{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:43:53Z","timestamp":1792550633504,"version":"4.5.0"},"reference-count":66,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2015,12,18]],"date-time":"2015-12-18T00:00:00Z","timestamp":1450396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>In the last few decades extreme heat events have led to substantial excess mortality, most dramatically in Central Europe in 2003, in Russia in 2010, and even in typically cool locations such as Vancouver, Canada, in 2009. Heat-related morbidity and mortality is expected to increase over the coming centuries as the result of climate-driven global increases in the severity and frequency of extreme heat events. Spatial information on heat exposure and population vulnerability may be combined to map the areas of highest risk and focus mitigation efforts there. However, a mismatch in spatial resolution between heat exposure and vulnerability data can cause spatial scale issues such as the Modifiable Areal Unit Problem (MAUP). We used a raster-based model to integrate heat exposure and vulnerability data in a multi-criteria decision analysis, and compared it to the traditional vector-based model. We then used the Getis-Ord Gi index to generate spatially smoothed heat risk hotspot maps from fine to coarse spatial scales. The raster-based model allowed production of maps at spatial resolution, more description of local-scale heat risk variability, and identification of heat-risk areas not identified with the vector-based approach. Spatial smoothing with the Getis-Ord Gi index produced heat risk hotspots from local to regional spatial scale. The approach is a framework for reducing spatial scale issues in future heat risk mapping, and for identifying heat risk hotspots at spatial scales ranging from the block-level to the municipality level.<\/jats:p>","DOI":"10.3390\/ijerph121215046","type":"journal-article","created":{"date-parts":[[2015,12,18]],"date-time":"2015-12-18T10:15:04Z","timestamp":1450433704000},"page":"16110-16123","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":88,"title":["A Spatial Framework to Map Heat Health Risks at Multiple Scales"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6505-3504","authenticated-orcid":false,"given":"Hung","family":"Ho","sequence":"first","affiliation":[{"name":"Department of Geography, Simon Fraser University, Burnaby, BC V5A 1S6, Canada"},{"name":"Department of Geography, Earth and Environmental Sciences, Okanagan College, Kelowna, BC V1Y 4X8, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8970-8504","authenticated-orcid":false,"given":"Anders","family":"Knudby","sequence":"additional","affiliation":[{"name":"Department of Geography, University of Ottawa, ON, K1N 6N5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Geography, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2015,12,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","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":"Meehi","year":"2004","journal-title":"Science"},{"key":"ref_2","doi-asserted-by":"crossref","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":"ref_3","doi-asserted-by":"crossref","unstructured":"Basu, R. (2009). High ambient temperature and mortality: A review of epidemiologic studies from 2001 to 2008. Environ. Health, 8.","DOI":"10.1186\/1476-069X-8-40"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/S0277-9536(99)00301-9","article-title":"The influence of weather on human mortality in Hong Kong","volume":"50","author":"Yan","year":"2000","journal-title":"Soc. Sci. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2418","DOI":"10.1016\/j.scitotenv.2010.02.009","article-title":"The impact of the 2003 heat wave on mortality in Shanghai, China","volume":"408","author":"Huang","year":"2010","journal-title":"Sci. Total Environ."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1344","DOI":"10.1289\/ehp.8328","article-title":"The relation between temperature, ozone, and mortality in nine French cities during the heat wave of 2003","volume":"114","author":"Filleul","year":"2006","journal-title":"Environ. Health Perspect."},{"key":"ref_7","doi-asserted-by":"crossref","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":"ref_8","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.2105\/AJPH.2012.300670","article-title":"Shifts in mortality during a hot weather event in Vancouver, British Columbia: Rapid assessment with case-only analysis","volume":"102","author":"Kosatsky","year":"2012","journal-title":"Am. J. Public Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1097\/EDE.0b013e318176bfcd","article-title":"Heat effects on mortality in 15 European cities","volume":"19","author":"Baccini","year":"2008","journal-title":"Epidemiology"},{"key":"ref_10","doi-asserted-by":"crossref","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":"ref_11","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.envres.2014.04.004","article-title":"What weather variables are important in predicting heat-related mortality? A new application of statistical learning methods","volume":"132","author":"Zhang","year":"2014","journal-title":"Environ. Res."