Nationally, the number of people experiencing cold weather-related illness (CRI) is expected to go down. This prediction comes as winter temperatures continue to rise.
However, CRI hospitalizations and emergency department (ED) visits in Massachusetts have increased from 2000 to 2022. In this same timeframe, CRI mortality rates more than doubled nationwide.
People who are more likely to develop a CRI include those without homes, reliable heating, and those who live alone. Substance use, working outside, and having a chronic health condition or mental health disorder can also increase risk.
A study of Boston Medical Center patients showed that about 75% of ED visits for CRI during 2005-2015 occurred among males and about 44% occurred among those who identified as Black non-Hispanic. Non-white Hispanic individuals were twice as likely to experience CRIs compared to others.
In 2022, similar trends were seen statewide in both hospital admission and ED data. Those who identified as male, Black, or Hispanic were more likely to visit the ED for CRI. Those who were also over age 65 were more likely to be admitted for hospitalization.
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 caused by exposure to cold or freezing temperatures over time. CRI includes hypothermia, frostbite, immersion foot, and chilblains.
Why does MA EPHT track CRI?
Climate change is expected to bring about warmer winters. However, cold temperatures will remain a reality in Massachusetts.
MA EPHT tracks ED visits and hospitalizations for CRI. Tracking allows us to look at changes in CRI over time. We can also identify and monitor geographic areas and populations that are most at risk to inform prevention strategies.
What are the symptoms of CRI?
Each CRI has its own set of symptoms which can range from mild to severe. If you recognize these symptoms, get out of the cold and seek medical attention as soon as possible.
Hypothermia
Hypothermia occurs when a person’s body temperature is below 95 degrees. This is very dangerous.
Symptoms of hypothermia 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 caused by freezing temperatures (below 32 degrees). It occurs most often on the hands, feet, nose, and ears. 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 cause permanent damage and lead to tissue death (called gangrene).
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 of immersion foot 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, immersion foot can lead to tissue death (gangrene).
Chilblains
Chilblains occur when skin is exposed to cold temperatures (but not freezing), often in combination with dampness.
Symptoms of chilblains include:
- Swelling and blistering, often on the feet and hands
- 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/or 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. Hypothermia can lead to decreased function of the brain and heart, which affects breathing, movement, and decision-making. Frostbite most commonly occurs when your body tissues freeze. Immersion foot and chilblains occur when the skin is cold (and often wet) over a long period of time. This can lead to decreased circulation and the breakdown of tissues.
Who is at risk for CRI?
Health
Having a chronic illness or medical condition can predispose someone to a CRI. This includes:
- 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 affected by the cold.
Age
Infants, young children and older adults (age 65 and older) can be more susceptible to the cold. This can be due to body size and a lower amount of muscle, which can affect their ability to adjust their own body temperature. Older adults are also more likely to have other chronic health conditions.
Work-Related Exposures
Working outdoors often means repeatedly being exposed to the cold for long periods of time. The following jobs may put individuals at higher risk:
- Transit workers, such as bus drivers or subway operators
- Water transit workers, such as 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
Social Factors
Our health is impacted by the social determinants of health (SDoH). These are the social, economic, and physical factors where we work, live, and play.
Income, housing availability, and housing quality can all affect a person’s risk of CRI. For example, those experiencing homelessness, without heat, with uninsulated homes, or unable to afford heat are at higher risk. Additionally, those unable to afford or access winter coats or jackets are also at higher risk.
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, possibly increasing the risk of CRI.
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 unintentional carbon monoxide poisoning.
- Take time to check on elderly neighbors and friends
- If you have infants and children, dress them warmly (as you would dress yourself)
- If working outside, take breaks in a warm area or inside. 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. Be aware of safe places to shelter in an emergency.
- Keep a kit for an extreme cold emergency in your car
- Do not ignore shivering -it can be one of the first signs that you are getting too cold!
Learn more Extreme Cold Safety Tips from the Massachusetts Emergency Management Agency (MEMA).
Available data
Use the Explore CRI hospitalization 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. To protect privacy, no information is shown that could potentially identify an individual.
Additional resources
Massachusetts
- MA Department Fire Services Ice and Cold Water Safety: 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
- CDC Safety Guidelines for During and After a Winter Storm: Information on how to protect yourself from winter storms when indoors and outdoors
- CDC Cold-related Illnesses in Workers: This page describes symptoms of these illnesses and how they can be treated
- OSHA Cold Stress: Information from the Occupational Health and Safety Administration on protecting people working in cold environments