Purpose: This study examines risk factors for heat-related mortality due to hyperthermia inemergency department patients, a vulnerable population. Methods: This matched case-control study used statewide, longitudinally linked emergency department (ED) data and death records from California. Cases comprised California residents (18 years) who presented to a state-licensed ED and died of hyperthermia during the study period (2009-2012). For each case, up to five ED patients were randomly selected as live controls and matched on sex and age. Patients’ demographic characteristics and history of ED utilization for alcohol use, drug use, psychiatric disorders, heart-related conditions, chronic respiratory disease, neurodegenerative disorders, and cerebrovascular disease were assessed in relationship to hyperthermia mortality. Results: In multivariate conditional logistic regression models, hyperthermia mortality cases had higher odds of prior ED utilization for alcohol use (OR=11.16, 95% CI=3.87, 32.17) compared to controls. Cases were also more likely than controls to have Medicare insurance (OR=5.80, 95% CI=1.70, 15.15) or self-pay (OR=5.39, 95% CI=1.73, 16.79), at their most recent ED visit. Conclusions: ED patients presenting with alcohol problems may face increased risk of hyperthermia mortality. To help reduce heat-related mortality, EDs should consider interventions that target patients vulnerable to heat exposure.

Historically, suicide rates among African Americans were comparatively low to other racial/ethnic groups despite the significant generational trauma, racial discrimination, inequity, and poverty experienced by African Americans. However, African Americans have experienced the greatest recent increases in suicide rates compared with all other racial/ethnic groups, giving renewed urgency to understanding risk factors for suicidal behavior in this population. This dissertation makes a contribution to the literature on suicidal behavior among African Americans by investigating socioeconomic risk factors for suicidal behavior and clinical risk factors for suicide mortality among African Americans. The first study examines the association between educational attainment, annual family income, and suicidal behavior among a representative sample of African American adults. The second study investigates the association between clinical factors (e.g., chronic illness, injuries, mental/substance use disorders) and suicide morality among African American emergency department patients. This dissertation also examines the risk of cause-specific mortality (e.g., heart disease, cerebrovascular disease, suicide) in the context of mental illness among African Americans. The results indicate that socioeconomic risk factors may not be strong predictors of suicidal behavior among African Americans. Lower income African American males in particular, may be a high-risk population for suicidal behavior. Mental disorders are strongly associated with suicidal behavior among African Americans. African Americans with mental disorders may also have an elevated risk of cause-specific mortality. Reducing the burden of suicidal behavior among African Americans may require community-based suicide prevention programing and reducing stigma associated with mental health. Improving chronic disease management and health behaviors among African Americans with mental disorder may help reduce mortality associated with mental illness in this population. Future studies should further investigate the causal mechanisms underlying the relationship between mental illness, suicidal behavior, and cause-specific mortality among African Americans.

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