Social disparities in neighborhood heat in the Northeast United States

Racial and Economic Disparities in High-Temperature Exposure in Brazil

Primary studies analyzing the distribution of exposure to the consequences of climate change among different vulnerable groups are scarce. This study addresses this gap by investigating racial and economic disparities in high-temperature exposure in Brazil, focusing on the impact on vulnerable subpopulations. We utilized georeferenced temperature data from the Global High-Resolution Estimates of Extreme Heat (GEHE) and population data from the 2010 Census. The disparity analyses included (i) estimating the exposure rate to temperatures exceeding 28 °C, expressed as population-weighted heat exposure (PHE¯); (ii) determining the difference in exposure between the most and least exposed groups; and (iii) calculating weighted Gini coefficients. The findings reveal that low-income and black, brown, and indigenous populations are predominantly the most exposed to PHE¯ exceeding 28 °C. Nationally, the indigenous population is the most exposed racial group, with a PHE¯ 47% higher than that of the white population. Stratified analyses indicate that, despite varying climatic and environmental conditions across regions, the black-brown-indigenous population consistently faces the highest heat exposure in Brazil. Income disparity analyses show that the lowest per capita income groups are the most exposed to high temperatures across the country. The study highlights the impact of climate change on economic inequality and the deepening of within-country inequalities, particularly affecting socioeconomically disadvantaged groups. These findings underscore the urgent need for evidence-informed public policies to address racial and economic disparities in high-temperature exposure, mitigate health risks associated with climate change, and emphasize the importance of context-sensitive analyses for a comprehensive understanding of heat-related risks and public health.

Interactive effects between extreme temperatures and PM2.5 on cause-specific mortality in thirteen U.S. states

The extent and robustness of the interaction between exposures to heat and ambient PM2.5 is unclear and little is known of the interaction between exposures to cold and ambient PM2.5. Clarifying these interactions, if any, is crucial due to the omnipresence of PM2.5 in the atmosphere and increasing scope and frequency of extreme temperature events. To investigate both of these interactions, we merged 6 073 575 individual-level mortality records from thirteen states spanning seventeen years with 1 km daily PM2.5 predictions from sophisticated prediction model and 1 km meteorology from Daymet V4. A time-stratified, bidirectional case-crossover design was used to control for confounding by individual-level, long-term and cyclic weekly characteristics. We fitted conditional logistic regressions with an interaction term between PM2.5 and extreme temperature events to investigate the potential interactive effects on mortality. Ambient PM2.5 exposure has the greatest effect on mortality by all internal causes in the 2 d moving average exposure window. Additionally, we found consistently synergistic interactions between a 10 μg m-3 increase in the 2 d moving average of PM2.5 and extreme heat with interaction odds ratios of 1.013 (95% CI: 1.000, 1.026), 1.024 (95% CI: 1.002, 1.046), and 1.033 (95% CI: 0.991, 1.077) for deaths by all internal causes, circulatory causes, and respiratory causes, respectively, which represent 75%, 156%, and 214% increases in the coefficient estimates for PM2.5 on those days. We also found evidence of interactions on the additive scale with corresponding relative excess risks due to interaction (RERIs) of 0.013 (95% CI: 0.003, 0.021), 0.020 (95% CI: 0.008, 0.031), and 0.017 (95% CI: -0.015, 0.036). Interactions with other PM2.5 exposure windows were more pronounced. For extreme cold, our results were suggestive of an antagonistic relationship. These results suggest that ambient PM2.5 interacts synergistically with exposure to extreme heat, yielding greater risks for mortality than only either exposure alone.

Heatwave frequency and disability status: Thermal inequities in the U.S. South

BACKGROUND

Although extreme heat has been found to be disproportionately distributed with respect to socially disadvantaged and marginalized groups, persons with disabilities have received limited attention in previous research on heat exposure disparities.

OBJECTIVE

This gap is addressed by analyzing the relationship between local heatwave frequency and the percentages of people with a disability and specific disability types in the U.S. South-a region characterized by extremely high summer temperatures and greater disability prevalence.

METHODS

Census tract level values of heatwave annualized frequency from the U.S. Federal Emergency Management Agency's National Risk Index are linked to relevant disability variables from the latest American Community Survey five-year estimates. Statistical analyses are based on bivariate correlations and multivariable generalized estimating equations that consider spatial clustering of tracts based on climate zone and county.

