Nationally, the number of cold weather-related illnesses (CRIs) is expected to go down. This prediction comes as winter temperatures continue to rise. However, from 2000 to 2022, hospitalizations and emergency department (ED) visits in Massachusetts have been increasing. In this same time frame CRI mortality rates have more than doubled nationwide.
Those without homes, reliable heating, and those who live alone can be more likely to develop a CRI. Other risk factors include age, sex, income, race, and gender. Mental health, substance use, having a chronic illness, and working outside can also play a role. A study on data from Boston Medical Centers patients, showed that 75% of CRI cases were male and 44% were Black. Non-white Hispanic individuals were 2x likely to experience CRIs. The majority of cases were male and 44% were Black. Non-white Hispanic individuals were 2x likely to experience CRIs.
In 2022, similar trends were seen Statewide in both hospital admission and ED data. Those who were identified as male, Black, Hispanic, and over the age of 35 were more likely to visit the ED for CRI. Those with similar demographics, and over the age of 65, were more likely to be admitted.
You can use the display to review CRI hospitalization or ED rates for any city or town in Massachusetts.
What is cold weather-related illness?
Cold weather-related illness (CRI) is also known as cold stress. CRI refers to a group of health conditions. Hypothermia, frostbite, immersion foot, and chilblains are all conditions included in this measure. These conditions are caused by exposure to cold/freezing temperatures over time.
What are the symptoms of CRI?
Each CRI comes with its own symptoms which can range from being mild to severe. If you recognize these symptoms, get the person out of the cold and seek medical attention as soon as possible.
Hypothermia
Hypothermia is categorized by having a body temperature below 95 degrees. This is very dangerous. Symptoms include:
- Confusion
- Drowsiness
- Pale and/or cold skin
- Slow breathing
- Slow heart rate
- Uncontrollable shivering
- Muscle weakness and loss of coordination
Without proper treatment, hypothermia can lead to heart attack, coma, and even death.
Frostbite
Frostbite is an injury to the skin, most often seen on the hands, feet, nose, and ears, caused by freezing temperatures (below 32 degrees). Skin will often redden and then become white, hard, and swollen. Symptoms of frostbite include:
- Burning and/or tingling sensations
- Numbness
- Loss of feeling in the area
- Throbbing, aching, and pain
- Blisters
In severe cases, frostbite can also lead to dead tissues.
Immersion foot
Immersion Foot is also known as trench foot. It occurs when the feet are wet and cold for a continued amount of time, often several days. Symptoms include:
- Red skin that turns white and swells
- Itching
- Numbness or burning pain
- Leg cramps
- Feet sensitive to the cold
- A slow or absent pulse in the foot
- Blisters, open sores, and ulcers
In severe cases, it can lead to tissue death.
Chilblains
Chilblains occur when skin is chronically exposed to cold, not freezing, temperatures. This exposure causes swelling and blistering and is often seen on the feet and hands. Other symptoms are itchy areas, open sores, pain, stinging, and reddening or whitening of the skin.
What causes CRI?
Cold weather-related illnesses and injuries are caused by exposure to cold and freezing temperatures. In the case of Hypothermia, the low temperature causes the body to lose more heat than it can make. This drops the body’s core temperature. This can lead to decreased function of the brain and heart which affects breathing, movement, and decision-making. Frostbite occurs most commonly when the tissues in your hand freeze. As for chilblains and trench foot, these occur when the skin is cold, or cold and wet, over a long period of time. Long periods of cold skin can lead to decreased circulation and the breakdown of tissues.
Who is at risk for CRI?
Health
Having chronic illness or medical condition can predispose someone to a CRI. This includes illnesses such as:
- Sickle cell anemia
- Circulatory disorders
- Hypotension
- Substance use disorder
- Thyroid and hormone disorders
- Mental health disorders
- Alzheimer’s and other memory disorders
- Diabetes
Individuals who are on certain medications such as beta blockers can also be more likely to be affected by the cold.
