Increased Patient Density in Period of Heat Waves and Sustainability of Healthcare




Heat Wave, Hospital Admissions, Sustainable Healthcare Services, Patient Density


Studies in recent years show increases in the number and duration of Heat Waves (HWs). These increases in HWs negatively affect human health. For this reason, studies investigating the temperature-health relationship have been carried out in many parts of the world. In this study, the increases in the number and duration of HWs in Fethiye between 1960 and 2019 were examined. For the definition of HWs, it is defined as temperatures that continue for 3 consecutive days or more at 90% of the daily maximum temperatures. In the analyses made using this definition, it was determined that there were significant increases in the number and duration of HWs, especially after 2000. Accordingly, the Risk ratio (RR) calculated by comparing the occurrence of HWs after 2000 with that before 2000 was calculated as 2.59 (95% CI: 2.21-3.05 p<0.05). The year 2018 was chosen to examine the effects of HWs on human health, and the increases in hospital admissions during the 4 HWs periods that occurred in this year were examined. The logarithmic Z test method was used in the analyses to determine the effects of HWs on hospital admissions. Using this method, RRs showing the relationship between HWs and hospital admissions were calculated. Accordingly, the RRs and confidence intervals showing the HWs-health relationship were calculated respectively 1.11(95% CI: 1.08-1.15 p<0.05), 1.15(95% CI: 1.11-1.19, p<0.05), 1.12(95% CI: 1.08-1.16 p<0.05) and 1.38(95% CI: 1.34-1.42 p<0.05). These results show that patient density increases in hospitals during HWs periods. Considering that HWs will occur more frequently and for longer periods of time in the future, more investment in the health sector is needed for sustainable health care.


Alessandrini, E., Sajani, S. Z., Scotto, F., Miglio, R., Marchesi, S., & Lauriola, P. Emergency ambulance dispatches and apparent temperature: A time series analysis in Emilia–Romagna, Italy. Environmental research, 2011, 111(8), 1192-1200.

Anderson G. B., Bell M. L.,(2011). Heat waves in the united states: mortality risk during heat waves and effect modification by heat wave characteristics in 43 U.S. communities. Environ Health Perspect, 119:210–218. doi:10.1289/ehp.1002313

Carina J. Gronlund, Antonella Zanobetti, Joel D. Schwartz, Gregory A. Wellenius, and Marie S. O’Neill 2014. Heat, Heat Waves, and Hospital Admissions among the Elderly in the United States, 1992–2006. Environmental Health Perspectives 122:11 CID:

Dhainaut, J. F., Claessens, Y. E., Ginsburg, C., Riou, B.,(2004). Unprecedented heat-related deaths during the 2003 heat wave in paris: consequences on emergency departments. Critical Care, 8 ,1.

D'Ippoliti D, Michelozzi1 P, Marino1 C, de'Donato1 F, Menne B, Katsouyanni K, Kirchmayer U, Analitis A, Medina-Ramón M., Paldy, A., Atkinson, R., Kovats, S., Bisanti, L., Schneider, A., Lefranc, A., Iñiguez, C., Perucc, A. C., The impact of heat waves on mortality in 9 European cities: results from the euroheat project. Environmental Health, 2010; 9:37

Domeisen, D.I.V., Eltahir, E.A.B., Fischer, E.M. vd. Prediction and projection of heatwaves. Nat Rev Earth Environ 4, 36–50 (2023).

Erlat, E., Türkeş, M., & Aydin-Kandemir, F. Observed changes and trends in heatwave characteristics in Turkey since 1950. Theoretical and Applied Climatology, 2021, 145(1), 137-157.

FDMD. Fethiye district meteorology directorate., (accessed on 2 July 2021).

FDPD, Fethiye district population directorate., (accessed on 2 July, 2021).

Hajat, S., Armstrong, B., Baccini, M., Biggeri, A., Bisanti, L., Russo, A., Paldy, A., Menne, B., and Kosatsky, T. Impact of high temperatures on mortality is there an added heat wave effect. Epidemiology 2006;17: 632-638. Doi: 10.1097/01.Ede.0000239688.70829.63

Hansen, A. L., Bi, P., Ryan, P., Nitschke, M., Pisaniello, D., & Tucker, G. (2008). The effect of heat waves on hospital admissions for renal disease in a temperate city of Australia. International journal of epidemiology, 37(6), 1359-1365.

