The Usefulness of Maximum Daily Temperatures Versus Defined Heatwave Periods in Assessing the Impact of Extreme Heat on ED Admissions for Chronic Conditions
DOI:
https://doi.org/10.6000/1929-6029.2016.05.02.2Keywords:
Emergency department admissions, excess heat, temperature threshold, chronic conditions, case-cross over design, conditional logistic regression, negative binomial regressionAbstract
Objective: To compare a heatwave based exposure classification with a maximum daily temperature based exposure classification in assessing the associations between increased heat and emergency department (ED) admissions for chronic conditions.
Methods: ED admission data was collected from 4 public hospitals in South Australia from 2007 to 2009. Effects of 5 heatwave periods were examined using conditional logistic regression (heatwave versus non-heatwave) whilst effects of maximum daily temperature were explored using negative binomial regression with temperature classified using <25 °C (reference category) and additional 5 °C increments. Non-linear regression (ED admissions per unit °C) was used to examine possible temperature thresholds for increased ED admissions.
Results: In heatwave/non-heatwave analysis, an increased odds of admission during heatwaves was observed for heat-related complaints [OR=3.2; 95%CI=2.5, 4.11] and renal conditions [OR=1.13; 95%CI=1.05, 1.21] only. In temperature based analysis, mental health related conditions began increasing at 30-34 °C compared to <25 °C [IRR=1.11; 95%CI=1.02, 1.20], heat related conditions were increased at 35-39 °C [IRR=3.4; 95%CI=2.48, 4.64] while CVD admissions were lower above 40 °C [IRR=0.89; 95%CI=0.80-0.99]. Significant threshold temperatures were identified for heat-related conditions at 37.6 °C [p<0.001] and for renal admissions at 39.2 °C [p<0.001].
Conclusions: Using maximum daily temperature was a more sensitive approach to detecting effects of heat on ED admissions for chronic disease and also allowed the detection of temperature threshold effects. Assessing the impact of temperature rather than heatwaves should better identify the weather conditions that increase the risk of events amongst individuals with specific chronic conditions.
References
Bi P, Parton KA, Wang J, Donald K. Temperature and direct effects on population health in Brisbane, 1986-1995. J Environ Health 2008; 70: 48-53.
Bi P, Williams S, Loughnan M, Lloyd G, Hansen A, Kjellstrom T, et al. The effects of extreme heat on human mortality and morbidity in Australia: implications for public health. Asia Pac J Public Health 2011; 23: 27S-36. http://dx.doi.org/10.1177/1010539510391644 DOI: https://doi.org/10.1177/1010539510391644
Nitschke M, Tucker GR, Bi P. Morbidity and mortality during heatwaves in metropolitan Adelaide. Med J Aust 2007; 187: 662-5. DOI: https://doi.org/10.5694/j.1326-5377.2007.tb01466.x
Williams S, Nitschke M, Weinstein P, Pisaniello DL, Parton KA, Bi P. The impact of summer temperatures and heatwaves on mortality and morbidity in Perth, Australia 1994-2008. Environ Int 2012; 40: 33-8. http://dx.doi.org/10.1016/j.envint.2011.11.011 DOI: https://doi.org/10.1016/j.envint.2011.11.011
ONS. Estimated daily mortality during July 2006 in England and Wales. Health Stat Q 2006: 107-11.
Abrahamson V, Wolf J, Lorenzoni I, Fenn B, Kovats S, Wilkinson P, et al. Perceptions of heatwave risks to health: interview-based study of older people in London and Norwich, UK. J Public Health (Oxf) 2009; 31: 119-26. http://dx.doi.org/10.1093/pubmed/fdn102 DOI: https://doi.org/10.1093/pubmed/fdn102
Brown G, Fearn V, Wells C. Exploratory analysis of seasonal mortality in England and Wales, 1998 to 2007. Health Stat Q 2010: 58-80. http://dx.doi.org/10.1057/hsq.2010.21 DOI: https://doi.org/10.1057/hsq.2010.21
Bosch X. European heatwave causes misery and deaths. Lancet 2003; 362: 543. http://dx.doi.org/10.1016/S0140-6736(03)14155-4 DOI: https://doi.org/10.1016/S0140-6736(03)14155-4
Bassil KL, Cole DC, Moineddin R, Lou W, Craig AM, Schwartz B, et al. The relationship between temperature and ambulance response calls for heat-related illness in Toronto, Ontario, 2005. J Epidemiol Community Health 2011; 65: 829-31. http://dx.doi.org/10.1136/jech.2009.101485 DOI: https://doi.org/10.1136/jech.2009.101485
Laaidi M, Laaidi K, Besancenot JP. Temperature-related mortality in France, a comparison between regions with different climates from the perspective of global warming. Int J Biometeorol 2006; 51: 145-53. http://dx.doi.org/10.1007/s00484-006-0045-8 DOI: https://doi.org/10.1007/s00484-006-0045-8
Hajat S, Kovats RS, Atkinson RW, Haines A. Impact of hot temperatures on death in London: a time series approach. J Epidemiol Community Health 2002; 56: 367-72. http://dx.doi.org/10.1136/jech.56.5.367 DOI: https://doi.org/10.1136/jech.56.5.367