Age
Both the elderly and children can be more susceptible to the cold and CRI. This can be due to body size and a lower amount of muscle in these groups can affect their ability to adjust their own body temperature. The elderly are also more likely to have other chronic health conditions. Infants are less able to advocate for themselves and their needs if they become cold.
Work-Related Exposures
Those following jobs may also put individuals at risk:
- Transit workers, such as bus drivers or subway operators
- Water transit workers, for example boat captains and deckhands
- Baggage handlers
- Landscapers and other lawn care service workers
- Support workers for oil and gas operations
- Recreational workers
- Snow cleanup crews
- Construction workers
- First responders
Working outdoors often means being exposed to the cold for long periods of time repeatedly. This can lead to increased injury or injury severity.
Social Factors
The Social Determinants of Health are the social, economic, behavioral, and physical factors that we experience where we work, live and play make up the majority of what impacts our health.
Income, housing availability, and housing quality can all affect a person’s risk of CRI. For example, those experiencing homelessness, those without heat or uninsulated homes, or those unable to afford heat. Additionally, not being able to afford or access winter coats or jackets.
Unfortunately, these social factors disproportionately affect Black, Indigenous, and Hispanic groups. Massachusetts’ has a history of racially discriminatory housing policies. For example, racial housing covenants, redlining, and the stealing and gentrification of indigenous land. These all still affect the availability and quality of housing for these communities. These issues with housing can lead to an increased risk of CRI or injury. For Hispanic groups, language barriers may also play a roll.
How can you prevent CRI?
CRI prevention can be done whether you are inside or outside.
- Try to stay warm and seek indoor spaces that are warm. To find a local community warming center or shelter, call 2-1-1
- Dress in layers, covering as much skin as possible
- Avoid getting wet or sweating
- If using heating devices indoors, be sure to do so safely and in accordance with the device’s instructions. Never use a gas range, oven, or grill for heating. Improper use can lead to carbon monoxide poisoning
- Take the time to check on elderly neighbors and friends
- If you have infants and children, dress them warmly, as you would dress yourself
- In the case of working outside, take your breaks in a warm area or inside and avoid working or having employees work on extremely cold days
- Avoid caffeinated or dehydrating beverages, alcohol, and other substances
- If you are planning to be outside for a hike, sledding, or other activity, make sure someone knows your location and there are safe places nearby to shelter in an emergency
- Pack an extreme cold emergency kit to keep in your car
- Do not ignore shivering, it can be one of the first signs that you are getting too cold!
Massachusetts Emergency Management Agency (MEMA) also offers important tips and information on prevention and staying safe during cold weather, visit Extreme Cold Safety Tips
Why does MA EPHT track CRI?
Climate change is expected to bring about warmer winters. However, cold temperatures will remain a reality in Massachusetts. EPHT tracks emergency visits and hospitalizations due to CRI. This allows us to see changes in CRI over time. We can also identify and monitor areas and populations that are at risk, and support prevention strategies.
Available data
Use the Explore CRI Data link on this page to access the following measures for cold weather-related illness:
- Annual number of hospitalizations / ED visits
- Annual crude rate per 100,000 population
- Annual age-adjusted rate per 100,000 population
- Explore data in tables, charts, and maps
MA EPHT presents case counts and crude rates on CRI emergency department and hospital admissions for the following geographies: city/town, county, EP region, EOHHS region, and statewide. Measures are offered by a combination of year, age group, and sex. The most current data available is shown. Be sure to check the site periodically as new data is added each year. To protect privacy, no information is shown that could identify an individual.
Additional resources
Massachusetts
- MA Department Fire Services Ice and Cold Water Safety | Cómo Protegerse del Agua Fría y el Hielo: Information on cold water safety tips.
- MEMA Extreme Cold Safety Tips: Information on cold weather safety tips.
- MEMA Winter Pet Safety Tips: Information on pet safety tips in cold weather.
National
- OSHA Cold Stress: Information on protecting people working in cold environments.
- CDC Safety Guidelines: During and After a Winter Storm: This page describes ways to protect yourself from winter storms in indoor and outdoor environments.
- CDC Cold-related Illnesses in Workers: This page describes symptoms of these illnesses and how they can be treated.