{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T07:05:15Z","timestamp":1784099115462,"version":"3.55.0"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Extreme heat poses increasing risks to cardiovascular health, yet fine-scale determinants of heat-related hypertension burden remain insufficiently understood. This study examines high hypertension burden in a heat-vulnerability context across 1,385 census tracts in Maryland using an interpretable machine learning framework. An XGBoost model was developed to classify census tracts with high hypertension burden using demographic, socioeconomic, built-environment, heat anomaly, and adaptive-capacity variables. SHapley Additive exPlanations (SHAP) were then used to identify key predictors, assess their contribution to model predictions, and examine non-linear effects. The model achieved strong predictive performance, with an accuracy of 0.819, balanced accuracy of 0.806, ROC-AUC of 0.821, and PR-AUC of 0.909. Results show substantial spatial heterogeneity in hypertension burden, with high-burden tracts concentrated in Baltimore City, Prince George's County, southern Maryland, western Maryland, and parts of the Eastern Shore. SHAP results indicate that African-American population share, older-adult population share, and low educational attainment were the strongest predictors, followed by summer maximum air temperature, non-vegetated land area, and lack of air conditioning. Dependence plots further reveal non-linear and threshold-like relationships, suggesting that predicted risk increases sharply beyond certain levels of demographic vulnerability, educational disadvantage, heat exposure, and limited cooling access. These findings indicate that high hypertension burden in a heat-vulnerability context is shaped by the intersection of structural social vulnerability, demographic susceptibility, environmental exposure, and household adaptive capacity. The study demonstrates the value of combining XGBoost and SHAP for tract-level heat-health risk assessment and provides policy-relevant evidence for targeted heat adaptation, cooling assistance, and public health preparedness in Maryland.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1894531","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:09:20Z","timestamp":1784095760000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Interpretable machine learning for identifying determinants of high hypertension burden under extreme heat vulnerability: evidence from Maryland, USA"],"prefix":"10.3389","volume":"14","author":[{"given":"Binbin","family":"Peng","sequence":"first","affiliation":[{"name":"School of Government, Nanjing University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1052","DOI":"10.1038\/s41558-025-02399-7","article-title":"Health losses attributed to anthropogenic climate change","volume":"15","author":"Carlson","year":"2025","journal-title":"Nat Clim Change"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1651","DOI":"10.1007\/s11069-014-1563-z","article-title":"Rising heat wave trends in large US cities","volume":"76","author":"Habeeb","year":"2015","journal-title":"Nat Hazards"},{"key":"B3","article-title":"Managing the risks of extreme events and disasters to advance climate change adaptation","volume-title":"Special Report of the Intergovernmental Panel on Climate Change","year":"2012"},{"key":"B4","volume-title":"Climate Change 2022: Impacts, Adaptation and Vulnerability","year":"2022"},{"key":"B5","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1038\/s44284-025-00290-2","article-title":"Standardized heat islands and persistence drive modeled urban heat events","volume":"2","author":"Liao","year":"2025","journal-title":"Nat Cities."},{"key":"B6","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1126\/science.1098704","article-title":"More intense, more frequent, and longer lasting heat waves in the 21st century","volume":"305","author":"Meehl","year":"2004","journal-title":"Science."},{"key":"B7","doi-asserted-by":"publisher","first-page":"108386","DOI":"10.1016\/j.aap.2025.108386","article-title":"Roadway traffic crash during extreme heat days: insights from hazards-exposure-vulnerability-adaptation","volume":"227","author":"Gu","year":"2026","journal-title":"Accid Anal Prev."},{"key":"B8","doi-asserted-by":"publisher","first-page":"105045","DOI":"10.1016\/j.ijdrr.2024.105045","article-title":"Higher traffic crash risk in extreme hot days? A spatiotemporal examination of risk factors and influencing features","volume":"116","author":"Gu","year":"2025","journal-title":"Int J Disaster Risk Reduct."},{"key":"B9","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1093\/aje\/155.1.80","article-title":"Temperature and mortality in 11 cities of the Eastern United States","volume":"155","author":"Curriero","year":"2002","journal-title":"Am J Epidemiol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1038\/jes.2016.83","article-title":"Summertime extreme heat events and increased risk of acute myocardial infarction hospitalizations","volume":"27","author":"Fisher","year":"2017","journal-title":"J Expo Sci Environ Epidemiol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1331","DOI":"10.1289\/ehp.9074","article-title":"Extreme temperatures and mortality: assessing effect modification by personal characteristics and specific cause of death in a multi-city case-only analysis","volume":"114","author":"Medina-Ram\u00f3n","year":"2006","journal-title":"Environ Health Perspect."