The Impact of Climate-Related Extreme Weather on U.S. Health Care Utilization and Costs

BackgroundAs global temperatures rise due to the climate crisis, extreme weather events like heatwaves, wildfires, hurricanes, and flooding are becoming more frequent, intense, and deadly. These events increase health risks, including cardiovascular, respiratory, and mental health disorders, which escalate health care utilization and strain the already overburdened United States (U.S.) health care system. Unfortunately, climate denialism does not stop the impact on the U.S. health care facilities or patients. Addressing these issues will improve health and lower health system and patient costs. This rapid evidence review examines U.S.-based studies published between 2018 and 2023 to understand the impact of climate change on health care utilization and costs, identify areas for further research, and discuss policy implications. MethodsA PubMed search identified U.S.-based studies published between 01/01/2018 and 10/31/2023 on health care utilization and costs related to extreme heat, wildfires, and hurricanes/floods. Three independent reviewers extracted key characteristics, including study design, sample size, location, participant sociodemographics, outcomes, and implications for health equity. ResultsOut of 554 identified studies, 54 met the inclusion criteria: 21 on heat, 12 on wildfires, and 21 on hurricanes/floods. Geographic patterns emerged, with 38% of extreme heat-related studies focusing on events in the Northeast, 75% of wildfire studies examining trends in the West, and 52% of hurricane/flooding studies using data from the South. Most studies (71%) reported demographics such as age, sex, and race/ethnicity, but none included data on persons with disabilities. One study focused on veterans health care utilization before and after Hurricane Harvey. Across all studies, participant ages varied: 33% included all ages, 9% focused on individuals 25 or younger, 11% on adults 18 or older, and 26% on adults 65 and older, with 20% not reporting age. The studies showed that extreme weather events led to increased health care utilization, including emergency department (ED) visits, Emergency Medical Services (EMS) calls, hospitalizations, and outpatient services. Older adults, Black individuals, and those of lower socioeconomic status experienced higher health care utilization. Only two studies examined health care costs, each within one year of Hurricane Sandy (2012) and the 2016 Baton Rouge flooding, both demonstrating increased health care costs during these periods. ConclusionThe evidence is undeniable: climate events- no matter where they occur or whom they impact -- drive up health care spending and utilization, straining systems already under pressure. Yet, critical gaps remain. We lack a complete understanding of the long-term consequences, the disproportionate burden on vulnerable populations, and the specific risks faced by individuals with chronic conditions such as cancer, HIV, and kidney disease. The absence of robust data on both immediate and sustained health care costs further weakens our ability to respond effectively. Urgent, targeted research is imperative to fill these gaps, shape strategic interventions, and drive policies that ensure health care systems can withstand and adapt to the escalating challenges climate change poses.