RESULTS

The overall percentage of civilian noninstitutionalized persons with a disability and more than one disability are significantly greater (p < 0.001) in census tracts with higher heatwave frequency, after controlling for clustering, race/ethnicity, socioeconomic status, older age, population density, and metropolitan status. Heatwave frequency is also positively and significantly associated (p < 0.01) with the percentages of people with hearing, vision, cognitive, ambulatory, self-care, and independent living difficulties.

CONCLUSIONS

These heat-related distributive injustices in the U.S. South demonstrate an urgent need to: (1) include disability status in future research on social disparities in heatwave exposure; (2) conduct more detailed investigations in other regions, states, and nations; and (3) develop disability-inclusive policies and interventions that provide equitable protection during extreme weather events.

Air Pollution and Temperature in Seizures and Epilepsy: A Scoping Review of Epidemiological Studies

PURPOSE OF THE REVIEW

Seizures and epilepsy can be debilitating neurological conditions and have few known causes. Emerging evidence has highlighted the potential contribution of environmental exposures to the etiology of these conditions, possibly manifesting via neuroinflammation and increased oxidative stress in the brain. We conducted a scoping review of epidemiological literature linking air pollution and temperature exposures with incidence and acute aggravation of seizures and epilepsy. We systematically searched PubMed, Embase, Web of Science, and APA PsycINFO databases for peer-reviewed journal articles published in English from inception to February 7, 2024.

RECENT FINDINGS

We identified a total of 34 studies: 16 examined air pollution exposure, 12 ambient temperature, and six examined both air pollution and ambient temperature. Most studies were conducted in Asia (China, Taiwan, South Korea, and Japan). Nearly all studies retrospectively derived acute (daily average), ambient, and postnatal exposure estimates from ground monitoring systems and ascertained epilepsy cases or seizure events through record linkage with medical records, health registry systems, or insurance claims data. Commonly assessed exposures were particulate matter (PM2.5, PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), ozone (O3), and daily mean ambient temperature. Overall, the main findings across studies lacked consistency, with mixed results reported for the associations of air pollutants and temperature metrics with both seizure incidence and acute aggravations of epilepsy.

Increased Stillbirth Rates and Exposure to Environmental Risk Factors for Stillbirth in Counties with Higher Social Vulnerability: United States, 2015-2018

INTRODUCTION

Exposure to unfavorable environmental conditions during pregnancy, such as extreme heat and air pollution, has been linked to increased risk of stillbirth, defined as fetal mortality at or after 20 weeks' gestation, however no studies have examined its association with social vulnerability. We examined associations between county-level stillbirth rates, environmental risk factors for stillbirth, and social vulnerability in the United States.

METHODS

This ecologic study linked county-level data from three nationwide datasets on stillbirths (National Vital Statistics System), environmental conditions (North American Land Data Assimilation System and Environmental Protection Agency), and social vulnerability (Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social Vulnerability Index). Poisson and negative binomial models were fit to the variables and produced rate ratios to estimate associations among stillbirth rates, environmental risk factors, and social vulnerability.

RESULTS

Social vulnerability was positively associated withn stillbirth rates, annual average number of extreme heat days, and ambient concentration of particulate matter ≤ 2.5 μm in diameter (PM2.5). The average number of days that ozone and PM2.5 each exceeded regulatory standards were not associated with stillbirth rates or social vulnerability. A positive association between average annual PM2.5 concentration and stillbirth rates was detected; no other significant associations between environmental risk factors and stillbirth rates were observed.

DISCUSSION

We found evidence of associations between social vulnerability and stillbirth rates, and between social vulnerability and environmental risk factors for stillbirth at the county level. Further research could inform understanding of how social vulnerability impacts the relationship between environmental exposures and stillbirth risk.

Effects of ambient temperature on mental and neurological conditions in older adults: A systematic review and meta-analysis

BACKGROUND

Emerging research has suggested a link between ambient temperature and mental and neurological conditions such as depression and dementia. This systematic review aims to summarize the epidemiological evidence on the effects of ambient temperature on mental and neurological conditions in older adults, who may be more vulnerable to temperature-related health effects compared to younger individuals.

METHODS

A systematic search was conducted in PubMed, Ovid/Embase, Web of Science, and Ovid/PsycINFO on July 17, 2023, and updated on July 31, 2024. We included epidemiological studies investigating the association between ambient temperature exposures and numerous mental and neurological conditions in populations aged 60 years and older. Exclusions were made for studies on indoor or controlled exposure, suicide, substance abuse, those not published as peer-reviewed journal articles, or those not written in English. The risk of bias of included studies was assessed using a tool developed by the World Health Organization (WHO). Qualitative synthesis was performed on all eligible studies, and random-effects meta-analyses were conducted on groups of at least four studies sharing similar study design, exposure metric, and health outcome. The certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework modified by the WHO.