},{"key":"B12","doi-asserted-by":"publisher","first-page":"5704","DOI":"10.3390\/ijerph17165704","article-title":"Heat-related illness is associated with lack of air conditioning and pre-existing health problems in Detroit, Michigan, USA: a community-based participatory co-analysis of survey data","volume":"17","author":"Cardoza","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"B13","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1016\/j.envres.2004.10.009","article-title":"Epidemiologic Study of Mortality During the Summer 2003 Heat Wave in Italy","volume":"98","author":"Conti","year":"2005","journal-title":"Environ Res."},{"key":"B14","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1007\/s00420-006-0089-4","article-title":"Excess Mortality Related to the August 2003 Heat Wave in France","volume":"80","author":"Fouillet","year":"2006","journal-title":"Int Arch Occup Environ Health."},{"key":"B15","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1097\/01.ede.0000208477.36665.34","article-title":"Vulnerability to heat-related mortality - a multicity, population-based, case-crossover analysis","volume":"17","author":"Stafoggia","year":"2006","journal-title":"Epidemiology"},{"key":"B16","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1016\/j.gloenvcha.2006.02.006","article-title":"Vulnerability","volume":"16","author":"Adger","year":"2006","journal-title":"Glob Environ Change Human Policy Dimens."},{"key":"B17","doi-asserted-by":"publisher","first-page":"242","DOI":"10.1111\/1540-6237.8402002","article-title":"Social vulnerability to environmental hazards","volume":"84","author":"Cutter","year":"2003","journal-title":"Soc Sci Q."},{"key":"B18","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1016\/j.apgeog.2008.11.004","article-title":"The socio-spatial dynamics of extreme urban heat events: the case of heat-related deaths in Philadelphia","volume":"29","author":"Johnson","year":"2009","journal-title":"Appl Geography."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1080\/09640568.2018.1462475","article-title":"Mapping vulnerability to extreme heat events: lessons from Metropolitan Chicago","volume":"62","author":"Wilson","year":"2018","journal-title":"J Environ Plan Manag."},{"key":"B20","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1289\/ehp.1104625","article-title":"Neighborhood effects on heat deaths: social and environmental predictors of vulnerability in Maricopa County, Arizona","volume":"121","author":"Harlan","year":"2013","journal-title":"Environ Health Perspect."},{"key":"B21","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.apgeog.2012.04.006","article-title":"Developing an applied extreme heat vulnerability index utilizing socioeconomic and environmental data","volume":"35","author":"Johnson","year":"2012","journal-title":"Appl Geography."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/qj.49710845502","article-title":"The energetic basis of the urban heat-island","volume":"108","author":"Oke","year":"1982","journal-title":"Q J Royal Meteorol Soc."},{"key":"B23","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1080\/01944360508976402","article-title":"Urban heat and air pollution - an emerging role for planners in the climate change debate","volume":"71","author":"Stone","year":"2005","journal-title":"J Am Plan Assoc."},{"key":"B24","doi-asserted-by":"publisher","first-page":"2721","DOI":"10.1038\/s41467-021-22799-5","article-title":"Disproportionate exposure to urban heat island intensity across major US cities","volume":"12","author":"Hsu","year":"2021","journal-title":"Nat Commun."},{"key":"B25","doi-asserted-by":"publisher","first-page":"2978","DOI":"10.3390\/buildings14092978","article-title":"Coupled impact of points of interest and thermal environment on outdoor human behavior using visual intelligence","volume":"14","author":"Wang","year":"2024","journal-title":"Buildings."},{"key":"B26","doi-asserted-by":"publisher","first-page":"2847","DOI":"10.1016\/j.socscimed.2006.07.030","article-title":"Neighborhood microclimates and vulnerability to heat stress","volume":"63","author":"Harlan","year":"2006","journal-title":"Soc Sci Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"16110","DOI":"10.3390\/ijerph121215046","article-title":"A spatial framework to map heat health risks at multiple scales","volume":"12","author":"Ho","year":"2015","journal-title":"Int J Environ Res Public Health"},{"key":"B28","doi-asserted-by":"publisher","first-page":"102507","DOI":"10.1016\/j.scs.2020.102507","article-title":"Spatiotemporal assessment of extreme heat risk for high-density cities: a case study of Hong Kong from 2006 to 2016","volume":"64","author":"Hua","year":"2021","journal-title":"Sustain Cities Soc."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1730","DOI":"10.1289\/ehp.0900683","article-title":"Mapping Community Determinants of Heat Vulnerability","volume":"117","author":"Reid","year":"2009","journal-title":"Environ Health Perspect."