Hu W, Mengersen K, McMichael A, Tong S. Temperature, air pollution and total mortality during summers in Sydney, 1994-2004. Int J Biometeorol 2008; 52: 689-96. http://dx.doi.org/10.1007/s00484-008-0161-8 DOI: https://doi.org/10.1007/s00484-008-0161-8
Khalaj B, Lloyd G, Sheppeard V, Dear K. The health impacts of heat waves in five regions of New South Wales, Australia: a case-only analysis. Int Arch Occup Environ Health 2010; 83: 833-42. http://dx.doi.org/10.1007/s00420-010-0534-2 DOI: https://doi.org/10.1007/s00420-010-0534-2
Mayner L, Arbon P, Usher K. Emergency department patient presentations during the 2009 heatwaves in Adelaide. Collegian 2010; 17: 175-82. http://dx.doi.org/10.1016/j.colegn.2010.09.004 DOI: https://doi.org/10.1016/j.colegn.2010.09.004
Williams S, Nitschke M, Sullivan T, Tucker GR, Weinstein P, Pisaniello DL, et al. Heat and health in Adelaide, South Australia: assessment of heat thresholds and temperature relationships. Sci Total Environ 2012; 414: 126-33. http://dx.doi.org/10.1016/j.scitotenv.2011.11.038 DOI: https://doi.org/10.1016/j.scitotenv.2011.11.038
Tong S, Wang XY, Guo Y. Assessing the short-term effects of heatwaves on mortality and morbidity in Brisbane, Australia: comparison of case-crossover and time series analyses. PLoS One 2012; 7: e37500. http://dx.doi.org/10.1371/journal.pone.0037500 DOI: https://doi.org/10.1371/journal.pone.0037500
Armstrong B. Models for the relationship between ambient temperature and daily mortality. Epidemiology 2006; 17: 624-31. http://dx.doi.org/10.1097/01.ede.0000239732.50999.8f DOI: https://doi.org/10.1097/01.ede.0000239732.50999.8f
Guo Y, Barnett AG, Pan X, Yu W, Tong S. The impact of temperature on mortality in Tianjin, China: a case-crossover design with a distributed lag nonlinear model. Environ Health Perspect 2011; 119: 1719-25. http://dx.doi.org/10.1289/ehp.1103598 DOI: https://doi.org/10.1289/ehp.1103598
Garcia-Pina R, Tobias Garces A, Sanz Navarro J, Navarro Sanchez C, Garcia-Fulgueiras A. [Effect of weather temperature on hospital emergencies in the Region of Murcia, Spain, throughout the 2000-2005 and its use in epidemiological surveillance]. Rev Esp Salud Publica 2008; 82: 153-66. http://dx.doi.org/10.1590/S1135-57272008000200002 DOI: https://doi.org/10.1590/S1135-57272008000200002
Woodruff RE, McMichael T, Butler C, Hales S. Action on climate change: the health risks of procrastinating. Aust N Z J Public Health 2006; 30: 567-71. http://dx.doi.org/10.1111/j.1467-842X.2006.tb00788.x DOI: https://doi.org/10.1111/j.1467-842X.2006.tb00788.x
Maclure M, Mittleman MA. Should we use a case-crossover design? Annu Rev Public Health 2000; 21: 193-221. http://dx.doi.org/10.1146/annurev.publhealth.21.1.193 DOI: https://doi.org/10.1146/annurev.publhealth.21.1.193
Nitschke M, Tucker GR, Hansen AL, Williams S, Zhang Y, Bi P. Impact of two recent extreme heat episodes on morbidity and mortality in Adelaide, South Australia: a case-series analysis. Environ Health 2011; 10: 42. http://dx.doi.org/10.1186/1476-069X-10-42 DOI: https://doi.org/10.1186/1476-069X-10-42
Hansen A, Bi P, Nitschke M, Ryan P, Pisaniello D, Tucker G. The effect of heat waves on mental health in a temperate Australian city. Environ Health Perspect 2008; 116: 1369-75. http://dx.doi.org/10.1289/ehp.11339 DOI: https://doi.org/10.1289/ehp.11339
Ng CF, Ueda K, Ono M, Nitta H, Takami A. Characterizing the effect of summer temperature on heatstroke-related emergency ambulance dispatches in the Kanto area of Japan. Int J Biometeorol 2013. DOI: https://doi.org/10.1289/isee.2013.P-1-12-04
Goldberg MS, Gasparrini A, Armstrong B, Valois MF. The short-term influence of temperature on daily mortality in the
temperate climate of Montreal, Canada. Environ Res 2011; 111: 853-60. http://dx.doi.org/10.1016/j.envres.2011.05.022 DOI: https://doi.org/10.1016/j.envres.2011.05.022
Ren C, Williams GM, Morawska L, Mengersen K, Tong S. Ozone modifies associations between temperature and cardiovascular mortality: analysis of the NMMAPS data. Occup Environ Med 2008; 65: 255-60. http://dx.doi.org/10.1136/oem.2007.033878 DOI: https://doi.org/10.1136/oem.2007.033878
Wang XY, Barnett AG, Hu W, Tong S. Temperature variation and emergency hospital admissions for stroke in Brisbane, Australia, 1996-2005. Int J Biometeorol 2009; 53: 535-41. http://dx.doi.org/10.1007/s00484-009-0241-4 DOI: https://doi.org/10.1007/s00484-009-0241-4
Qian Z, He Q, Lin HM, Kong L, Zhou D, Liang S, et al. Part 2. Association of daily mortality with ambient air pollution, and effect modification by extremely high temperature in Wuhan, China. Res Rep Health Eff Inst 2010: 91-217.