RESULTS

From 16,786 screened articles, 76 studies were deemed eligible, primarily from mainland China and North America. There was notable heterogeneity in study variables and methodologies. The most commonly used exposure metrics were daily absolute temperature and heat waves, and time-series and case-crossover analyses were the most frequently employed study designs. Meta-analysis of four studies on the effect of a 1 °C increase in temperature on hospital admissions/visits for mental disorders showed a pooled risk ratio (RR) of 1.014 (95 % Confidence Interval, CI: 1.001, 1.026). Comparing heat wave days to non-heat wave days, pooled effect estimates showed increased risk in hospital admissions/visits (RR: 1.269; 95 % CI: 1.030, 1.564; six studies) and mortality related to mental disorders (RR: 1.266; 95 % CI: 0.956, 1.678; four studies). Despite the limited number of studies on cold exposures, they consistently reported that lower temperatures were associated with an increased risk of various mental and neurological conditions.

CONCLUSIONS

This review presents epidemiological evidence of the adverse impacts of ambient temperature exposures, such as high temperatures and heat waves, on mental and neurological conditions among the older adult population, with overall moderate certainty. The findings highlight the need for greater attention to the mental and neurological health of older adults in the context of climate change and population aging. Registration number (PROSPERO ID): CRD42023428137.

Identifying groups at-risk to extreme heat: Intersections of age, race/ethnicity, and socioeconomic status

Anthropogenic climate change has resulted in a significant rise in extreme heat events, exerting considerable but unequal impacts on morbidity and mortality. Numerous studies have identified inequities in heat exposure across different groups, but social identities have often been viewed in isolation from each other. Children (5 and under) and older adults (65 and older) also face elevated risks of heat-related health impacts. We employ an intersectional cross-classificatory approach to analyze the distribution of heat exposure between sociodemographic categories split into age groups in the contiguous US. We utilize high-resolution daily air temperature data to establish three census tract-level heat metrics (i.e., average summer temperature, heat waves, and heat island days). We pair those metrics with American Community Survey estimates on racial/ethnic, socioeconomic, and disability status by age to calculate population weighted mean exposures and absolute disparity metrics. Our findings indicate few substantive differences between age groups overall, but more substantial differences between sociodemographic categories within age groups, with children and older adults from socially marginalized backgrounds facing greater exposure than adults from similar backgrounds. When looking at sociodemographic differences by age, people of color of any age and older adults without health insurance emerge as the most exposed groups. This study identifies groups who are most exposed to extreme heat. Policy and program interventions aimed at reducing the impacts of heat should take these disparities in exposure into account to achieve health equity objectives.

Using geographic effect measure modification to examine socioeconomic-related surface temperature disparities in New York City

BACKGROUND

Lower socioeconomic (SES) communities are more likely to be situated in urban heat islands and have higher heat exposures than their higher SES counterparts, and this inequality is expected to intensify due to climate change.

OBJECTIVES

To examine the relationship between surface temperatures and SES in New York City (NYC) by employing a novel analytical approach. Through incorporating modifiable features, this study aims to identify potential locations where mitigation interventions can be implemented to reduce heat disparities associated with SES.

METHODS

Using the 2013-2017 American Community Survey, U.S Landsat-8 Analysis Ready Data surface temperatures (measured on 8/12/2016), and the NYC Land Cover Dataset at the census tract level (2098 tracts), this study examines the association between two components of tract-level SES (percentage of individuals living below the poverty line and the percentage of individuals without a high school degree) and summer day surface temperature in NYC. First, we examine this association with an unrestricted NYC linear regression, examining the city-wide association between the two SES facets and summer surface temperature, with additional models adjusting for altitude, shoreline, and nature-cover. Then, we assess geographic effect measure modification by employing the same models to three supplemental regression model strategies (borough-restricted and community district-restricted linear regressions, and geographically weighted regression (GWR)) that examined associations within smaller intra-city areas.

RESULTS

All regression strategies identified areas where lower neighborhood SES composition is associated with higher summer day surface temperatures. The unrestricted NYC regressions revealed widespread disparities, while the borough-restricted and community district-restricted regressions identified specific political boundaries within which these disparities existed. The GWR, addressing spatial autocorrelation, identified significant socioeconomic heat disparities in locations such as northwest Bronx, central Brooklyn, and uptown Manhattan. These findings underscore the need for targeted policies and community interventions, including equitable urban planning and cooling strategies, to mitigate heat exposure in vulnerable neighborhoods.

