Quantifying the health-care burden of temperature in the National Health Service in England: an economic analysis of resource use and costs

Background

Climate change poses a severe and escalating threat to human health, yet its broader implications for health-care systems remain poorly understood. Although previous studies have examined mortality and hospital admissions, crucial domains such as medical prescriptions and system-wide costs have been overlooked. This study aims to provide the first comprehensive analysis of the impact of daily average temperature variability on a national health-care system.

Methods

In this economic analysis of resource use and costs, we analysed 4 366 981 patient records from the National Health Service (NHS) in England from the Clinical Practice Research Datalink GOLD, from April 1, 2007, to June 1, 2019. We sourced weather data from the Met Office HadUK-Gridded climate observations. We used a fixed-effects regression model, aligned with methodologies used in other climate-health studies, to estimate the temperature–health-care relationship while controlling for seasonality and practice-specific characteristics. Outcomes included daily counts of health-care events and associated costs per 1000 general-practice-registered individuals, stratified by age, sex, and care domains. We conducted additional robustness checks using alternative lag structures and model specifications.

Findings

Colder days (average temperature 0°C to 9°C) were associated with cumulative increases in consultations with general practitioners, inpatient admissions, and deaths, with disproportionately larger effects among older adults (age >65 years). In contrast, attendance to the Accident and Emergency (A&E) department declined on cold days. Very hot days (>23°C) produced sharp same-day surges in A&E attendances and prescriptions, but cumulative effects were attenuated once the dips in the following days were included. Overall, suboptimal temperature exposure accounted for 3·0% (95% CI 1·2–4·7) of total health-care expenditure, with cold driving 64·4% of this burden. Robustness checks confirmed that these results were stable across alternative model specifications and lag structures.

Interpretation

Temperature variability disrupts health-care delivery, straining service capacity during busy periods. These findings provide the first system-wide benchmark for understanding the health burden of temperature, highlighting potential discrepancies between mortality and access to care. Globally, health-care systems must anticipate these disruptions, and adaptation policies outside of health-care systems are essential to reduce health and financial pressures. Investments in climate-resilient infrastructure and strategies to protect vulnerable populations, especially older adults, are urgently needed.