Ren C, Tong S. Temperature modifies the health effects of particulate matter in Brisbane, Australia. Int J Biometeorol 2006; 51: 87-96. http://dx.doi.org/10.1007/s00484-006-0054-7 DOI: https://doi.org/10.1007/s00484-006-0054-7
Wang XY, Barnett AG, Yu W, FitzGerald G, Tippett V, Aitken P, et al. The impact of heatwaves on mortality and emergency hospital admissions from non-external causes in Brisbane, Australia. Occup Environ Med 2012; 69: 163-9. http://dx.doi.org/10.1136/oem.2010.062141 DOI: https://doi.org/10.1136/oem.2010.062141
Hansen AL, Bi P, Ryan P, Nitschke M, Pisaniello D, Tucker G. The effect of heat waves on hospital admissions for renal disease in a temperate city of Australia. Int J Epidemiol 2008; 37: 1359-65. http://dx.doi.org/10.1093/ije/dyn165 DOI: https://doi.org/10.1093/ije/dyn165
Fletcher BA, Lin S, Fitzgerald EF, Hwang SA. Association of summer temperatures with hospital admissions for renal diseases in New York State: a case-crossover study. Am J Epidemiol 2012; 175: 907-16. http://dx.doi.org/10.1093/aje/kwr417 DOI: https://doi.org/10.1093/aje/kwr417
Anderson SC, Murrell WG, O'Neill CC, Rahilly PM. Effect of ambient temperature on SIDS rate. Med J Aust 1993; 158: 703-4. DOI: https://doi.org/10.5694/j.1326-5377.1993.tb121920.x
Leiss JK, Suchindran CM. Sudden infant death syndrome and local meteorologic temperature in North Carolina. Am J Epidemiol 1996; 144: 111-5. http://dx.doi.org/10.1093/oxfordjournals.aje.a008897 DOI: https://doi.org/10.1093/oxfordjournals.aje.a008897
Wasilevich EA, Rabito F, Lefante J, Johnson E. Short-term outdoor temperature change and emergency department visits for asthma among children: a case-crossover study. Am J Epidemiol 2012; 176 Suppl 7: S123-30. http://dx.doi.org/10.1093/aje/kws326 DOI: https://doi.org/10.1093/aje/kws326
Beard JD, Beck C, Graham R, Packham SC, Traphagan M, Giles RT, et al. Winter temperature inversions and emergency department visits for asthma in Salt Lake County, Utah, 2003-2008. Environ Health Perspect 2012; 120: 1385-90. http://dx.doi.org/10.1289/ehp.1104349 DOI: https://doi.org/10.1289/ehp.1104349
Carder M, McNamee R, Beverland I, Elton R, Van Tongeren M, Cohen GR, et al. Interacting effects of particulate pollution and cold temperature on cardiorespiratory mortality in Scotland. Occup Environ Med 2008; 65: 197-204. http://dx.doi.org/10.1136/oem.2007.032896 DOI: https://doi.org/10.1136/oem.2007.032896
Fernandez-Raga M, Tomas C, Fraile R. Human mortality seasonality in Castile-Leon, Spain, between 1980 and 1998: the influence of temperature, pressure and humidity. Int J Biometeorol 2010; 54: 379-92. http://dx.doi.org/10.1007/s00484-009-0289-1 DOI: https://doi.org/10.1007/s00484-009-0289-1
Michelozzi P, Accetta G, De Sario M, D'Ippoliti D, Marino C, Baccini M, et al. High temperature and hospitalizations for cardiovascular and respiratory causes in 12 European cities. Am J Respir Crit Care Med 2009; 179: 383-9. http://dx.doi.org/10.1164/rccm.200802-217OC DOI: https://doi.org/10.1164/rccm.200802-217OC
Dear K, Ranmuthugala G, Kjellstrom T, Skinner C, Hanigan I. Effects of temperature and ozone on daily mortality during the August 2003 heat wave in France. Arch Environ Occup Health 2005; 60: 205-12. http://dx.doi.org/10.3200/AEOH.60.4.205-212 DOI: https://doi.org/10.3200/AEOH.60.4.205-212
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2016 Richard J. Woodman, Lidia Mayner
This work is licensed under a Creative Commons Attribution 4.0 International License.
Policy for Journals/Articles with Open Access
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work
Policy for Journals / Manuscript with Paid Access
Authors who publish with this journal agree to the following terms:
- Publisher retain copyright .
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work .
