergency Department and Urgent Care Visits
Key Takeaway: “The rates of cold-related illness ED/UC visits per 100,000 ED/UC visits have steadily declined since a peak in 2019 across all counties and the region.”
Alt Text: ” Line graph showing rates of cold-related illness ED/UC visits per 100,000 ED/UC visits from 2016 to 2024 for each county and the region.”
Cold-Related Illness Hospitalizations
Key Takeaway: “The rates of cold-related illness hospitalizations per 100,000 all-cause hospitalizations have risen sharply in Multnomah County since 2019, driving a slight regional increase. Clackamas County has seen a decline since a peak in 2021. Rates in Washington County have steadily increased since 2016.”
Alt Text: “Line graph showing rates of cold-related illness hospitalizations per 100,000 all-cause hospitalizations from 2016 to 2024 for each county and the region.”
Cold-Related Illness Deaths
Key Takeaway: “Rates of cold-related illness deaths per 100,000 all-cause deaths saw a peak in 2021 and have steadily declined in all counties and regionally.”
Alt Text: “Line graph showing rates of cold-related illness deaths per 100,000 all-cause deaths from 2016 to 2024 for each county and the region.”
Ice Falls
Ice Falls Annual Counts
Ice Falls Hospitalizations
Key Takeaway: “Hospitalizations for falls caused by ice saw a large increase in 2024.”
Alt Text: “Bar graph showing hospitalizations for falls caused by ice during the 2019 - 2024 cold months by county and region.”
Ice Falls Rates
Ice Falls Hospitalizations
Key Takeaway: “The rate of hospitalizations for falls caused by ice per 100,000 saw large increases in 2017 and 2024.”
Alt Text: “Line graph showing hospitalizations for falls caused by ice for the 2016 to 2024 cold months for all counties and the region.”
Carbon Monoxide Exposure
Carbon Monoxide Exposure Annual Counts
Carbon Monoxide Exposure Emergency Department and Urgent Care Visits
Key Takeaway: “ED/UC visits for unintentional carbon monoxide poisoning remained steady until 2023, when there was a large increase in Multnomah County that drove a regional increase.”
Alt Text: “Bar graph showing ED/UC visits of unintentional carbon monoxide poisoning during 2019 to 2024 cold months by county and for the region.”
Carbon Monoxide Exposure Rates
Carbon Monoxide Exposure Emergency Department and Urgent Care Visits
Key Takeaway: “Rates of ED/UC visits for unintentional carbon monoxide poisoning per 100,000 total ED/UC visits remained steady in Multnomah county until 2023. Clackamas County saw increases in 2016 and 2019.”
Alt Text: “Line graph showing the rates of ED/UC visits for unintentional carbon monoxide poisoning per 100,000 total ED/UC visits from 2016 to 2024 for the three counties and the region.”
Demographics
This section looks at demographic information of emergency department and urgent care (ED/UC) visits, hospitalizations, and deaths for the region. Percentage of visits from 2016 – 2024 are shown for age, race/ethnicity, and sex.
Cold Related Illness
Cold Related Illness Demographics
Cold Related Illness Emergency Department and Urgent Care Visits
Key Takeaway: “The percentage of men was higher for cold-related ED/UC visits compared with total visits for men. Younger adults (18 – 44) saw lower percentages compared with total visits for this age group. Black people saw a higher percentage of ED/UC visits compared to total visits for Black people.”
Alt Text: “Table comparing cold-related ED/UC visits and all ED/UC visits by age, race and ethnicity, and sex during the 2021 to 2024 cold months in the tri-counties.”
Category
Sub-Category
Cold-Related ED Visits
All ED Visits
Sex
Male*
0.60
0.45
Sex
Female*
0.40
0.55
Age
Older Adult (45-64)*
0.33
0.24
Age
Younger Adult (18-44)*
0.28
0.39
Age
Older Senior (75+)*
0.15
0.11
Age
Senior (65-74)*
0.14
0.11
Age
Preschool (0-4)*
0.07
0.05
Age
Adolescence (10-17)*
0.01
0.06
Age
Childhood (5-9)*
0.00
0.04
Race Alone
White alone
0.65
0.64
Race Alone
Other Race
0.12
0.11
Race Alone
Black or African American alone*
0.10
0.06
Race Alone
Hispanic or Latino*
0.09
0.12
Race Alone
Asian alone*
0.02
0.05
Race Alone
American Indian or Alaska Native alone
0.01
0.01
Race Alone
Native Hawaiian or Pacific Islander alone
0.01
0.01
Cold Related Illness Hospitalizations
Key Takeaway: “Men had a higher percentage cold-related hospitalizations compared with total hospitalizations for men. Women saw much lower percentages. Older adults (45 – 64) had much higher percentages of hospitalizations compared with all hospitalizations for that age group. White and Black people had higher percentages of cold-related hospitalizations, while Hispanic people had lower percentages of hospitalizations compared with all hospitalizations.”