IMPACT STATEMENT

This study redefines previous research on urban socioeconomic disparities in heat exposure by investigating both modifiable (nature cover) and non-modifiable (altitude and shoreline) built environment factors affecting local temperatures at the census tract level in New York City. Through a novel analytical approach, the research aims to highlight intervention opportunities to mitigate heat disparities related to socioeconomic status. By examining the association between surface temperatures and socioeconomic status, as well as investigating different geographic and governmental scales, this study offers actionable insights for policymakers and community members to address heat exposure inequalities effectively across different administrative boundaries. The objective is to pinpoint potential sites for reducing socioeconomic heat exposure disparities at various geographic and political levels.

Racial/ethnic disparities in the distribution of heatwave frequency and expected economic losses in the US

Previous research on social disparities in heat exposure has not examined heatwave frequency or economic damage at the local or neighborhood level. Additionally, most US studies have focused on specific cities or regions, and few national-scale studies encompassing both urban and rural areas have been conducted. These gaps are addressed here by analyzing racial/ethnic disparities in the distribution of annual heatwave frequency and expected economic losses from heatwave occurrence in the contiguous US. Census tract-level data on annualized heatwave frequency and expected loss from the FEMA's National Risk Index are linked to relevant variables from the American Community Survey. Results indicate that all racial/ethnic minority groups except non-Hispanic Black are significantly overrepresented in neighborhoods with greater annual heatwave frequency (top 10% nationally), and all minority groups are overrepresented in neighborhoods with greater total expected annual loss from heatwaves, compared to non-Hispanic Whites. Multivariable models that control for spatial clustering, climate zone, and relevant socio-demographic factors reveal similar racial/ethnic disparities, and suggest significantly greater heatwave frequency and economic losses in neighborhoods with higher percentages of Hispanics and American Indians. These findings represent an important starting point for more detailed investigations on the adverse impacts of heatwaves for US minority populations and formulating appropriate policy interventions.

Disparities in the impact of heat wave definitions on emergency department visits during the first year of life among preterm and full-term infants in California

INTRODUCTION

Heat waves will be aggravated due to climate change, making this a critical public health threat. However, heat wave definitions to activate alert systems can be ambiguous, highlighting the need to assess a range of definitions to identify those that contribute to the most adverse health outcomes. Additionally, children are highly susceptible to the impacts of heat waves, especially infants, despite the lack of focus on this subpopulation. We aimed to assess the relationship between 30 heat wave definitions and the first all-cause emergency department (ED) visits for California infants. We also examined modification of this relationship by preterm birth status and demographic characteristics to identify possible health disparities.

METHODS

Live-born, singleton deliveries from the Study of Outcomes in Mothers and Infants born in 2014-2018 were included. Thirty heat wave definitions were assessed based on temperature metrics (minimum/maximum temperatures), thresholds (90th; 92.5th; 95th; 97.5th; 99th percentiles), and duration (1-; 2-; 3-days). A time-stratified case-crossover design assessed heat wave impacts on ED visits using infants with a warm season ED visit (May-October) within the first year of life (n = 228,250). Effect modification by preterm birth status, age, sex, race/ethnicity, education, and delivery payment type was also investigated.

RESULTS

Infants demonstrated increased risk of an ED visit with exposure to all heat definitions. The 3-day minimum temperature 99th percentile definition had the highest adjusted odds ratio (AOR: 1.14; 95% CI: 1.05-1.23) for the total population. Term infants were more affected by some heat waves than preterm infants. Effect modification was additionally identified, such as by maternal education.

DISCUSSION

This study provides insight on the heat wave definitions that lead to adverse health outcomes and the identification of the most susceptible infants to these impacts, which has implications on heat-related interventions.

