Advisor(s)

David Warner

Committee Member(s)

Azar Abadi
Gabriela Oates
Magdalena Szaflarski
Verna Keith

Document Type

Dissertation

Date of Award

6-1-2026

Degree Name

Doctor of Philosophy (PhD)

School

College of Arts and Sciences

Department

Medical Sociology

Abstract

Socially marginalized people face a higher risk of adverse health outcomes from extreme heat—as many as 12,000 U.S. deaths a year are attributable to heat-related illness (HRI), a preventable but multifactorial condition. Where one lives plays a critical role in HRI incidence, with evidence linking historically segregated and disinvested urban environments to a higher risk. The literature also suggests that Black adults experience worse HRI outcomes than non-Hispanic White adults, and that men are often, though not always, at higher risk than women. Individuals with heat-sensitive conditions and socially isolated adults also face elevated risk. Yet the mechanisms by which extreme heat differentially affects vulnerable groups remain unclear. This analysis assesses how place-based structural factors interact with—and are moderated by—individual sociodemographic and health characteristics to shape the risk of Severe HRI (i.e., heat exhaustion, heat stroke). Using HRI case data from the University of Alabama at Birmingham Hospitals, multilevel logistic regression models were estimated for patients (n = 640) nested within residential Census tracts (n = 202). Contextual predictors included housing era, redlining history, and education, while individual characteristics included race, sex, age, marital/partnered status, insurance, and heat-sensitive conditions (hypertension, obesity, and autoimmune disease). Results revealed patterned cross-level heterogeneity in HRI severity. White males exhibited the highest likelihood of Severe HRI, with odds more than five times greater than Black females (OR = 5.12, 90% CI: 3.02, 8.67), diverging from much of the literature. Associations with tract-level conditions were not uniform: higher tract education was selectively protective for Black females, adults aged 30–49, insured patients, and non-obese individuals. Patients without preexisting conditions were more responsive to tract-level factors, suggesting vulnerability saturation. Together, these socially patterned results indicate that Severe HRI risk is highly stratified and emerges from interactions between patient characteristics and place-based factors. This study is among the first to show how these factors combine to shape vulnerability differentially across groups and, in some cases, significantly amplify risk. Its findings extend research on the health effects of neighborhoods and offer insights that may help municipalities prepare for longer, hotter, more frequent periods of extreme heat.

Keywords

Fundamental Cause Theory;health disparities;heat-related illness;multilevel modeling;structural racism;syndemics

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