Alt Text: “Table comparing cold-related hospitalizations and all hospitalizations by age, race and ethnicity, and sex during the 2021 – 2024 cold months in the tri-counties.”
Category
Sub-Category
Cold-Related Hospitalizations
All Hospitalizations
Sex
Male*
0.69
0.47
Sex
Female*
0.31
0.53
Age
Older Adult (45-64)*
0.43
0.21
Age
Younger Adult (18-44)
0.22
0.21
Age
Senior (65-74)
0.18
0.16
Age
Older Senior (75+)*
0.16
0.23
Age
Preschool (0-4)*
0.01
0.17
Age
Adolescence (10-17)*
0.01
0.02
Race Alone
White alone*
0.71
0.65
Race Alone
Black or African American alone*
0.11
0.06
Race Alone
Refused/Unknown/NA*
0.07
0.11
Race Alone
Hispanic or Latino*
0.05
0.09
Race Alone
Other Race alone
0.03
0.04
Race Alone
Asian alone*
0.02
0.05
Race Alone
American Indian or Alaska Native alone
0.01
0.01
Race Alone
Native Hawaiian or Pacific Islander alone
0.00
0.01
Cold Related Illness Deaths
Key Takeaway: “The percentage of men was higher for cold-related deaths compared to all deaths in men. Women saw much lower percentages of cold-related deaths compared to all deaths in women. There were higher percentages across ages 18 – 74, while adults ages 75+ saw lower percentages. Black people saw higher percentages of cold-related deaths compared with total deaths in Black people.”
Alt Text: “Table comparing cold-related deaths with all deaths by age, race and ethnicity, and sex during the 2021 – 2024 cold months in the tri-counties.”
Category
Sub-Category
Cold-Related Deaths
All Deaths
Sex
Male
0.65
0.54
Sex
Female
0.35
0.46
Age
Older Adult (45-64)*
0.35
0.17
Age
Senior (65-74)
0.23
0.20
Age
Younger Adult (18-44)*
0.23
0.08
Age
Older Senior (75+)*
0.19
0.54
Race Alone
White alone
0.81
0.85
Race Alone
Black or African American alone
0.12
0.04
Race Alone
American Indian and Alaska Native alone
0.04
0.01
Race Alone
Asian alone
0.04
0.04
Cold Related Illness Rates by Demographic
Cold Related Illness Emergency Department and Urgent Care Visits
Key Takeaway: “The rate of cold-related ED/UC visits for all ages has declined when comparing 2019 – 2022 to 2023 – 2024, with the exception of preschool (0 – 4) aged people who saw a large increase between the two time frames. Visits by race have declined or remained steady, with the exception of Native Hawaiian or Pacific Islander people, who saw a large increase in visits. Visits by sex have remained steady.”
Alt Text: “Barbell chart comparing rates of cold-related ED/UC visits per 100,000 total visits in 2019 – 2022 with rates in 2023 – 2024 by patient age, race and ethnicity, and sex.”
Cold Related Illness Hospitalization
Key Takeaway: “The rate of hospitalizations for cold-related illness for young adults increased while other age groups remained steady when comparing visits in 2019 – 2022 and visits in 2023 – 2024. Hospitalizations for men and women have remained steady. Hospitalizations have increased across all racial groups.”
Alt Text: “Barbell chart showing rates of cold-related hospitalizations per 100,000 total hospitalizations for 2019 – 2022 compared with 2023 – 2024 by patient age, race and ethnicity, and sex.”
Cold Related Illness Deaths
Key Takeaway: “The percentage of cold-related deaths in younger adults, older adults, and older seniors have gone down when comparing deaths in 2019 – 2022 with deaths in 2023 – 2024, while seniors saw a slight increase. Deaths for Asian people have increased, while other races have remained steady. Deaths for men and women have gone down.”
Alt Text: “Barbell chart showing rates of cold-related deaths per 100,000 total deaths for 2019 – 2022 compared with 2023 – 2024 by patient age, race and ethnicity.”
Ice Falls
Ice Falls Demographics
Ice Falls Hospitalizations
Key Takeaway: “The percentage of hospitalizations for falls caused by ice for men was higher than visits for all hospitalizations, while women saw a smaller percentage compared with all hospitalizations. People ages 45+ saw a much higher percentage for ice falls when compared to all hospitalizations. White people saw higher percentages of hospitalizations, while other races so lower percentages for ice falls when compared to total hospitalizations.”
