Racial and socioeconomic disparities in heat-related health effects and their mechanisms: a review

Adaptation to increasing extreme heat in a changing climate requires a precise understanding of who is most vulnerable to the health effects of extreme heat. The evidence for race, ethnicity, income, education, and occupation at both the individual and area levels as indicators of vulnerability is reviewed. The evidence for the social, behavioral, and technological mechanisms by which racial and socioeconomic disparities in vulnerability exist is also reviewed. These characteristics include cardiorespiratory, renal and endocrine comorbidities; cognitive, mental, or physical disabilities; medication use; housing characteristics; neighborhood characteristics such as urban heat islands, crime, and safety; social isolation; and individual behaviors such as air conditioning use, opening windows, using fans, and use of cooler public spaces. Pre-existing and future research identifying these more proximal indicators of vulnerability will provide information that is more generalizable across locations and time to aid in identifying who to target for prevention of heat-associated morbidity and mortality.