Winter Health Report

About this report

Health Effects of Winter Hazards

In the fall and winter, the chances of extreme cold, snow, ice, and power outages from windstorms increases. There are also more air inversions. These are when there is colder air above that traps pollution nearer to the surface and leads to people breathing higher levels of harmful particles in the air. While the overall number of cold events might be decreasing because of climate change, the severity of these events is increasing.^[1]

In recent years, Portland has more often been hit by severe winter storms. Because of this, we are now tracking cold-related risks and health impacts in Washington County as part of climate health planning. The goal is to better understand the effects of climate change during the winter and to improve both emergency planning and long-term climate adaptation strategies.

Key Takeaways

In 2022 and 2023, there were at least two weeks when temperatures were 25°F or colder, which was almost double what we have seen in recent years.
Most emergency room and urgent care visits for winter-related injuries were by residents in the 97225 and 97123 zip codes.
Normally, we would expect about 3,800 visits for fall-related injuries during the winter, but from 2022 to 2023, there were more than 4,200 visits. Most by people 65 years old and older.
Most emergency department and urgent care visits for cold-related illness, asthma, unintentional carbon monoxide exposure, and all traffic-related injuries were by people between 18-64 years of age.
Based on all emergency department and urgent care visits, a greater percent than expected of cold-related illness visits were by people identified as male and white.
Based on all emergency department and urgent care visits, a greater percent than expected of unintentional carbon monoxide exposure visits were by people identified as Asian.

Data details

Daily data on low temperatures, maximum wind speed, average PM2.5, and snowfall, as well as number of Emergency Department and Urgent Care visits (ED visits) for cold related illness (hypothermia, frost bite and other cold exposure), unintentional carbon monoxide exposure, asthma, traffic-related accidents, and falls came from the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) in Oregon.

Measures of PM2.5 24-hour averages were taken from all air monitor stations and results from the air monitor with the highest daily average were included in this report.

Data on falls, traffic-related, and cardiovascular deaths came from death certificates from Oregon Vital Statistics from 2014-2023.

Methods

Quantitative

We report number of days based on categories of cold temperatures, wind speeds, and snowfall in Washington County, Oregon, from 2017 to 2024, during the months of November to March.

We focus on how these weather conditions are related to health emergencies like cold-related illness, carbon monoxide poisoning, and asthma.

We report low temperatures and snowfall in the following categories based on weather conditions that trigger emergency shelters. These categories are:

Temperatures of 25°F or lower (-3.9°C)
Snowfall of 1 inch or more

We included an additional category of 25-32°F for low temperatures to capture milder cold days with freezing temperatures.

We report air quality using levels of PM2.5. In Oregon Particulate Matter (PM2.5) typically drives air quality index values, therefore we define air quality as the following ^[2]:

Good: PM2.5 24-hour average = 0.0-12.0 µg/m³
Moderate: PM2.5 24-hour average = 12.1-35.4 µg/m³
Poor: PM2.5 24-hour average (starts where air quality is considered unhealthy for sensitive groups) = 35.5+ µg/m³

Qualitative

A graduate student who is part of our community and has worked closely with groups focused on environmental justice interviewed three people: two community health workers and a director of a local organization.

They each had a 45-minute conversation about their experiences working with the community during extreme weather events. They discussed

Challenges people face
Community resilience in tough situations
Hopes for the future

They identified important ideas from these talks and worked with the county and community to summarize.

This community voice spotlight helps us understand what is happening during winter and will guide future work.

Acknowledgments

(as prepared by representatives of Confederate Tribes of Grand Ronde, Nez Perce, Siletz, and Yavapai)

We want to acknowledge the people on whose land we live—the Atfalati-Kalapuyans also known as the Tualatin Band of Kalapuyans—the first inhabitants of Washington County. We are grateful for the land we are on, Kalapuyan land.

Signers of the Willamette Valley Treaty of 1855 were removed from their homelands to the Grand Ronde Indian Reservation. Today their descendants are tribal members of Grand Ronde and Siletz tribes, carrying on the traditions and cultures of their ancestors.

We acknowledge and express gratitude for the ancestors of this place and recognize that we are here because of the sacrifices forced upon them. In remembering these communities, we honor their legacy, their lives, and their continuation in our community. Please reflect on the role government has played in the painful, colonial history and reflect as well on the resilience and healing of the Indigenous land and communities.

We would like to invite everyone to collaborate and work together with the tribes to take care of the land and water and the people who inhabit these spaces.

