Background: Increasing average temperatures and extreme heat events due to climate change have adverse effects on human health. Previous studies focus on the heat impacts in urban areas due to the focus on the greater population and urban heat island effect, but this tendency results in the effect of heat on rural health being overlooked. Methods: Using the National Emergency Medical Services Information System (NEMSIS) data from 2021 to 2023, this study compares heat-related illness (HRI) in urban and rural areas of the U.S.

Results: We found the odds of EMS events in an urban area resulting with a positive outcome for the patient was 1.24 times that of EMS events in rural areas. This urban-rural disparity was not equal across regions with the odds of EMS events to rural areas of the Western U.S. resulting with a positive outcome for the patient was 54% less than that for urban areas.

Conclusion: This critical evidence of a rural-urban heat health disparity calls attention to the impact of climate change-fueled heat impacts on health in communities of all sizes, and a need for more rural heat resilience research to inform practice.