Association of neighborhood-level socioeconomic status and urban heat in China: Evidence from Hangzhou

The escalating contradiction between global urban development and thermal environments has become increasingly apparent, underscoring the imperative to address social inequality in heat exposure and advocate for environmental justice (EJ) in the pursuit of sustainable urban development. To bridge the research gap in this domain, a comprehensive study was conducted to examine the correlation mechanism linking the thermal environment with the socioeconomic status (SES) of Chinese cities, employing Hangzhou as a representative case-a pivotal city among China's "four fire stoves". The investigation involved analyzing the spatial distribution pattern of diurnal Land Surface Temperature (LST) during the summer months spanning 2016 to 2018 (July to September). For SES characterization, a holistic indicator was established. Community-level LST variables were derived from LST surfaces obtained through the Terra and Aqua satellite MODIS sensors, with the community serving as the fundamental unit of analysis. The relationship between SES and LST was explored using random forest regression (RF), eXtreme Gradient Boosting (XGBoost), and support vector regression (SVR) to assess socioeconomic inequality in urban heat. The findings reveal that (1) RF exhibits the highest fitting accuracy and adeptly elucidates the nonlinear relationship and marginal effects between LST variables and SES. (2) Community SES in the Hangzhou metropolitan area exhibits spatial clustering. (3) Residents of low and middle SES communities experience heightened heat inequality. (4) A complex nonlinear relationship exists between daytime and nighttime LST and SES, with significant social disparities in urban heat within specific temperature thresholds. When deciding on measures to advance thermal environmental justice, it is crucial to prioritize both relatively disadvantaged groups and specific temperature intervals. This study departs from conventional approaches, exploring the nonlinear relationship between SES and urban heat at a fine scale, thereby assisting urban planners in developing effective strategies.

Insects in the city: Determinants of a contained aquatic microecosystem across an urbanized landscape

Cities can have profound impacts on ecosystems, yet our understanding of these impacts is currently limited. First, the effects of the socioeconomic dimensions of human society are often overlooked. Second, correlative analyses are common, limiting our causal understanding of mechanisms. Third, most research has focused on terrestrial systems, ignoring aquatic systems that also provide important ecosystem services. Here we compare the effects of human population density and low-income prevalence on the macroinvertebrate communities and ecosystem processes within water-filled artificial tree holes. We hypothesized that these human demographic variables would affect tree holes in different ways via changes in temperature, water nutrients, and the local tree hole environment. We recruited community scientists across Greater Vancouver (Canada) to provide host trees and tend 50 tree holes over 14 weeks of colonization. We quantified tree hole ecosystems in terms of aquatic invertebrates, litter decomposition, and chlorophyll a (chl a). We compiled potential explanatory variables from field measurements, satellite images, or census databases. Using structural equation models, we showed that invertebrate abundance was affected by low-income prevalence but not human population density. This was driven by cosmopolitan species of Ceratopogonidae (Diptera) with known associations to anthropogenic containers. Invertebrate diversity and abundance were also affected by environmental factors, such as temperature, elevation, water nutrients, litter quantity, and exposure. By contrast, invertebrate biomass, chl a, and litter decomposition were not affected by any measured variables. In summary, this study shows that some urban ecosystems can be largely unaffected by human population density. Our study also demonstrates the potential of using artificial tree holes as a standardized, replicated habitat for studying urbanization. Finally, by combining community science and urban ecology, we were able to involve our local community in this pandemic research pivot.

Exploring the Spatial Patterning of Sociodemographic Disparities in Extreme Heat Exposure at Multiple Scales Across the Conterminous United States

Climate change has led to an increase in heat-related morbidity and mortality. The impact of heat on health is unequally distributed amongst different socioeconomic and demographic groups. We use high-resolution daily air temperature-based heat wave intensity (HWI) and neighborhood-scale sociodemographic information from the conterminous United States to evaluate the spatial patterning of extreme heat exposure disparities. Assuming differences in spatial patterns at national, regional, and local scales; we assess disparities in heat exposure across race, housing characteristics, and poverty level. Our findings indicate small differences in HWI based on these factors at the national level, with the magnitude and direction of the differences varying by region. The starkest differences are present over the Northeast and Midwest, where primarily Black neighborhoods are exposed to higher HWI than predominantly White areas. At the local level, we find the largest difference by socioeconomic status. We also find that residents of nontraditional housing are more vulnerable to heat exposure. Previous studies have either evaluated such disparities for specific cities and/or used a satellite-based land surface temperature, which, although correlated with air temperature, does not provide the true measure of heat exposure. This study is the first of its kind to incorporate high-resolution gridded air temperature-based heat exposure in the evaluation of sociodemographic disparities at a national scale. The analysis suggests the unequal distribution of heat wave intensities across communities-with higher heat exposures characterizing areas with high proportions of minorities, low socioeconomic status, and homes in need of retrofitting to combat climate change.

