Projected Increases in Heat-Related Emergency Department Imaging Utilization Under Climate Change Scenarios

The impact of climate-driven warming on future demand for medical imaging remains unclear.

To project temperature-attributable excess imaging volumes requested by emergency departments (ED) under future climate scenarios.

Associations between ambient temperature and imaging utilization were estimated during the baseline period (2013-2022) using data from 5 EDs in Toronto. Baseline exposure-response relationships were applied to statistically downscaled, bias-corrected daily temperature projections through 2092 from an ensemble of 23 general circulation models. Temperature-attributable excess ED imaging volumes were projected by decade under 3 Shared Socioeconomic Pathways (SSPs).

Higher ambient temperature was associated with increased imaging utilization at baseline (incidence rate ratio 1.033; 95% CI, 1.028-1.037; P < .001). Temperature-attributable emergency medical imaging utilization is projected to increase under all climate scenarios. Relative increases ranged from 0.04% to 0.10% in the early period (2023-2032), with a 3- to 12-fold increase over the study period. By 2083 to 2092, temperature-attributable emergency imaging utilization is projected to increase by 0.32% (95% CI, 0.28-0.37) under the SSP1-2.6 low-emissions scenario and by 1.25% (95% CI, 1.08-1.43) under the SSP3-7.0 high-emissions scenario. This corresponds to annual excess imaging studies attributable to rising temperatures of 570 (95% CI, 488-655) to 2219 (95% CI, 1922-2528) locally, and 13 900 (95% CI, 11 900-15 950) to 55 475 (95% CI, 48 050-63 200) across Canada.

Climate-driven warming is projected to increase emergency imaging utilization across all emissions scenarios. These findings support the need for climate-informed radiology planning and integration of adaptation and mitigation strategies to sustain health system capacity.