Current Trends Hypothermia-Related Deaths -- North Carolina, November 1993-March 1994

For 1979-1991, North Carolina (1990 population: 6,628,637) ranked second in number and ninth in rate of deaths associated with hypothermia (clinically defined as an unintentional lowering of the body temperature to less than or equal to 95 F {less than or equal to 35 C}) {1}). From November 1993 through March 1994, a total of 28 deaths attributed to hypothermia were reported to the Office of the Chief Medical Examiner in North Carolina. This report summarizes information about those deaths and describes specific findings for four deaths that reflect circumstances commonly associated with hypothermia. Summary of Findings

Of the 28 hypothermia-associated deaths in North Carolina during November 1993-March 1994, 16 (57%) occurred among men, three (11%) among persons who were homeless, and 13 (46%) among persons in whom alcohol abuse was mentioned on the pathology or police report. The median age of the decedents was 65.5 years (range: 32- 91 years). Specific Findings for Four Deaths

Case 1. On November 23, 1993, an 83-year-old woman with Alzheimer disease was found dead in a field. On November 20, dressed only in lightweight clothing, she had wandered away from a nearby nursing home. The average low temperature for the 3 days she was missing was 34 F (1.1 C). The autopsy report listed hypothermia as the cause of death.

Case 2. On December 12, 1993, a fully clothed 58-year-old man was found dead in a grassy area behind a store. He had a history of chronic alcohol abuse. At autopsy, his blood alcohol concentration (BAC) was 0.26 g/dL. The average temperature the day the decedent was found was 32 F (0 C). Death was attributed to a combination of hypothermia and ethanol intoxication (North Carolina state law defines legal intoxication as a BAC greater than 0.08 g/dL). The decedent's only known residence was a shelter for the homeless.

Case 3. On January 22, 1994, a 32-year-old man was found unconscious in his vehicle, which had minimal damage from an apparent single-car collision on an ice-covered dirt road. When admitted to the hospital, his core body temperature was 92 F (33.3 C), and his BAC was 0.56 g/dL. He died 2 days later; death was attributed to aspiration pneumonia with hypothermia listed as a contributing cause. The low temperature the day he was found was 14 F (-10 C).

Case 4. On February 2, 1994, a 55-year-old man was found unclothed in his unheated home. When admitted to the hospital, his core body temperature was 80 F (26.7 C), and his BAC was 0.11 g/dL. He died within 24 hours; his death was attributed to complications resulting from hypothermia. The low temperature the day he was found was 26 F (-3.3 C). Reported by: JD Butts, MD, Office of the Chief Medical Examiner, Div of Postmortem Medicolegal Examination, North Carolina Dept of Environment, Health, and Natural Resources. Div of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC.

Editorial Note

Editorial Note: From 1979 (the earliest year for which on-line data are available) through 1991, an annual average of 770 persons died from hypothermia * in the United States (range: 586 in 1991 to 1021 in 1983) Figure_1; the age-adjusted annual death rate for hypothermia during this period was 0.2 deaths per million population. Most of these deaths occurred among males (67%) and whites (61%). Sex- and race-specific annual death rates were higher for black males than for white males (13.7 versus 3.2 deaths per million) and for black females than white females (4.1 versus 0.1 deaths per million). Approximately 50% of all hypothermia-related deaths occurred among persons aged greater than 64 years. These differences in risks for hypothermia-associated death may reflect differences in socioeconomic status, nutritional status, condition of clothing, and access to adequate shelter. The risk for hypothermia is increased among the elderly in mildly cool environments (i.e., 65 F {18 C}) because of an impaired shivering mechanism, lower levels of protective fat, limited mobility, and lower metabolic rate (2).

From 1979 through 1991, the highest total number of deaths from hypothermia occurred in Illinois (633); the age-adjusted death rate was highest in Alaska (29 deaths per million). States in the highest quartiles for both number of deaths and hypothermia death rates included those characterized by severe winter weather (e.g., Illinois, New York, and Pennsylvania) as well as those having milder climates (e.g., North Carolina, South Carolina, and Virginia).

The onset of hypothermia is insidious; early manifestations include shivering, numbness, fatigue, poor coordination, slurred speech, impaired mentation, blueness or puffiness of the skin, and irrationality (3). Risk factors associated with hypothermia are consumption of alcoholic beverages, using neuroleptic medications, hypothyroidism, mental illness, starvation, poverty, and any immobilizing illnesses (2).

Early recognition and prompt treatment of hypothermia can prevent morbidity and death. Most hypothermia deaths can be prevented through measures that include wearing layered, insulated clothing (particularly head gear, because 30% of body heat loss occurs from the head), maintaining adequate fluid and caloric intake, and having adequate heated shelter. Targeting prevention efforts to groups at elevated risk during cold weather and provision of adequate shelter may reduce the number of hypothermia-related deaths.

References

1. Kilbourne EM. Cold environments. In: Gregg MB, ed. The public health consequences of disasters. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1989:63-8.

2. Berkow R, ed. The Merck manual of diagnosis and therapy. 16th ed. Rahway, New Jersey: Merck and Company, 1992.

3. CDC. Hypothermia -- United States. MMWR 1983;32:46-8.

* Data obtained from the Compressed Mortality File maintained by CDC. Hypothermia was defined as the International Classification of Diseases, Ninth Revision, codes E901.0, E901.8, and E901.9 and excludes manmade cold (E901.1).

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