Washington County Climate and Health Team

We would like to acknowledge G Lopez-Ixta for identifying community health worker voices as a critical part of this report and for reaching out to a community organization as a first step towards that in this report.

We would like to also acknowledge those interviewed for their dedication to their communities and willingness to share experiences and stories that give critical context to how we track and respond to impacts of climate on the community.

^[1] Cohen, J., et al., Linking Arctic variability and change with extreme winter weather in the United States. Science, 2021. 373(6559): p. 1116-1121. ↩︎

^[2] Oregon Department of Environmental Quality, Oregon Air Quality Monitoring Annual Report, 2021, p. 2. ↩︎

Weather

Why we track this?

Winter weather events are expected to happen less often as climate change continues, but for now it’s still very important to track winter weather over time in the Portland, Oregon area. The weather here is usually mild, so is less prepared for extreme weather. By tracking low temperatures, poor air quality, snowfall, and strong winds each year, we can better understand how these conditions affect people’s health and improve how we respond to emergencies.

What are you seeing

This section has 4 tabs that show the number of days each year with different winter weather conditions. These include cold temperatures, poor air quality, and snowfall from weather stations in Washington County.

In both 2022 and 2023, there were more winter days below 25°F than recent years.
During the winter, there were very few days with poor air quality, but at least 25 days each year since 2016 had air quality that was considered “moderate”.
There were also few days with more than 1 inch of snow each year.

In both 2022 and 2023, there were more winter days below 25°F.
The number of days above 32°F and between 25°F and 32°F remain fairly consistent.

Source: Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

Since 2017, there have been at least 28 days each winter where average PM2.5 indicate moderate air quality.
Most days had good air quality and few poor air quality.

There were few days with more than 1 Inch of snow each year.
(Days with less than an inch)

Cold Related Illness

Why we track this?

Cold-related illness (hypothermia, frost bite and other cold exposure) can range in severity and result in lifelong disability or even death if not promptly treated^[3]

Weather does not have to be extreme to cause injury. People with no heating, no shelter, substance use, and who are older are most vulnerable.

It is critical to explore factors that contribute to vulnerability and resilience in Portland.

What are you seeing?

This section has three tabs. One shows the total number of emergency department and urgent care (ED) visits for cold-related illnesses each year. The second tab shows the number of visits by zip code, and the third tab shows the percentage of visits by sex, race, and age group for all emergency department and urgent care (ED) from 2017 to 2024.

Since 2019 , the number of cold-related illnesses has generally been higher than in previous years. It’s important to remember notable population growth during this period and and increased reporting from emergency departments and urgent care centers to ESSENCE, especially post pandemic in Washington County.
Most cold-related illness visits were in the 97225 and 97123 zip codes nearer to the urban part of Washington County.
Most cold-related illness visits were by men and people identified as white.
When compared to all other types of emergency department and urgent care (ED), cold-related illness visits were more likely to be by men.

Since 2019, the number of cold-related illnesses has generally been higher than in previous years.

Source: Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

References

^[3] Lane, K., et al., Burden and Risk Factors for Cold-Related Illness and Death in New York City. Int J Environ Res Public Health, 2018. 15(4). ↩︎

Asthma

Why we track this?

Cold weather can cause something called a “weather inversion”, which makes the air outside worse to breathe and may worsen asthma. When it’s cold, people also spend more time inside, which can help sickness spread. Because of this, it’s important to track asthma-related emergency department and urgent care (ED) and look for patterns during winter^[4].

What are you seeing?

The number of emergency room visits for asthma during winter has stayed about the same each year since 2017, except for a drop in 2021, which was probably because of the pandemic.
The zip codes with the most asthma emergency department and urgent care (ED) (97144 & 97117) were in the Northwest part of Washington County
More ER visits for asthma were by women when compared to other types of visits.

There was a decrease in asthma ED visits during the pandemic that returned to previous levels this year.

Source: Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

References

^[4] Beard, J.D., et al., Winter temperature inversions and emergency department visits for asthma in Salt Lake County, Utah, 2003-2008. Environ Health Perspect, 2012. 120(10): p. 1385-90. ↩︎

Falls

Why we track this?

Winter weather can lead to more falls, both inside and outside ^[5]. Falls are a major cause of injury for older adults in Oregon. Some falls are mild, but others can cause serious long-term problems. Cold and snowy weather often leads to broken bones from falls ^[6].

