Author(s) :

Koeun Kwak.

Volume/Issue :

Abstract :

Extreme heat increases emergency department (ED) utilization. However, there are only a few place-level studies conducted to see whether industry mix in a community may signal vulnerability to extreme heat. This study specifically seeks to answer whether localities in Virginia with a higher outdoor-labor employment share tend to experience higher rates of heat-related illness (HRI) emergency department (ED) visit. This study hypothesized that localities with higher outdoor-labor share may have higher heat-related illness ED visit rates. Two datasets: Virginia Department of Health locality HRI counts (VHD HRI, year 2025) and Bureau of Labor Statistics (BLS) Quarterly Census of Employment and Wages (QCEW, 2023) were merged to generate outdoor-labor share (construction + natural resources & mining) / All private industries. Records with jurisdictions combined by VDH were retained, and labels were programmatically split and allocated with HRI counts in proportion to QCEW “All industries” employment in each component and rounded with integers. 114 unique localities (with 125 complete-case entries) were included in the analytic datasets. The primary model was Poisson generalized linear model applied with log link and log(QCEW “All industries”) size offset. Incidence rate ratios (IRRs) were estimated per 10-percentage-point increase in outdoor-labor share with standard errors. With the Poisson (offset) estimates, the hypothesis in this study was supported. IRR was 1.60 (95% confidence interval 1.10-2.33, p=0.013). A Negative Binomial sensitivity with Akaike Information Criterion-selected dispersion (α ≈ 0.93) was directionally positive but less precise. IRR was 1.21 (95% confidence interval 0.96-1.53, p=0.104). The ecological (place-level) analysis in this study suggests that industry structure can inform targeting of heat-health prevention.