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Morabito, M., Crisci, A., Messeri, A., Capecchi, V., Modesti, P.A., Gensini, G.F., and Orlandini, S. (2014). Environmental Temperature and Thermal Indices: What is the Most Effective Predictor of Heat-Related Mortality in Different Geographical Contexts?. Sci. World. J.","DOI":"10.1155\/2014\/961750"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1289\/ehp.1002313","article-title":"Heat Waves in the United States: Mortality Risk during Heat Waves and Effect Modification by Heat Wave Characteristics in 43 U.S. Communities","volume":"119","author":"Anderson","year":"2011","journal-title":"Environ. Health Perspect."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.apgeog.2011.07.008","article-title":"The spatial variability of heat-related mortality in Massachusetts","volume":"33","author":"Hattis","year":"2012","journal-title":"Appl. Geogr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.healthplace.2013.04.005","article-title":"Differences in heat-related mortality across four ecological regions with diverse urban, rural, and remote populations in British Columbia, Canada","volume":"23","author":"Henderson","year":"2013","journal-title":"Health Place"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/1476-069X-11-16","article-title":"Fine-scale spatial variability of heat-related mortality in Philadelphia County, USA, from 1983 to 2008: A case-series analysis","volume":"11","author":"Hondula","year":"2012","journal-title":"Environ. Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3327","DOI":"10.1001\/jama.1982.03320490025030","article-title":"Morbidity and Mortality Associated with the July 1980 Heat Wave in St. Louis and Kansas City, MO","volume":"247","author":"Jones","year":"1982","journal-title":"J. Am. Med. Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1289\/ehp.1103532","article-title":"The Impact of Heat Islands on Mortality in Paris during the August 2003 Heat Wave","volume":"120","author":"Laaidi","year":"2012","journal-title":"Environ. Health Perspect."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1289\/ehp.1103759","article-title":"The Impact of Heat Waves on Mortality in Seven Major Cities in Korea","volume":"120","author":"Son","year":"2012","journal-title":"Environ. Health Perspect."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Son, J.-Y., Lee, J.-T., Anderson, B., and Bell, M.L. (2012). Vulnerability to temperature-related mortality in Seoul, Korea. Environ. Res. Lett., 6.","DOI":"10.1088\/1748-9326\/6\/3\/034027"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1289\/ehp.1103766","article-title":"Evaluation of a Heat Vulnerability Index on Abnormally Hot Days: An Environmental Public Health Tracking Study","volume":"120","author":"Reid","year":"2012","journal-title":"Environ. Health Perspect."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"71","DOI":"10.3354\/cr030071","article-title":"Assessing public health risk due to extremely high temperature events: Climate and social parameters","volume":"30","author":"Vescovi","year":"2005","journal-title":"Clim. Res."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Chuang, W.C., and Gober, P. (2015). Predicting hospitalization for heat-related illness at the census tract level: Accuracy of a generic heat vulnerability index in Phoenix, Arizona (USA). Environ. Health Perspect., 123.","DOI":"10.1289\/ehp.1307868"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Buscail, C., Upegui, E., and Viel, J.-F. (2012). Mapping heatwave health risk at the community level for public health action. Int. J. Health Geogr., 11.","DOI":"10.1186\/1476-072X-11-38"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Tomlinson, C., Chapman, L., Thornes, J., and Baker, C. (2011). Including the urban heat island in spatial heat health risk assessment strategies: A case study for Birmingham, UK. Int. J. Health Geogr., 10.","DOI":"10.1186\/1476-072X-10-42"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Morabito, M., Crisci, A., Gioli, B., Gualtieri, G., Toscano, P., di Stefano, V., and Gensini, G.F. (2015). Urban-Hazard Risk Analysis: Mapping of Heat-Related Risks in the Elderly in Major Italian Cities. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0127277"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1068\/a270105","article-title":"Searching for the elusive aggregation effect: Evidence from statistical simulations","volume":"27","author":"Amrhein","year":"1995","journal-title":"Environ. Plan. A"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1080\/07038992.1999.10874734","article-title":"The scale issue in social and natural sciences","volume":"25","author":"Marceau","year":"1999","journal-title":"Can. J. Remote Sens."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1080\/07038992.1999.10874735","article-title":"Remote sensing contributions to the scale issue","volume":"25","author":"Marceau","year":"1999","journal-title":"Can. J. Remote Sens."