By keeping track of when and where these falls happen, like whether they happen outside, we can find better ways to prevent them.

What are you seeing?

The annual number of emergency department and urgent care (ED) for falls from 2021-2023 have been greater than recent years. The year 2023 had the greatest number since 2017.
The greatest number of fall emergency department and urgent care (ED) were zip codes (97119 & 97116) in the southwest region.
A greater portion of these visits have been by women and people 65 years and older than what is observed for all other visit types.

In 2022 and 2023 there were more ED visits for falls than in previous years.

Source: Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

References

^[5] Magota, C., et al., Seasonal ambient changes influence inpatient falls, Age Ageing, 2017. 46(3): p. 513-517. ↩︎

^[6] Hughes, H.E., et al., Using an Emergency Department Syndromic Surveillance System to investigate the impact of extreme cold weather events. Public Health, 2014. 128(7): p. 628-35. ↩︎

Unintentional Carbon Monoxide Exposure

Why we track this?

As winter weather gets more severe, power outages are happening more often. One of the main public health concerns is carbon monoxide (CO) poisoning, which can happen when people use generators or cars to stay warm in enclosed spaces. This can lead to a sudden rise in emergency room visits. By tracking these changes, we can give better advice to the public to help keep them safe^[7].

What are you seeing?

In recent years, there have been an average of 12 emergency room visits each year for unintentional carbon monoxide (CO) poisoning. But more emergency department and urgent care (ED) visits were observed in 2017, 2021, and 2023.
Since 2017, the most emergency department and urgent care (ED) visits for unintentional carbon monoxide (CO) poisoning have come from people living in the Southeast part of Washington County.
A larger number of these visits were by people ages 18-64 years old, and there were slightly more visits by people who were Asian when compared to other types of visits.
Community spotlight: Community groups have shared stories about people who have limited options for staying warm late at night, which can lead to CO poisoning. Luckily, in these situations, neighbors have come together to share resources and help keep each other safe and warm.

Each year people visit the ED for unintentional carbon monoxide poisoning.

Source: Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

References

^[7] Johnson-Arbor, K.K., A.S. Quental, and D. Li, A comparison of carbon monoxide exposures after snowstorms and power outages. Am J Prev Med, 2014. 46(5): p. 481-6. ↩︎

All Traffic Related

Why we track this?

The Portland area usually has mild weather, so there aren’t many resources for dealing with ice and snow. In the past, people would just stay off the roads when it snowed or froze for a short time.

But with winter weather lasting longer now, it’s important to keep track of traffic-related injuries. There haven’t been many studies on traffic-related emergency department and urgent care (ED), but the local patterns mentioned show that it’s important to start tracking this information in the future ^[8].

What are you seeing?

The number of emergency room visits related to traffic accidents has stayed about the same from 2020 to 2023.
There were fewer visits in 2017, but this is probably because of changes in how the visits were reported.
Many of these traffic-related visits came from people living in western Washington County.
Compared to other types of visits, a larger percentage of traffic-related visits were by people ages 18-44 and by Hispanic people.

The number of emergency room visits related to traffic accidents has stayed about the same from 2020 to 2023.

Source: Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE)

References

^[8] Amin, K., et al., Fall- and collision-related injuries among pedestrians in road traffic environment - A Swedish national register-based study. J Safety Res, 2022. 81: p. 153-165. ↩︎

Mortality

Why we track this?

In the absence of climate adaptation, the rate of mortality during winter is predicted to persist^[9]. People are more likely to die from heart disease in the winter than in the summer^[10].

Some jobs, especially those that require working outside, also have a higher risk of suicide during the winter months ^[11].

As winter weather becomes more severe, it will be important to track deaths related to the weather. This can help us find patterns early, so we can take action to save lives.

What are you seeing?

We share yearly number of deaths from falls, traffic accidents, all causes, and heart-related issues because these have been linked to extreme winter weather in other areas^[12] ^[13].
We do not share the total number of deaths from carbon monoxide poisoning and hypothermia because there have been 4 and 7 deaths from 2018 to now and we want to respect the privacy of the families who lost loved ones.
Over the past two years, we have seen more deaths from falls and traffic accidents than in previous years.