Alt Text: “Table comparing hospitalizations for ice falls and all hospitalizations by age, race and ethnicity, and sex in the tri-county region.”
Category
Sub-Category
Falls Hospitalizations
All Hospitalizations
Sex
Male*
0.64
0.47
Sex
Female*
0.36
0.53
Age
Older Senior (75+)*
0.32
0.23
Age
Older Adult (45-64)*
0.30
0.21
Age
Senior (65-74)*
0.27
0.16
Age
Younger Adult (18-44)*
0.11
0.21
Age
Adolescence (10-17)
0.01
0.02
Age
Preschool (0-4)*
0.00
0.17
Age
Childhood (5-9)
0.00
0.01
Race Alone
White alone*
0.82
0.65
Race Alone
Refused/Unknown/NA*
0.07
0.11
Race Alone
Black or African American alone*
0.03
0.06
Race Alone
Hispanic or Latino*
0.03
0.09
Race Alone
Other Race alone
0.03
0.04
Race Alone
Asian alone*
0.01
0.05
Race Alone
American Indian or Alaska Native alone
0.00
0.01
Ice Falls Rates by Demographic
Key Takeaway: ” The rate of hospitalizations per 100,000 for falls caused by ice saw large increases across most age groups when comparing 2019 – 2022 to 2023 – 2024. Both men and women saw increases in hospitalizations. All racial and ethnic categories saw increases in hospitalizations when comparing 2019 – 2022 to 2023 – 2024. ”
Alt Text: “Barbell chart showing hospitalizations for ice falls per 100,000 in 2019 – 2022 compared with 2023 – 2024 by patient age, race and ethnicity, and sex.”
Carbon Monoxide
Carbon Monoxide Demographics
Carbon Monoxide Emergency Department and Urgent Care Visits
Key Takeaway: “Younger adults ages 18 – 44 saw a large increase in ED/UC visits when compared to all visits. Black people also saw a large increase in ED/UC visits when compared to all visits.”
Alt Text: “Table comparing ED/UC visits for unintentional carbon monoxide poisoning and all visits by age, race and ethnicity, and sex during the 2021 – 2024 cold months in the tri-counties.”
Category
Sub-Category
CO Exposure ED Visits
All ED Visits
Sex
Male*
0.52
0.45
Sex
Female*
0.48
0.55
Age
Younger Adult (18-44)*
0.52
0.39
Age
Older Adult (45-64)
0.20
0.24
Age
Older Senior (75+)
0.08
0.11
Age
Senior (65-74)
0.07
0.11
Age
Adolescence (10-17)
0.06
0.06
Age
Childhood (5-9)
0.04
0.04
Age
Preschool (0-4)
0.03
0.05
Race Alone
White alone
0.57
0.64
Race Alone
Black or African American alone*
0.13
0.06
Race Alone
Other Race
0.12
0.11
Race Alone
Asian alone
0.08
0.05
Race Alone
Hispanic or Latino
0.08
0.12
Race Alone
American Indian or Alaska Native alone
0.02
0.01
Race Alone
Native Hawaiian or Pacific Islander alone
0.01
0.01
Carbon Monoxide Rates by Demographic
Carbon Monoxide Emergency Department and Urgent Care Visits
Key Takeaway: “Older adults ages 45 – 64 saw a decreased rate in ED/UC visits for unintentional carbon monoxide poisoning while all other ages saw increased rates when comparing visits in 2019 – 2022 to 2023 – 2024. Black, Hispanic, Native Hawaiian and Pacific Islanders saw increased rates, while Asian and American Indian and Alaska Natives groups saw decreased rates. Men saw a large increase in the rate of ED/UC visits for unintentional carbon monoxide poisoning.”
Alt Text: “Barbell chart showing rates of ED/UC visits for unintentional carbon monoxide poisoning per 100,000 total visits for 2019 – 2022 compared with 2023-2024 by patient age, race and ethnicity, and sex.”
Notes
Data details
Data for Cold-Related Illness, falls, and carbon monoxide poisoning came from the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) in Oregon. The number of hospitalizations was obtained by request from the Office of Health Analytics at Oregon Health Authority Health Policy and Analytics Division. This data was October-March 2016-2024. Data on deaths came from death certificates from Oregon Vital Statistics. See table of winter weather health indicators for more details.
Vital records data captures information on the cause and manner of death, and demographic information about the decedent. Deaths have one underlying cause and up to twenty contributing causes that are recorded by a medical professional or the county medical examiner. The underlying cause is the disease or injury that initiated the chain of events leading to death. Contributing causes contribute to death but are not to the ultimate direct cause. All causes of death are translated into codes (ICD-10, or International Statistical Classification of Disease, 10th revision) which can then be queried to find heat related deaths.