},{"key":"B30","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1136\/oem.2010.058396","article-title":"Air conditioning and intrahospital mortality during the 2003 Heatwave in Portugal: evidence of a protective effect","volume":"68","author":"Nunes","year":"2011","journal-title":"Occup Environ Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.maturitas.2009.08.005","article-title":"Preventing heat-related morbidity and mortality: new approaches in a changing climate","volume":"64","author":"O'Neill","year":"2009","journal-title":"Maturitas."},{"key":"B32","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1038\/s41558-025-02398-8","article-title":"Rising temperatures increase added sugar intake disproportionately in disadvantaged groups in the USA","volume":"15","author":"He","year":"2025","journal-title":"Nat Clim Chang."},{"key":"B33","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1145\/2939672.2939785","article-title":"XGBoost: a scalable tree boosting system","volume-title":"Proceedings of the 22nd ACM SIGKDD International Conference on Knowledge Discovery and Data Mining","author":"Chen","year":"2016"},{"key":"B34","doi-asserted-by":"publisher","first-page":"4765","DOI":"10.5555\/3295222.3295230","article-title":"A unified approach to interpreting model predictions","author":"Lundberg","year":"2017","journal-title":"NIPS'17"},{"key":"B35","doi-asserted-by":"publisher","first-page":"e484","DOI":"10.1016\/S2542-5196(22)00117-6","article-title":"Heat exposure and cardiovascular health outcomes: a systematic review and meta-analysis","volume":"6","author":"Liu","year":"2022","journal-title":"Lancet Planet Health."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1098","DOI":"10.1161\/CIRCRESAHA.123.323615","article-title":"Heat and cardiovascular mortality: an epidemiological perspective","volume":"134","author":"Singh","year":"2024","journal-title":"Circ Res."},{"key":"B37","doi-asserted-by":"publisher","first-page":"108005","DOI":"10.1016\/j.envint.2023.108005","article-title":"Urban heat island impacts on heat-related cardiovascular morbidity: a time series analysis of older adults in US metropolitan areas","volume":"178","author":"Cleland","year":"2023","journal-title":"Environ Int."},{"key":"B38","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1016\/j.healthplace.2010.12.005","article-title":"Intra-urban societal vulnerability to extreme heat: the role of heat exposure and the built environment, socioeconomics, and neighborhood stability","volume":"17","author":"Uejio","year":"2011","journal-title":"Health Place."},{"key":"B39","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1111\/risa.13207","article-title":"Developing a broadly applicable measure of risk perception","volume":"39","author":"Wilson","year":"2019","journal-title":"Risk Anal."},{"key":"B40","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1093\/jurban\/jti043","article-title":"Disparities by race in heat-related mortality in four US cities: the role of air conditioning prevalence","volume":"82","author":"O'Neill","year":"2005","journal-title":"J Urban Health."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1132","DOI":"10.1111\/risa.17645","article-title":"Reexploring the conception of heat\u2013health risk: from the perspectives of dimensionality and spatiality","volume":"45","author":"Peng","year":"2024","journal-title":"Risk Anal."},{"key":"B42","doi-asserted-by":"publisher","first-page":"103677","DOI":"10.1016\/j.scs.2022.103677","article-title":"Explainable heat-related mortality with random forest and SHapley Additive exPlanations (SHAP) models","volume":"79","author":"Kim","year":"2022","journal-title":"Sustain Cities Soc."},{"key":"B43","doi-asserted-by":"publisher","first-page":"102320","DOI":"10.1016\/j.uclim.2025.102320","article-title":"Leveraging machine learning to explore nonlinear associations between urban heat vulnerability and morbidity risk","volume":"59","author":"Yang","year":"2025","journal-title":"Urban Clim."},{"key":"B44","volume-title":"Maryland Climate and Health Profile Report.","year":"2016"},{"key":"B45","volume-title":"2018 Tiger\/Line Shapefiles (Machine-Readable Datafiles)","year":"2018"},{"key":"B46","volume-title":"American Community Survey 5-year Estimates.","year":"2018"},{"key":"B47","volume-title":"Zillow Transaction and Assessment Database (ZTRAX)","year":"2026"},{"key":"B48","author":"Multi-Resolution","year":"2019","journal-title":"National Land Cover Database 2019 Land Cover and Imperviousness Products."},{"key":"B49","volume-title":"Global Historical Climatology Network Daily.","year":"2022"},{"key":"B50","year":"2022","journal-title":"About PLACES: local data for better health"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1894531\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T06:09:22Z","timestamp":1784095762000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1894531\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":50,"alternative-id":["10.3389\/fpubh.2026.1894531"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1894531","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]},"article-number":"1894531"}}