There were more deaths from falls in 2022 and 2023 than previous years.
(The yearly average is shown in a dotted line)

There were more traffic-related deaths in 2022 and 2023 than previous years.
(The yearly average is shown in a dotted line)

Deaths from cardiovascular disease have increased in recent years.
(All other causes)

References

^[9] Madaniyazi, L., et al., Seasonality of mortality under climate change: a multicountry projection study. Lancet Planet Health, 2024. 8(2): p. e86-e94. ↩︎

^[10] Fares, A., Winter cardiovascular diseases phenomenon. N Am J Med Sci, 2013. 5(4): p. 266-79.; Achebak, H., et al., Ambient temperature and risk of cardiovascular and respiratory adverse health outcomes: a nationwide cross-sectional study from Spain. Eur J Prev Cardiol, 2024.↩︎

^[11] O., et al., Is occupation relevant in suicide? J Affect Disorder, 2002. 70(2): p. 197-203. ↩︎

^[12] Fowler,T.,etal., Excess Winter Deaths in Europe: a multi-country descriptive analysis, European Journal of Public Health, 2015, p,339–345 ↩︎

^[13] Fonseca-Rodriguez,O.,etal., Effect of extreme hot and cold weather on cause-specific hospitalizations in Sweden: A time series analysis. Environmental Research, 2021. ↩︎

Key

Text representing major themes identified are bolded

(+Bigger text for emphasis)

Blue: Resilience and Resources: These quotes represent progress towards improving social determinants of health in our community (+Bold for emphasis)

Red: Challenges and Barriers: These quotes represent challenges and barriers to health of the community (+Bold for emphasis)

Community Voices Spotlight

Who is impacted?

Based on the lived experiences of community health workers and the director of a community-based organization, extreme winter weather impacts certain groups more than others. All described those with fewer resources as being most impacted and named systemic issues that lead to groups being under resourced. People described were elders, youth, unsheltered people, outdoor workers, people without stable work, people with chronic conditions, and people who did not speak English. We heard stories of families already struggling with medical conditions, who couldn’t afford to pay for electricity and heat and of houseless individuals soaked and unable to reach shelters.

Quotes:

“Because we know well that the most vulnerable, are those who have less resources”
“I think the most, most vulnerable people in our community that are being impacted negatively by poverty issues are senior citizens, families with children, and unaccompanied youth.”
“The group that I always see with most need are those that do not have stable work.”
“For example, a senior citizen or someone who’s physically disabled or mentally disabled: They’re really struggling to access resources. There’s probably not enough.”

Social determinants of health

A system’s perspective on Extreme winter weather’s impact on community health.

Interviews not only identified vulnerable groups but described the multi-layered systems creating this vulnerability. The rapid increase in housing and rent cost, as well as cost of utility services were major barriers observed in the community members they worked with. Access to affordable transportation and cars built to navigate winter weather was also described as a major challenge to reaching safety during winter storms. Food security was also problematic during winter because of increased costs and fewer resources available. Many stories shared ended with them connecting people with resources, negotiating with utility companies, and reaching out to other community members for support, but they noted that language barriers as well as a hesitance to reach out for help may limit the access of man.

“The rates for public services are very high.For some people is not easy to pay high rates for power and water and we don’t have the resources, so I feel that services have increased (in cost) a lot here. I don’t know if this is a national level or only here in Washington County.”

“It was a very cold winter and they didn’t have electricitybecause they shut off the electricity, well they didn’t have heating and it was so cold. This winter was very harsh.And I said, well, what is missing here, I mean, the family discussed with me. Well, that ”my husband didn’t work the last month the amount he usually works.so, well we did not have enough to pay for the past monthand well this month the cost accumulated, then, well, our services were cut and I had children.”Well, and now that I am more involved with the community I know about the resource that we can access…I believe that it is good to know that for all of these (experiences) what we can give in these moments of need. And well, get involved a little more. Knowing resources and sharing them and learning.Yes, yes we could have helped them. Only this, seems to have happened on New Years, so offices were closedso how would they have gone to pay something (in those circumstances). So, two days passed, so we offered for them to come to our house,but it was as if les daba pena,I feel that in our community, there still exists this myth, that of, I shouldn’t bother others, it’s better to endure here until I can,so yes, they were offered help but even so they said “No, we’ll wait to pay and turn on the electricity.” Well, also, we can’t force people. Now, like I told you, I am more involved in the community. I know that with electric companies you can reach an agreement (payment plan) when payments are past due.But during that time the language barrier was the determinant. It is a social determinant that we still have to work on.”