Hong Y-J, Min Y-K, Lee S, Choi S. Expanded Orientation of Urban Public Health Policy in the Climate Change Era: Response to and Prevention of Heat Wave in Paris and Seoul: A Brief Review. Iran J Public Health. 2022;51(7):1461-1468

Huang, C., Barnett, A. G., Wang, X., & Tong, S. (2012). Effects of extreme temperatures on years of life lost for ca

rdiovascular deaths: a time series study in Brisbane, Australia. Circulation: Cardiovascular Quality and Outcomes, 5(5), 609-614

Huynen, M.T.E. M., Martens, P., Schram. D., Weijenberg, M. P., Kunst, A. E., The impact of heat waves and cold spells on mortality rates in the dutch population. Environ Health Perspect 2001;109:463–470.

Knowlton, K., Rotkin-Ellman, M., King, G., Margolis, H. G., Smith, D., Solomon, G., ... & English, P. (2009). The 2006 California heat wave: impacts on hospitalizations and emergency department visits. Environmental health perspectives, 117(1), 61-67.

Lissner, T. K., Holsten, A., Walther, C., & Kropp, J. P. (2012). Towards sectoral and standardised vulnerability assessments: the example of heatwave impacts on human health. Climatic change, 112(3), 687-708.

Nitschke, M., Tucker, G. R., Bi, P., Morbidity and mortality during heatwaves in metropolitan Adelaide. The Medical jounal of Australia, 2007;187: 662–665.

Peng, R. D., Bobb, J. F., Tebaldi, C., McDaniel, L., Bell, M. L., & Dominici, F. (2011). Toward a quantitative estimate of future heat wave mortality under global climate change. Environmental health perspectives, 119(5), 701-706.

Perkins, S. E., Alexander, L. V., On the measurement of heat waves. Journal of Climate 2013; 26: 4500-4517. Doi: 10.1175/JCLI-D-12-00383.1

Poumadere, M., Mays, C., Le Mer, S., & Blong, R. The 2003 heat wave in France: dangerous climate change here and now. Risk Analysis: an International Journal, 2005; 25(6), 1483-1494.

Robinne J. M, Cheung S. L. K, Roy S. L, Oyen H. V, Griffiths C, Michel J. P, Herrmann F. R. Death toll exceeded 70,000 in Europe during the summer of 2003. C. R. Biologies 2008; 331: 171–178

Rocklov, J., Barnett, A. G., & Woodward, A. On the estimation of heat-intensity and heat-duration effects in time series models of temperature-related mortality in Stockholm, Sweden. Environmental Health, 2012; 11(1), 1-12.

Schaffer, A., Muscatello, D., Broome, R. et al. Emergency department visits, ambulance calls, and mortality associated with an exceptional heat wave in Sydney, Australia, 2011: a time-series analysis. Environ Health 11, 3 (2012).

Semenza C. J., McCullough E. J., Flanders D. W., McGeehin A. M., Lumpkin R. J. Excess hospital admissions during the July 1995 heat wave in Chicago. American Journal of Preventive Medicine, Volume 16, Issue 4, 1999, Pages 269-277, ISSN 0749-3797,

Semenza C. J., McCullough E. J., Flanders D. W., McGeehin A. M., Lumpkin R. J. Excess hospital admissions during the July 1995 heat wave in Chicago. American Journal of Preventive Medicine, Volume 16, Issue 4, 1999, Pages 269-277, ISSN 0749-3797,

Smoyer-Tomic, K.E., Kuhn, R. & Hudson, A. Heat Wave Hazards: An overview of heat wave impacts in Canada. Natural Hazards 28, 465–486 (2003).

Son, JY., Bell, M.L. & Lee, JT. The impact of heat, cold, and heat waves on hospital admissions in eight cities in Korea. Int J Biometeorol 58, 1893–1903 (2014).

Tan, J., Zheng, Y., Tang, X., Guo, C., Li, L., Song, G., ... & Chen, H. (2010). The urban heat island and its impact on heat waves and human health in Shanghai. International journal of biometeorology, 54(1), 75-84.

Tong, S., Wang, XY., Barnett, AG., Assessment of heat-related health impacts in Brisbane, Australia: comparison of different heatwave definitions. Plos One 2010; 5(8): E12155.

Unal, Y., Tan, E., Menteş, S., Summer heat waves over western turkey between 1965 and 2006. Theor Appl Climatol 2013; 112:339–350

Williams, S., Nitschke, M., Weinstein, P., Pisaniello, D. L., Parton, K. A., Bi, P. The impact of summer temperatures and heatwaves on mortality and morbidity in Perth, Australia 1994–2008, Environment International, Volume 40, 2012, Pages 33-38, ISSN 0160-4120,

Zhang, K., Chen, T. H., Begley, C. E., Impact of the 2011 heat wave on mortality and emergency department visits in Houston, Texas. Environmental Health 2015; 14:11



How to Cite

ÖZTÜRK, Y., BALTACI, H., & AKKOYUNLU , B. O. (2023). Increased Patient Density in Period of Heat Waves and Sustainability of Healthcare. International Journal of Sustainability, 1(1), 48–57.