Neighborhood violence and socioeconomic deprivation influence associations between acute air pollution and temperature on childhood asthma in New York city

Ambient air pollution, temperature, and social stressor exposures are linked with asthma risk, with potential synergistic effects. We examined associations for acute pollution and temperature exposures, with modification by neighborhood violent crime and socioeconomic deprivation, on asthma morbidity among children aged 5-17 years year-round in New York City. Using conditional logistic regression in a time-stratified, case-crossover design, we quantified percent excess risk of asthma event per 10-unit increase in daily, residence-specific exposures to PM2.5, NO2, SO2, O3, and minimum daily temperature (Tmin). Data on 145,834 asthma cases presenting to NYC emergency departments from 2005 to 2011 were obtained from the New York Statewide Planning and Research Cooperative System (SPARCS). Residence- and day-specific spatiotemporal exposures were assigned using the NYC Community Air Survey (NYCCAS) spatial data and daily EPA pollution and NOAA weather data. Point-level NYPD violent crime data for 2009 (study midpoint) was aggregated, and Socioeconomic Deprivation Index (SDI) scores assigned, by census tract. Separate models were fit for each pollutant or temperature exposure for lag days 0-6, controlling for co-exposures and humidity, and mutually-adjusted interactions (modification) by quintile of violent crime and SDI were assessed. We observed stronger main effects for PM2.5 and SO2 in the cold season on lag day 1 [4.90% (95% CI: 3.77-6.04) and 8.57% (5.99-11.21), respectively]; Tmin in the cold season on lag day 0 [2.26% (1.25-3.28)]; and NO2 and O3 in the warm season on lag days 1 [7.86% (6.66-9.07)] and 2 [4.75% (3.53-5.97)], respectively. Violence and SDI modified the main effects in a non-linear manner; contrary to hypotheses, we found stronger associations in lower-violence and -deprivation quintiles. At very high stressor exposures, although asthma exacerbations were highly prevalent, pollution effects were less apparent-suggesting potential saturation effects in socio-environmental synergism.

Compound climate-pollution extremes in Santiago de Chile

Cities in the global south face dire climate impacts. It is in socioeconomically marginalized urban communities of the global south that the effects of climate change are felt most deeply. Santiago de Chile, a major mid-latitude Andean city of 7.7 million inhabitants, is already undergoing the so-called "climate penalty" as rising temperatures worsen the effects of endemic ground-level ozone pollution. As many cities in the global south, Santiago is highly segregated along socioeconomic lines, which offers an opportunity for studying the effects of concurrent heatwaves and ozone episodes on distinct zones of affluence and deprivation. Here, we combine existing datasets of social indicators and climate-sensitive health risks with weather and air quality observations to study the response to compound heat-ozone extremes of different socioeconomic strata. Attributable to spatial variations in the ground-level ozone burden (heavier for wealthy communities), we found that the mortality response to extreme heat (and the associated further ozone pollution) is stronger in affluent dwellers, regardless of comorbidities and lack of access to health care affecting disadvantaged population. These unexpected findings underline the need of a site-specific hazard assessment and a community-based risk management.

Temperature and mental health-related emergency department and hospital encounters among children, adolescents and young adults

AIMS

We examine the association between high ambient temperature and acute mental health-related healthcare encounters in New York City for children, adolescents and young adults.

METHODS

This case-crossover study included emergency department (ED) visits and hospital encounters with a primary diagnosis of any mental health disorder during warm-season months (June-August) in New York City from 2005 to 2011 from patients of three age groups (6-11, 12-17 and 18-25 years). Using a distributed lag non-linear model over 0-5 lag days, by fitting a conditional logistic regression for each age group, we calculated the cumulative odds ratios of mental health encounters associated with an elevated temperature. Analyses were stratified by race/ethnicity, payment source and mental health categories to elucidate vulnerable subpopulations.

RESULTS

In New York City, there were 82,982 mental health-related encounters for young people aged 6 to 25 years during our study period months. Elevated temperature days were associated with higher risk of mental health-related ED and hospital encounters for the 6- to 11-year-olds (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.13-1.46), for the 12- to 17-year-olds (OR: 1.17, 95% CI: 1.09-1.25) and for the 18- to 25-year-olds (OR: 1.09, 95% CI: 1.04-1.15). Children with reaction disorders, adolescents with anxiety and bipolar disorders, young adults with psychosis and reaction disorders and Black and non-Hispanic children and adolescents showed vulnerability to elevated temperature.

CONCLUSIONS

We found that elevated ambient temperatures were associated with acute mental health ED or hospital encounters across childhood, adolescence and young adulthood.