“And when people come to our church and say, “Hey, I need help”. We’re gonna refer them to you and know that your organization has the skills to address multi-layered challenges that these people are dealing with, because it’s never just one thing. It’s always, you know, you’ve got an illness, and then your rent’s gone up and, you know, it’s just a you don’t have enough food on the table. It’s kind of like a domino effect with a lot of people. Once you start down that slippery hill of poverty and it’s really hard to climb back up without a lot of support.”

Key Interview Themes

Unaffordable rent
Food security exacerbated during winter season
Accessible transportation
Language as a barrier to access
Clarity of accessing support or hesitance in accessing
Access to information about safe heating systems (Propane story) that link directly to our CO outcome

Resilience

The resilience described in communities across Washington County came from community members coming together in times of need and sharing knowledge and preparation based on past experiences.

Community health workers shared stories of their organization working to facilitate access to support from community members to those facing challenges. Stories of the strength from the Latino community and spiritual communities were examples of how that mutual support has allowed communities to overcome challenges.

“I believe that we have taken the step of learning to know our necessities, for example, during winter, if we know that winter is coming, this is a reason to have more warm blankets or a way to stay warm at home.”

“We had another situation- kind of similar- Grandma, senior, fairly elderly in her seventies, responsible for her grandchildren and her heat was out, and she called, and she had a fireplace. So we helped her get firewood but you know it took a lot of negotiating. One, to find the donation for the fireworks, and then to find a bunch of guys to pick up the wood, bring it over to her house, split it, and stack it. So we got her a cord of wood, and we had to make a lot of calls, and we found a men’s group through a church who was willing to do the pickup, the stacking, the cut, splitting of the wood. But this family wouldn’t have had heat if we hadn’t done that. And you know, that’s kind of a good Samaritan thing, and that’s one of the roles that the organization fills is, we invite people to be good Samaritans and help out in situations like this…So that was not something that required a financial investment. That was something that took human equity and time to resolve, and it took a village, you know, a collaboration of people coming together and saying, “How can we help this individual?” And we need to get creative like that more often, because there isn’t the money.”

“I believe that promoting the awareness of people that I am seeing, that truly not all is lost because there are many people who want to help .”

Key Interview Themes

Recent access to resources for basic needs such as heating systems and food or support for utilities
Connectedness of community
Latino community and church community

Hopes for the future

All had hopes for their communities and suggested solutions to existing challenges. These included more support for centers that facilitate shared resources across the community, payment plans for utilities that took into account increased needs during the winter season, and outreach to vulnerable and isolate groups such as elderly and disabled community members. Below are there hopes in their own words:

“My hopes for our community are that we can continue to expand opportunity for those who have the time, the knowledge, the skill set and the resources to step in and help take care of a lot of these really challenging issues, and that that is supported at a county level and at a state level, and even within our city itself.

Each city has to empower communities members to take on some part of this. It’s too much for one single entity to take on. The State itself can’t. Education can’t. The county, it can’t. We need to come togetheras a whole community to address these challenges because they’re serious, and if we don’t they’ll either continue to grow and expand, or they’ll just stay stable and stagnant, and we’ll always be dealing with it. We can do better than this. We really, truly can. I have no doubt that we can”

“In general, I want to see my community secure. I want to see my community without so many people on the streets. I want to see my community with accessible resources.Such as doctors or public services. I want to see my community secure, above all, secure.”

“My wishes. I believe are the same: that all have access to help that they need in the moment of need. Like I mentioned to you earlier, after a disaster, after a harsh event, well that the government, the community unite and go out to help., that they are not passive. That we have to go out and help.We have to go out and help, and we have to be aware of what we need more sources of employment, decent homes , right?”

Spotlights

Discussion of carbon monoxide in the context of the story

“We had a family that they couldn’t pay their bill, so they lost their heat. And the mom was dying of cancer, breast cancer. And the dad was just trying to stay, you know, pay bills and keep food on the table. They had a lot of kids. I think they had 5 children and the kids called me one night and said, we have no heat. My dad gave us this tank and a heat adapter but it’s making our house smell really bad, and I went over there. They had a propane tank and a construction heater that attaches to the tank and that was heating their house, but their whole house was filled with propane and I told him, “Turn that thing off. Open the windows.” You guys need to get out of here and my husband and I went and bought them an electric heater and came back and got them set up. But it’s situations like that–that, that’s an emergency that’s happening in the middle of the night. There’s not a county agency that we could call and say, “Hey we need a heater over at this house right now.” It’s up to the small nonprofit organizations like us, and the majority of them aren’t available in an urgency situation like that at 9.”