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1007\/s11524-007-9193-3","article-title":"Deprivation indices, population health and geography: An evaluation of the spatial effectiveness of indices at multiple scales","volume":"84","author":"Schuurman","year":"2007","journal-title":"J. Urban. Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.rse.2014.08.012","article-title":"Mapping Maximum Urban Air Temperature on Hot Summer Days","volume":"154","author":"Ho","year":"2014","journal-title":"Remote Sens. Environ."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.rse.2011.04.042","article-title":"Impact of spatial resolution and satellite overpass time on evaluation of the surface urban heat island effects","volume":"117","author":"Sobrino","year":"2012","journal-title":"Remote Sens. Environ."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"8108","DOI":"10.1080\/01431161.2014.978957","article-title":"Estimating daily maximum air temperature from MODIS in British Columbia, Canada","volume":"35","author":"Xu","year":"2014","journal-title":"Int. J. Remote Sens."},{"key":"ref_34","unstructured":"Statistics Canada Greater Vancouver, British Columbia (Code5915) (Table). 2006 Community Profiles. 2006 Census, Publisher. Released 13 March 2007."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1023\/A:1022946528157","article-title":"Heat wave hazards: An overview of heat wave impacts in Canada","volume":"28","author":"Kuhn","year":"2003","journal-title":"Nat. Hazards"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1016\/j.gloenvcha.2010.11.010","article-title":"Heat health planning: The importance of social and community factors","volume":"21","author":"Yardley","year":"2011","journal-title":"Glob. Environ. Chang."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Schifano, P., Cappai, G., de Sario, M.D., Michelozzi, P., Marino, C., Bargagli, A.M., and Perucci, C.A. (2012). Susceptibility to heat wave-related mortality: A follow-up study of a cohort of elderly in Rome. Environ. Health, 8.","DOI":"10.1186\/1476-069X-8-50"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1093\/ije\/dyn023","article-title":"Commentary: People\u2019s vulnerability to heat wave","volume":"37","author":"Tan","year":"2008","journal-title":"Int. J. Epidemiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1093\/qjmed\/hci025","article-title":"Why do older patients die in a heatwave?","volume":"98","author":"Flynn","year":"2005","journal-title":"QJM Int. J. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1093\/eurpub\/ckl063","article-title":"August 2003 heat wave in France: Risk factors for death of elderly people living at home","volume":"16","author":"Vandentorren","year":"2006","journal-title":"Eur. J. Public Health"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1093\/pubmed\/fdi059","article-title":"Were less disabled patients the most affected by 2003 heat wave in nursing homes in Paris, France?","volume":"27","author":"Holstein","year":"2005","journal-title":"J. Public Health"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1136\/bmj.2.5300.287","article-title":"Heat illness in infants and young children","volume":"2","author":"Danks","year":"1962","journal-title":"Br. Med. J."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1289\/ehp.1307960","article-title":"Ambient Heat and Sudden Infant Death: A Case-Crossover Study Spanning 30 Years in Montreal, Canada","volume":"123","author":"Auger","year":"2015","journal-title":"Environ. Health Perspect."},{"key":"ref_44","first-page":"185","article-title":"The Potential Impacts of Climate Variability and Change on Temperature-Related Morbidity and Mortality in the United States","volume":"109","author":"McGeehin","year":"2001","journal-title":"Environ. Health Perspect."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1056\/NEJM199607113350203","article-title":"Heat-related deaths during the July 1995 heat wave in Chicago","volume":"335","author":"Semenza","year":"1996","journal-title":"N. Engl. J. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1175\/JAMC-D-12-094.1","article-title":"History of Pacific Northwest heat waves: Synoptic pattern and trends","volume":"52","author":"Bumbaco","year":"2013","journal-title":"J. Appl. Meteorol. Climatol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1176\/ps.44.9.854","article-title":"Mental and physical health of homeless persons who use emergency shelters in Vancouver","volume":"44","author":"Acorn","year":"1993","journal-title":"Psychiatr. Serv."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s11205-013-0302-2","article-title":"Subjective health-related quality of life in homeless and vulnerably housed individuals and its relationship with self-reported physical and mental health status","volume":"116","author":"Gadermann","year":"2014","journal-title":"Soc. Indic. Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1080\/17523281.2011.618143","article-title":"Prolonged and persistent homelessness: Multivariable analyses in a cohort experiencing current homelessness and mental illness in Vancouver, British Columbia","volume":"5","author":"Patterson","year":"2012","journal-title":"Ment. Health Subst. Use"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/S0749-3797(02)00421-X","article-title":"Heat-related mortality during a 1999 heat wave in Chicago","volume":"22","author":"Naughton","year":"2002","journal-title":"Am. J. Prevent. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1093\/aje\/kwg096","article-title":"Modifiers of the temperature and mortality association in seven US cities","volume":"157","author":"Zanobetti","year":"2003","journal-title":"Am. J. Epidemiol."},{"key":"ref_52","doi-asserted-by":"crossref","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":"Zanobetti","year":"2005","journal-title":"J. Urban. Health"},{"key":"ref_53","unstructured":"Barsi, J.A., Barker, J.L., and Schott, J.R. (2003, January 21\u201325). An Atmospheric Correction Parameter Calculator for a single thermal band earth-sensing instrument. Proceedings of the IGARSS IEEE International Geoscience and Remote Sensing Symposium, Toulouse, France."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1967","DOI":"10.1016\/j.rse.2009.05.005","article-title":"The North American ASTER Land Surface Emissivity Database (NAALSED) version 2.0","volume":"113","author":"Hulley","year":"2009","journal-title":"Remote Sens. Environ."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1109\/TGRS.2009.2024934","article-title":"Validation of Landsat-7\/ETM+ Thermal-Band Calibration and Atmospheric Corrections with Ground Based Measurements","volume":"48","author":"Coll","year":"2010","journal-title":"IEEE Trans. Geosci. Remote Sens."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"609","DOI":"10.4113\/jom.2010.1146","article-title":"Land developability: Developing an index of land use and development for population research","volume":"6","author":"Chi","year":"2010","journal-title":"J. Maps"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1007\/s12665-013-2543-4","article-title":"Fuzzy-based Spatial Modeling Approach to Predict Island Karst Distribution","volume":"71","author":"Ho","year":"2014","journal-title":"Environ. Earth Sci."},{"key":"ref_58","unstructured":"Ingleton, J. (1999). Natural Disaster Management, Tudor Rose."},{"key":"ref_59","first-page":"186","article-title":"The Data Model Concept in Statistical Mapping","volume":"7","author":"Jenks","year":"1967","journal-title":"Int. Yearb. Cartogr."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/j.1538-4632.1992.tb00261.x","article-title":"The analysis of spatial association by use of distance statistics","volume":"24","author":"Getis","year":"1992","journal-title":"Geogr. Anal."},{"key":"ref_61","first-page":"42","article-title":"Multiscale mapping of burn area and severity using multisensor satellite data and spatial autocorrelation analysis","volume":"20","author":"Lanorte","year":"2013","journal-title":"Int. J. Appl. Earth Obs. Geoinform."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Hansen, A., Bi, L., Saniotis, A., and Nitschke, M. (2013). Vulnerability to extreme heat and climate change: Is ethnicity a factor?. Glob. Health Action, 6.","DOI":"10.3402\/gha.v6i0.21364"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"S28","DOI":"10.1007\/BF03403826","article-title":"The Vancouver Area Neighbourhood Deprivation Index (Vandix): A census-based tool for assessing small-area variations in health status","volume":"103","author":"Bell","year":"2012","journal-title":"Can. J. Public Health Rev. Can. Sant\u00e9 Publique"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s004840050118","article-title":"The physiological equivalent temperature\u2014A universal index for the biometeorological assessment of the thermal environment","volume":"43","year":"1999","journal-title":"Int. J. Biometeorol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1007\/s004840050119","article-title":"Applications of a universal thermal index: Physiological equivalent temperature","volume":"43","author":"Matzarakis","year":"1999","journal-title":"Int. J. Biometeorol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.isprsjprs.2012.09.007","article-title":"Temporal characteristics of thermal satellite images for urban heat stress and heat island mapping","volume":"74","author":"Nichol","year":"2012","journal-title":"ISPRS J. Photogramm. Remote Sens."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/12\/12\/15046\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T20:54:22Z","timestamp":1760216062000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/12\/12\/15046"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,12,18]]},"references-count":66,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2015,12]]}},"alternative-id":["ijerph121215046"],"URL":"https:\/\/doi.org\/10.3390\/ijerph121215046","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,12,18]]}}}