Top 5 Takeaways

  1. Increased Heat Exposure and Illnesses: Maricopa and Yuma counties in Arizona saw an increase in heat exposure and heat-related illnesses (HRIs) from 2010 to 2020, with a significant impact on older adults (≥65 years).
  2. Higher Risk Among Older Adults: Adults aged ≥65 years experienced higher rates of HRI hospitalizations compared to those aged <65 years. Barriers to accessing cooling centers for older adults included lack of awareness and transportation difficulties.
  3. Use and Awareness of Cooling Centers: A survey revealed that only 54% of older adults knew what a cooling center was, and 36% were aware of their locations. This suggests a need for increased outreach and information dissemination.
  4. Social Vulnerability and Cooling Center Locations: The analysis of cooling center locations against the CDC’s Social Vulnerability Index indicated that in 2019 and 2020, a significant portion of cooling centers were located in areas with high social vulnerability.
  5. Public Health Implications: The findings underscore the importance of states and communities implementing and evaluating adaptation strategies, such as cooling centers, to mitigate heat risks, especially for communities disproportionately affected by HRIs.

Original Article Author and Citation

Corresponding Author

Evan Mallen,

Suggested Citation

Mallen E, Roach M, Fox L, et al. Extreme Heat Exposure: Access and Barriers to Cooling Centers — Maricopa and Yuma Counties, Arizona, 2010–2020. MMWR Morb Mortal Wkly Rep 2022;71:781–785. DOI:


This report analyzes trends in heat exposure and HRIs in Maricopa and Yuma counties, Arizona, from 2010 to 2020, with a focus on the elderly population. It examines the availability and use of cooling centers as a mitigation strategy against HRIs, identifying barriers to access for older adults.


Data from hospital discharge records were analyzed to identify HRI-associated hospitalizations. Surveys were conducted among older adults to assess awareness and use of cooling centers, and the Social Vulnerability Index (SVI) was used to evaluate the placement of cooling centers in vulnerable areas.


The report highlights the increasing incidence of HRIs in the context of rising temperatures and identifies older adults as particularly vulnerable. It points out the critical role of cooling centers in HRI prevention but notes existing barriers to their effective use, including awareness and accessibility issues.


To combat the growing threat of heat exposure, particularly among vulnerable populations like the elderly, there is a need for comprehensive public health strategies that include the establishment and promotion of cooling centers. Improving access and awareness is essential for these centers to serve as effective refuges during extreme heat events.


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