These data were for the months of October-March from 2016-2024.
Each query looks for ICD-9 and ICD-10 codes related to the specific health outcome of interest. Query details and sources are presented in the table of winter weather health indicators below.
Methods
We obtain data on ED/UC visits of county residents, hospitalization of county residents, and deaths occurring within each county that indicate cold-related illness, falls from slips on ice, and carbon monoxide poisoning (See table of Winter Extreme health indicators). We aggregate indicators per cold season and present annual number of visits for each county and the entire tri-county region in bar graphs. We calculate annual rates of each indicator. Rates for ED/UC visits, hospitalizations, and deaths are among all ED/UC visits, hospitalizations, and deaths for the same time period and region.
We do not calculate visit percent or rates by census population data because some visits and hospitalizations can be by the same person. Urgent care facilities reporting to ESSENCE can also change over time. Therefore, the percentage of indicators is among all ED/UC visits and hospitalizations provides a consistent way to track changes in the burden of climate-related care over time and identify differences between who typically seek care. Rates for deaths are among all deaths in the region for the same time period, since we count the deaths by place of injury and not by place of residence.
Winter Weather Health Indicators
Health Outcome
Data Source
Query Details
Cold-related illness (ED/UC Visits) (Cold-related illness refers to illness or injury related to weather, such as hypothermia and frostbite)
Oregon ESSENCE (Electronic Surveillance System for the Early Notification of Community-Based Epidemics) https://knowledgerepository.syndromicsurveillance.org/cold-related-illness-cste
Keywords in patient records that suggest cold-related illness:
• 'Cold exposure' or similar phrases like:
- 'exposure to cold'
- 'environmental exposure'
- 'cold-exp'
- 'out in the cold'
• Specific cold-related conditions:
- 'frostbite'
- 'frost nip' or 'frostnip'
- 'hypothermia'
- 'frozen fingers,' 'frozen hands,' 'frozen toes,' or 'frozen feet'
Excludes mentions that are clearly unrelated to weather or cold injury:
• Food or meat references (e.g., 'frozen meat,' 'frozen burger,' 'pork')
• Common unrelated body issues (e.g., 'wart,' 'growth,' 'shoulder,' 'knee')
• Routine care or non-urgent check-ups (e.g., 'recheck,' 'history of frostbite,' 'dressing change')
• Respiratory symptoms or infections (e.g., 'cough,' 'chest congestion,' 'infection')
• Codes or notes that point to unrelated conditions (e.g., fever, rashes, other ICD codes like R68.0, 780.65)
Terms and Codes That Suggest Carbon Monoxide Exposure
The query includes: Words or abbreviations that indicate CO poisoning:
• 'monox' (short for monoxide)
• 'carbon monoxide'
• 'carbon oxid' or 'carbonoxid'
• 'CO inh' (short for CO inhalation)
• 'CO pois,' 'CO tox,' 'CO exp' (abbreviated forms of CO poisoning, toxicity, or exposure, including common misspellings or substitutions like zero for O)
ICD or SNOMED diagnosis codes that specifically match CO poisoning:
• Codes starting with T58, which refer to toxic effects of carbon monoxide
• ICD-9 code 986 (toxic effect of carbon monoxide)
• External cause codes like E868.2, E868.3, E868.9 (e.g., exposure to carbon monoxide from a furnace, motor vehicle, or other source)
• SNOMED codes for carbon monoxide poisoning (e.g., 95875007, 17383000)
Terms That Are Excluded (Not Carbon Monoxide Related)
To avoid false matches, the search filters out: Other toxic substances:
• 'Mycotox' (mycotoxins)
• 'Vanco tox' or 'vancotox' (vancomycin toxicity)
• 'Alco tox' or 'alcotox' (alcohol toxicity)
• 'Tobacco exposure' or similar terms
ICD codes for different conditions that look similar to carbon monoxide codes but are not the correct subtypes or stages
Falls (ED/UC Visits) This query looked for free text terms related to falls, including 'slipped,' 'tripped,' and 'stumbled.' Importantly, this subsyndrome does not look for diagnosis codes among ED/UC visits.
Oregon ESSENCE
ChiefComplaintSubSyndrome: Falls SubSyndrome
Cold-related hospitalization among Tricounty residents
and deaths that occurred in the Tricounty region
Office of Health Analytics: Hospital Reporting Program Oregon Vital Statistics
ICD 10 Codes: T33, T34, T68, T69, and X31
Ice Fall hospitalization among Tricounty residents
Office of Health Analytics: Hospital Reporting Program
ICD code: W00
Note: All queries were conducted for the period October to March, 2016-2024
Other Sections of the Report
You can find the rest of the report in the following links:
