The unprecedented Pacific Northwest heatwave of June 2021

Environmental and social framework to protect marine bivalves under extreme weather events

Rising ocean temperatures, a consequence of anthropogenic climate change, are increasing the frequency, intensity, and magnitude of extreme marine heatwaves (MHWs). These persistent anomalous warming events can have severe ecological and socioeconomic impacts, threatening ecologically and economically vital organisms such as bivalves and the ecosystems they support. Developing robust environmental and social frameworks to enhance the resilience and adaptability of bivalve aquaculture is critical to ensuring the sustainability of this crucial food source. This review synthesizes the current understanding of the physiological and ecological impacts of MHWs on commercially important bivalve species farmed globally. We propose an integrated risk assessment framework that encompasses environmental monitoring, farm-level preparedness planning, and community-level social support systems to safeguard bivalve aquaculture. Specifically, we examine heatwave prediction models, local mitigation strategies, and social programs that could mitigate the impacts on bivalve farms and vulnerable coastal communities economically dependent on this fishery. At the farm level, adaptation strategies such as selective breeding for heat-tolerant strains, optimized site selection, and adjustments to culture practices can improve survival outcomes during MHWs. Robust disease surveillance and management programs are essential for early detection and rapid response. Furthermore, we highlight the importance of stakeholder engagement, knowledge exchange, and collaborative governance in developing context-specific, inclusive, and equitable safeguard systems. Proactive measures, such as advanced forecasting tools like the California Current Marine Heat Wave Tracker developed by NOAA's Southwest Fisheries Science Center, enable preemptive action before losses occur. Coordinated preparation and response, underpinned by continuous monitoring and adaptive management, promise to protect these climate-vulnerable food systems and coastal communities. However, sustained research, innovation, and cross-sector collaboration are imperative to navigate the challenges posed by our rapidly changing oceans.

Concurrent Measurement of O2 Production and Isoprene Emission During Photosynthesis: Pros, Cons and Metabolic Implications of Responses to Light, CO2 and Temperature

Traditional leaf gas exchange experiments have focused on net CO2 exchange (Anet). Here, using California poplar (Populus trichocarpa), we coupled measurements of net oxygen production (NOP), isoprene emissions and δ18O in O2 to traditional CO2/H2O gas exchange with chlorophyll fluorescence, and measured light, CO2 and temperature response curves. This allowed us to obtain a comprehensive picture of the photosynthetic redox budget including electron transport rate (ETR) and estimates of the mean assimilatory quotient (AQ = Anet/NOP). We found that Anet and NOP were linearly correlated across environmental gradients with similar observed AQ values during light (1.25 ± 0.05) and CO2 responses (1.23 ± 0.07). In contrast, AQ was suppressed during leaf temperature responses in the light (0.87 ± 0.28), potentially due to the acceleration of alternative ETR sinks like lipid synthesis. Anet and NOP had an optimum temperature (Topt) of 31°C, while ETR and δ18O in O2 (35°C) and isoprene emissions (39°C) had distinctly higher Topt. The results confirm a tight connection between water oxidation and ETR and support a view of light-dependent lipid synthesis primarily driven by photosynthetic ATP/NADPH not consumed by the Calvin-Benson cycle, as an important thermotolerance mechanism linked with high rates of (photo)respiration and CO2/O2 recycling.

Increasing extreme precipitation variability plays a key role in future record-shattering event probability

Climate events that break records by large margins are a threat to society and ecosystems. Climate change is expected to increase the probability of such events, but quantifying these probabilities is challenging due to natural variability and limited data availability, especially for observations and very rare extremes. Here we estimate the probability of precipitation events that shatter records by a margin of at least one pre-industrial standard deviation. Using large ensemble climate simulations and extreme value theory, we determine empirical and analytical record shattering probabilities and find they are in high agreement. We show that, particularly in high emission scenarios, models project much higher record-shattering precipitation probabilities in a changing relative to a stationary climate by the end of the century for almost all the global land, with the strongest increases in vulnerable regions in the tropics. We demonstrate that increasing variability is an essential driver of near-term increases in record-shattering precipitation probability, and present a framework that quantifies the influence of combined trends in mean and variability on record-shattering behaviour in extreme precipitation. Probability estimates of record-shattering precipitation events in a warming world are crucial to inform risk assessment and adaptation policies.

A hybrid reanalysis-forecast meteorological forcing data for advancing climate adaptation in agriculture

Climate variability in the growing season is well suited for testing adaptation measures. Adaptation to adverse events, such as heatwaves and droughts, increases the capacity of players in agri-food systems, not only producers but also transporters and food manufacturers, to prepare for production disruptions due to seasonal extremes and climate change. Climate impact models (e.g., crop models) can be used to develop adaptation responses. To run these models, historical records and climate forecasts need to be combined as a single daily time series. We introduce the daily 0.5° global hybrid reanalysis-forecast meteorological forcing dataset from 2010 to 2021. The dataset consists of the Japanese 55-yr Reanalysis (JRA55) and the Japan Meteorological Agency/Meteorological Research Institute Coupled Prediction System version 2 (JMA/MRI-CPS2) 5-member ensemble forecast. Both are bias-corrected using the Delta method and integrated with a baseline climatology derived from the Environmental Research and Technology Development Fund's Strategic Research 14 Meteorological Forcing Dataset (S14FD). The dataset is called JCDS (JRA55-CPS2-Delta-S14FD) and offers a framework for monitoring and forecasting applications towards adaptation.

Previously hidden landslide processes revealed using distributed acoustic sensing with nanostrain-rate sensitivity

Landslides sometimes creep for decades before undergoing runaway acceleration and catastrophic failure. Observing and monitoring the evolution of strain in time and space is crucial to understand landslide processes, including the transition from slow to fast movement. However, the limited spatial or temporal resolution of existing landslide monitoring instrumentation limits the study of these processes. We employ distributed acoustic sensing strain data below 1 Hertz frequency during a three-day rainfall at the Hollin Hill landslide and quantify strain-rate changes at meter and sub-minute scales. We observe near-surface strain onset at the head scarp, strain acceleration at a developing rupture zone, retrogression towards the scarp, and flow-lobe activity. These processes with displacements of less than 0.5 mm are undetected using other methods. However, the millimeter processes over three days agree with previously observed seasonal landslide patterns. Here, we show landslide processes occurring with nanostrain-rate sensitivity at spatiotemporal resolution previously not possible.

Amplified warming of North American cold extremes linked to human-induced changes in temperature variability

How global warming is impacting winter cold extremes is uncertain. Previous work has found decreasing winter temperature variability over North America which suggests a reduction in frequency and intensity of cold extremes relative to mean changes. However, others argue that cold air outbreaks are becoming more likely because of Arctic-induced changes in atmospheric circulation. Here we show that cold extremes over North America have warmed substantially faster than the winter mean temperature since 1980. This amplified warming is linked to both decreasing variance and changes in higher moments of the temperature distributions. Climate model simulations with historical forcings robustly capture the observed trends in extremes and variability. A pattern-based detection and attribution analysis shows that the changes in variability are detectable in observations and can be attributed to human influence. Our results highlight that human emissions are warming North American extreme cold temperatures beyond only shifting the winter mean temperature.

Compound mortality impacts from extreme temperatures and the COVID-19 pandemic

Extreme weather and coronavirus-type pandemics are both leading global health concerns. Until now, no study has quantified the compound health consequences of the co-occurrence of them. We estimate the mortality attributable to extreme heat and cold events, which dominate the UK health burden from weather hazards, in England and Wales in the period 2020-2022, during which the COVID-19 pandemic peaked in terms of mortality. We show that temperature-related mortality exceeded COVID-19 mortality by 8% in South West England. Combined, extreme temperatures and COVID-19 led to 19 (95% confidence interval: 16-22 in North West England) to 24 (95% confidence interval: 20-29 in Wales) excess deaths per 100,000 population during heatwaves, and 80 (95% confidence interval: 75-86 in Yorkshire and the Humber) to 127 (95% confidence interval: 123-132 in East of England) excess deaths per 100,000 population during cold snaps. These numbers are at least ~2 times higher than the previous decade. Society must increase preparedness for compound health crises such as extreme weather coinciding with pandemics.

"Breaking down in tears, soaked in sweat, and sick from the heat": Media-based composite narratives of first responders working during the 2021 Heat Dome

BACKGROUND

During the summer of 2021, a deadly, unprecedented multiday Heat Dome engulfed western Canada. As a result of this extreme heat event (EHE), emergency dispatchers received an unparalleled increase in incoming 911 calls for ambulance, police, and fire (as first responders) services to attend to hundreds of heat-vulnerable community members succumbing to the heat. With 103 all-time heat records broken during this EHE and indoor temperatures of nearly 40°C, the first responders attending these calls faced extensive job demands and highly challenging operating conditions. Initial investigations have explored the health system-level impacts; however, little has been done to explore the impact on the first responders themselves. Therefore, this study aimed to improve our understanding of EHEs' impacts on the operational capabilities and health of first responders, specifically police, fire, ambulance, and dispatch services.

METHODS

A systematized review and content analysis of media articles published on the 2021 Heat Dome in Canada was conducted (n = 2909), and four media-based composite narratives were developed highlighting police, fire, ambulance, and dispatch services. The Job Demands-Resources (JD-R) model was applied as a theoretical framework for occupational burnout.

RESULTS

The media-based composite narratives highlighted that first responders faced record-breaking call volumes, increased mental-health-related claims, and exhaustive heat-related physiological stress. Using the JD-R model as a theoretical framework for occupational burnout, we identified three measures of stressful job demand: work overload (e.g., the surge in call volume, firefighters responding to medical emergencies), emotional demands (e.g., severe medical emergencies, sudden deaths, unresponsive patients, distraught family members), and physical demands (e.g., resuscitation in personal protective equipment, heat-related illness).

CONCLUSION

The experiences described underscore the importance of supporting first responders during work in extreme heat conditions. These findings have important implications for addressing rising rates of burnout during and following public health crises, such as EHEs, a problem that is increasingly being recognized as a threat to the Canadian public healthcare system.

Estimating the impacts of nonoptimal temperatures on mortality: A study in British Columbia, Canada, 2001-2021

Background

Studies show that more than 5.1 million deaths annually are attributed to nonoptimal temperatures, including extreme cold and extreme heat. However, those studies mostly report average estimates across large geographical areas. The health risks attributed to nonoptimal temperatures in British Columbia (BC) are reported incompletely or limit the study area to urban centers. In this study, we aim to estimate the attributable deaths linked to nonoptimal temperatures in all five regional health authorities (RHAs) of BC from 2001 to 2021.

Methods

We applied the widely used distributed lag nonlinear modeling approach to estimate temperature-mortality association in the RHAs of BC, using daily all-cause deaths and 1 × 1 km gridded daily mean temperature. We evaluated the model by comparing the model-estimated attributable number of deaths during the 2021 heat dome to the number of heat-related deaths confirmed by the British Columbia Coroners Service.

Results

Overall, between 2001 and 2021, we estimate that 7.17% (95% empirical confidence interval = 3.15, 10.32) of deaths in BC were attributed to nonoptimal temperatures, the majority of which are attributed to cold. On average, the mortality rates attributable to moderate cold, moderate heat, extreme cold, and extreme heat were 47.04 (95% confidence interval [CI] = 45.83, 48.26), 0.94 (95% CI = 0.81, 1.08), 2.88 (95% CI = 2.05, 3.71), and 3.10 (95% CI = 1.79, 4.4) per 100,000 population per year, respectively.

Conclusions

Our results show significant spatial variability in deaths attributable to nonoptimal temperatures across BC. We find that the effect of extreme temperatures is significantly less compared to milder nonoptimal temperatures between 2001 and 2021. However, the increased contribution of extreme heat cannot be ruled out in the near future.

Promoting community health and climate justice co-benefits: insights from a rural and remote island climate planning process

Climate change is an environmental crisis, a health crisis, a socio-political and an economic crisis that illuminates the ways in which our human-environment relationships are arriving at crucial tipping points. Through these relational axes, social structures, and institutional practices, patterns of inequity are produced, wherein climate change disproportionately impacts several priority populations, including rural and remote communities. To make evidence-based change, it is important that engagements with climate change are informed by data that convey the nuance of various living realities and forms of knowledge; decisions are rooted in the social, structural, and ecological determinants of health; and an intersectional lens informs the research to action cycle. Our team applied theory- and equity-driven conceptualizations of data to our work with the community on Cortes Island-a remote island in the northern end of the Salish Sea in British Columbia, Canada-to aid their climate change adaptation and mitigation planning. This work was completed in five iterative stages which were informed by community-identified needs and preferences, including: An environmental scan, informal scoping interviews, attending a community forum, a scoping review, and co-development of questions for a community survey to guide the development of the Island's climate change adaptation and mitigation plan. Through this community-led collaboration we learned about the importance of ground truthing data inaccuracies and quantitative data gaps through community consultation; shifting planning focus from deficit to strengths- and asset-based engagement; responding to the needs of the community when working collaboratively across academic and community contexts; and, foregrounding the importance of, and relationship to, place when doing community engagement work. This suite of practices illuminates the integrative solution-oriented thinking needed to address complex and intersecting issues of climate change and community health.

Street trees provide an opportunity to mitigate urban heat and reduce risk of high heat exposure

Climate change is exacerbating the need for urban greening and the associated environmental and human well-being benefits. Trees can help mitigate urban heat, but more detailed understanding of cooling effects of green infrastructure are needed to guide management decisions and deploy trees as effective and equitable climate adaptation infrastructure. We investigated how urban trees affect summer air temperature along sidewalks within a neighborhood of Tacoma, Washington, USA, and to what extent urban trees reduce risks of high summer temperatures (i.e., the levels regulated by state outdoor heat exposure rules intended to reduce heat-related illnesses). Air temperature varied by 2.57 °C, on average, across our study area, and the probability of daytime temperatures exceeding regulated high temperature thresholds was up to five times greater in locations with no canopy cover within 10 m compared to those with 100% cover. Air temperatures decreased linearly with increasing cover within 10 m, suggesting that every unit of added tree cover can help cool the air. Our findings highlight the value of trees in mitigating urban heat, especially given expected warming with climate change. Protecting existing urban trees and increasing tree cover (e.g., by planting street trees), are important actions to enhance climate change resilience of urban areas.

Role of atmospheric resonance and land-atmosphere feedbacks as a precursor to the June 2021 Pacific Northwest Heat Dome event

We demonstrate an indirect, rather than direct, role of quasi-resonant amplification of planetary waves in a summer weather extreme. We find that there was an interplay between a persistent, amplified large-scale atmospheric circulation state and soil moisture feedbacks as a precursor for the June 2021 Pacific Northwest "Heat Dome" event. An extended resonant planetary wave configuration prior to the event created an antecedent soil moisture deficit that amplified lower atmospheric warming through strong nonlinear soil moisture feedbacks, favoring this unprecedented heat event.

The impact of extreme heat on lake warming in China

Global lake ecosystems are subjected to an increased occurrence of heat extremes, yet their impact on lake warming remains poorly understood. In this study, we employed a hybrid physically-based/statistical model to assess the contribution of heat extremes to variations in surface water temperature of 2260 lakes in China from 1985 to 2022. Our study indicates that heat extremes are increasing at a rate of about 2.08 days/decade and an intensity of about 0.03 °C/ day·decade in China. The warming rate of lake surface water temperature decreases from 0.16 °C/decade to 0.13 °C/decade after removing heat extremes. Heat extremes exert a considerable influence on long-term lake surface temperature changes, contributing 36.5% of the warming trends within the studied lakes. Given the important influence of heat extremes on the mean warming of lake surface waters, it is imperative that they are adequately accounted for in climate impact studies.

Marine latitudinal diversity gradients are generally absent in intertidal ecosystems

Current latitudinal diversity gradient (LDG) meta-analyses have failed to distinguish one of the most widespread marine habitats, the intertidal zone, as a separate system despite it having unique abiotic challenges and spatially compressed stress gradients that affect the distribution and abundance of resident species. We address this issue by revisiting published literature and datasets on LDGs since 1911 to explore LDG patterns and their strengths in intertidal benthic, subtidal benthic, and pelagic realms and discuss the importance of recognizing intertidal ecosystems as distinct. Rocky shorelines were the most studied intertidal ecosystem encompassing 64.2% of intertidal LDG studies, and 62.9% of studies focused on assemblage composition, while the remaining 37.1% of studies were taxa specific. While our analyses confirmed LDGs in subtidal benthic and pelagic realms, with a decrease in richness toward the poles, we found no consistent intertidal LDGs in any ocean or coastline across hemispheres or biodiversity unit. Analyzing intertidal and subtidal zones as separate systems increased the strength of subtidal benthic LDGs relative to analyses combining these systems. We demonstrate that in intertidal ecosystems across oceans in both hemispheres, a latitudinal decrease in species richness is not readily apparent, which stands in contrast with significant LDG patterns found in the subtidal realm. Intertidal habitat heterogeneity, regional environmental variability and biological interactions can create species-rich hot spots independent of latitude, which may functionally outweigh a typical latitudinal decline in species richness. Although previous work has shown weaker LDGs in benthic than pelagic systems, we demonstrate that this is caused by combining subtidal and intertidal benthic ecosystems into a single benthic category. Thus, we propose that subtidal and intertidal ecosystems cannot be combined into one entity as the physical and biological parameters controlling ecosystem processes are vastly different, even among intertidal ecosystems. Thus, the intertidal zone offers a unique model system in which hypotheses can be further tested to better understand the complex processes underlying LDGs.

Uncovering the roles of sirtuin activity and food availability during the onset of the heat shock response in the California mussel (Mytilus californianus): Implications for antioxidative stress responses

Sirtuins are a class of NAD+-dependent deacylases, with known regulatory roles in energy metabolism and cellular stress responses in vertebrates. Previous work using marine mussels have suggested a similar role in invertebrates, providing a potential mechanism linking food availability and thermal sensitivity in Mytilids. Sirtuin inhibitors affect mussels' recovery from environmental stressors, including acute heat shock and well-fed mussels exposed to sirtuin inhibitors and/or acute heat shock respond differently than poorly fed mussels, at the protein and whole-organism levels. While this implies a relationship between sirtuins, food availability, and temperature, the direct effects of sirtuin inhibitors (nicotinamide and suramin) on sirtuin activity or their putative effectors have not been explicitly tested. In this study, adult Mytilus californianus were acclimated to a low or high food availability and exposed to one of the following treatments: control, acute heat shock, sirtuin inhibitors, or acute heat shock and sirtuin inhibitors. Mussels increased sirtuin activity during early recovery (5 h) from sirtuin inhibition and acute heat shock, but only if acclimated to a high food availability. Redox balance was also impacted in mussels acclimated to high food availability and exposed to sirtuin inhibitors, signifying interactions between ration, acute heat shock, and sirtuin inhibitors. Additionally, we found a correlation between sirtuin and superoxide dismutase activities, suggesting a potential regulatory role of oxidative stress by sirtuins. Following prolonged recovery (17 h), we found increased sirtuin activity in mussels acclimated to low food availability, indicating that endogenous sirtuin activity may be related to food availability in mussels.

Satellite mapping of red snow on North American glaciers

Red snow caused by blooms of microalgae darkens the surface of summer snowfields, increasing snowmelt. To assess the contribution of red snow to supraglacial snowmelt in northwestern North America, we systematically mapped the 2019-2022 distribution of blooms by applying supervised classification to 6158 satellite images. Blooms occurred on 5% of the total glaciated area, heavily affecting many glaciers in years of prolonged snow cover duration. Individual glaciers had up to 65% of their surface area affected by bloom in one melt season, which we estimate caused as much as 3 cm of snow meltwater equivalent averaged across the glacier surface. These results demonstrate appreciable snowmelt caused by red snow albedo over vast areas of North American glaciers.

Ambient temperatures associated with reduced cognitive function in older adults in China

The cognitive function status of older adults determines the social function and living quality of older adults, which is related to the healthy development and stability of the society. However, the impact of high or low ambient temperature on cognitive function in older adults remains unclear. Based on data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), we comprehensively assessed the impact of ambient temperature on the cognitive function of older adults in this study. The findings exhibited that for each 1 °C ascent in monthly temperature of high temperature, the examination score of global cognitive function of older adults decreased by 0.48 (95% CI 0.21-0.74), which was greater than that of 0.14 (95% CI 0.06-0.25) for each 1 °C reduction in low temperature. Overall, the detrimental effect of high temperature on cognitive function in older adults was more significant than that of low temperature, including on the five sub-cognitive functions involved. Our research provides vital technical guidance and reference for the health protection and prevention of cognitive function of older adults in specific external environmental conditions under the current climatic variation and temperature rise.

Working under the 2021 Heat Dome: A Content Analysis of Occupational Impacts Mentioned in the Canadian Media

Extreme heat events directly impact worker health and cause additional cascading and transitional workplace impacts. However, current investigations on these impacts often rely on specific datasets (e.g., compensation claims, hospitalizations). Thus, to continue to work towards preventing and mitigating the occupational risks posed by extreme heat events, this study aimed to explore the occupational impacts of the 2021 Heat Dome in Canada using a qualitative content analysis method on a news-based dataset. A systematized review of news articles published before, during, and after the 2021 Heat Dome was conducted on academic (n = 8) and news (n = 5) databases, along with targeted grey literature. Two researchers qualitatively coded the articles in NVivo for occupational impacts or references mentioned within the articles. Overall, 52 different occupations were identified as being impacted by the 2021 Heat Dome. Impacts were diverse and ranged from work cancellations or delays to work modifications and reports of heat-related illnesses. The 2021 Heat Dome impacted the health and safety of many occupational groups and provided new insights into the expanding impacts that extreme heat events can have on the Canadian workforce. With climate projections showing a growing trend of more hot days and intense heat waves in Canada, addressing these concerns should be a critical priority.

Storylines for unprecedented heatwaves based on ensemble boosting

Recent temperature extremes have shattered previously observed records, reaching intensities that were inconceivable before the events. Could the possibility of an event with such unprecedented intensity as the 2021 Pacific Northwest heatwave have been foreseen, based on climate model information available before the event? Could the scientific community have quantified its potential intensity based on the current generation of climate models? Here, we demonstrate how an ensemble boosting approach can be used to generate physically plausible storylines of a heatwave hotter than observed in the Pacific Northwest. We also show that heatwaves of much greater intensities than ever observed are possible in other locations like the Greater Chicago and Paris regions. In order to establish confidence in storylines of 'black swan'-type events, different lines of evidence need to be combined along with process understanding to make this information robust and actionable for stakeholders.

Survey of extreme heat public health preparedness plans and response activities in the most populous jurisdictions in the United States

BACKGROUND

Increasingly frequent and intense extreme heat events (EHEs) are indicative of climate change impacts, and urban areas' social and built environments increase their risk for health consequences. Heat action plans (HAPs) are a strategy to bolster municipal EHE preparedness. The objective of this research is to characterize municipal interventions to EHEs and compare U.S. jurisdictions with and without formal heat action plans.

METHODS

An online survey was sent to 99 U.S. jurisdictions with populations > 200,000 between September 2021 and January 2022. Summary statistics were calculated to describe the proportion of total jurisdictions, as well as jurisdictions with and without HAPs and in different geographies that reported engagement in extreme heat preparedness and response activities.

RESULTS

Thirty-eight (38.4%) jurisdictions responded to the survey. Of those respondents, twenty-three (60.5%) reported the development of a HAP, of which 22 (95.7%) reported plans for opening cooling centers. All respondents reported conducting heat-related risk communications; however, communication approaches focused on passive, technology-dependent mechanisms. While 75.7% of jurisdictions reported having developed a definition for an EHE, less than two-thirds of responding jurisdictions reported any of the following activities: conducting heat-related surveillance (61.1%), implementing provisions for power outages (53.1%), increasing access to fans or air conditioners (48.4%), developing heat vulnerability maps (43.2%), or evaluating activities (34.2%). There were only two statistically significant (p ≥ .05) differences in the prevalence of heat-related activities between jurisdictions with and without a written HAP, possibly attributable to a relatively small sample size: surveillance and having a definition of extreme heat.

CONCLUSIONS

Jurisdictions can strengthen their extreme heat preparedness by expanding their consideration of at-risk populations to include communities of color, conducting formal evaluations of their responses, and by bridging the gap between the populations determined to be most at-risk and the channels of communication designed to reach them.

Chronic Diseases Associated With Mortality in British Columbia, Canada During the 2021 Western North America Extreme Heat Event

Western North America experienced an unprecedented extreme heat event (EHE) in 2021, characterized by high temperatures and reduced air quality. There were approximately 740 excess deaths during the EHE in the province of British Columbia, making it one of the deadliest weather events in Canadian history. It is important to understand who is at risk of death during EHEs so that appropriate public health interventions can be developed. This study compares 1,614 deaths from 25 June to 02 July 2021 with 6,524 deaths on the same dates from 2012 to 2020 to examine differences in the prevalence of 26 chronic diseases between the two groups. Conditional logistic regression was used to estimate the odds ratio (OR) for each chronic disease, adjusted for age, sex, and all other diseases, and conditioned on geographic area. The OR [95% confidence interval] for schizophrenia among all EHE deaths was 3.07 [2.39, 3.94], and was larger than the ORs for other conditions. Chronic kidney disease and ischemic heart disease were also significantly increased among all EHE deaths, with ORs of 1.36 [1.18, 1.56] and 1.18 [1.00, 1.38], respectively. Chronic diseases associated with EHE mortality were somewhat different for deaths attributed to extreme heat, deaths with an unknown/pending cause, and non-heat-related deaths. Schizophrenia was the only condition associated with significantly increased odds of EHE mortality in all three subgroups. These results confirm the role of mental illness in EHE risk and provide further impetus for interventions that target specific groups of high-risk individuals based on underlying chronic conditions.