Time-Course of Cause-Specific Hospital Admissions During Snowstorms: An Analysis of Electronic Medical Records From Major Hospitals in Boston, Massachusetts

Impact of extreme weather events on healthcare utilization and mortality in the United States

Climate change is intensifying extreme weather events. Yet a systematic analysis of post-disaster healthcare utilization and outcomes for severe weather and climate disasters, as tracked by the US government, is lacking. Following exposure to 42 US billion-dollar weather disasters (severe storm, flood, flood/severe storm, tropical cyclone and winter storm) between 2011 and 2016, we used a difference-in-differences (DID) approach to quantify changes in the rates of emergency department (ED) visits, nonelective hospitalizations and mortality between fee-for-service Medicare beneficiaries in affected compared to matched control counties in post-disaster weeks 1, 1-2 and 3-6. Overall, disasters were associated with higher rates of ED utilization in affected counties in post-disaster week 1 (DID of 1.22% (95% CI, 0.20% to 2.25%; P < 0.020)) through week 2. Nonelective hospitalizations were unchanged. Mortality was higher in affected counties in week 1 (DID of 1.40% (95% CI, 0.08% to 2.74%; P = 0.037)) and persisted for 6 weeks. Counties with the greatest loss and damage experienced greater increases in ED and mortality rates compared to all affected counties. Thus, billion-dollar weather disasters are associated with excess ED visits and mortality in Medicare beneficiaries. Tracking these outcomes is important for adaptation that protects patients and communities, health system resilience and policy.

The association between temperature and alcohol- and substance-related disorder hospital visits in New York State

BACKGROUND

Limited evidence exists on how temperature increases are associated with hospital visits from alcohol- and substance-related disorders, despite plausible behavioral and physiological pathways.

METHODS

In the present study, we implemented a case-crossover design, which controls for seasonal patterns, long-term trends, and non- or slowly-varying confounders, with distributed lag non-linear temperature terms (0-6 days) to estimate associations between daily ZIP Code-level temperature and alcohol- and substance-related disorder hospital visit rates in New York State during 1995-2014. We also examined four substance-related disorder sub-causes (cannabis, cocaine, opioid, sedatives).

RESULTS

Here we show that, for alcohol-related disorders, a daily increase in temperature from the daily minimum (-30.1 °C (-22.2 °F)) to the 75th percentile (18.8 °C (65.8 °F)) across 0-6 lag days is associated with a cumulative 24.6% (95%CI,14.6%-34.6%) increase in hospital visit rates, largely driven by increases on the day of and day before hospital visit, with an association larger outside New York City. For substance-related disorders, we find evidence of a positive association at temperatures from the daily minimum (-30.1 °C (-22.2 °F)) to the 50th percentile (10.4 °C (50.7 °F)) (37.7% (95%CI,27.2%-48.2%), but not at higher temperatures. Findings are consistent across age group, sex, and social vulnerability.

CONCLUSIONS

Our work highlights how hospital visits from alcohol- and substance-related disorders are currently impacted by elevated temperatures and could be further affected by rising temperatures resulting from climate change. Enhanced social infrastructure and health system interventions could mitigate these impacts.

Aging Hearts in a Hotter, More Turbulent World: The Impacts of Climate Change on the Cardiovascular Health of Older Adults

PURPOSE OF REVIEW

Climate change has manifested itself in multiple environmental hazards to human health. Older adults and those living with cardiovascular diseases are particularly susceptible to poor outcomes due to unique social, economic, and physiologic vulnerabilities. This review aims to summarize those vulnerabilities and the resultant impacts of climate-mediated disasters on the heart health of the aging population.

RECENT FINDINGS

Analyses incorporating a wide variety of environmental data sources have identified increases in cardiovascular risk factors, hospitalizations, and mortality from intensified air pollution, wildfires, heat waves, extreme weather events, rising sea levels, and pandemic disease. Older adults, especially those of low socioeconomic status or belonging to ethnic minority groups, bear a disproportionate health burden from these hazards. The worldwide trends responsible for global warming continue to worsen climate change-mediated natural disasters. As such, additional investigation will be necessary to develop personal and policy-level interventions to protect the cardiovascular wellbeing of our aging population.

Ambient Temperature and External Causes of Death in Japan from 1979 to 2015: A Time-Stratified Case-Crossover Analysis

BACKGROUND

Although substantial evidence suggests that high and low temperatures are adversely associated with nonaccidental mortality, few studies have focused on exploring the risks of temperature on external causes of death.

OBJECTIVES

We investigated the short-term associations between temperature and external causes of death and four specific categories (suicide, transport, falls, and drowning) in 47 prefectures of Japan from 1979 to 2015.

METHODS

We conducted a two-stage meta-regression analysis. First, we performed time-stratified case-crossover analyses with a distributed lag nonlinear model to examine the association between temperature and mortality due to external causes for each prefecture. We then used a multivariate meta-regression model to combine the association estimates across all prefectures in Japan. In addition, we performed stratified analyses for the associations by sex and age.

RESULTS

A total of 2,416,707 external causes of death were included in the study. We found a J-shaped exposure-response curve for all external causes of death, in which the risks increased for mild cold temperatures [20th percentile; relative risk (RR)=1.09 (95% confidence interval [CI]: 1.05,1.12)] and extreme heat [99th percentile; RR=1.24 (95% CI: 1.20, 1.29)] compared with those for minimum mortality temperature (MMT). However, the shapes of the exposure-response curves varied according to four subcategories. The risks of suicide and transport monotonically increased as temperature increased, with RRs of 1.35 (95% CI: 1.26, 1.45) and 1.60 (95% CI: 1.35, 1.90), respectively, for heat, whereas J- and U-shaped curves were observed for falls and drowning, with RRs of 1.14 (95% CI: 1.03, 1.26) and 1.95 (95% CI: 1.70, 2.23) for heat and 1.13 (95% CI: 1.02, 1.26) and 2.33 (95% CI: 1.89, 2.88) for cold, respectively, compared with those for cause-specific MMTs. The sex- and age-specific associations varied considerably depending on the specific causes.

DISCUSSION

Both low and high temperatures may be important drivers of increased risk of external causes of death. We suggest that preventive measures against external causes of death should be considered in adaptation policies. https://doi.org/10.1289/EHP9943.

Associations between meteorological factors and emergency department visits for unintentional falls during Ontario winters

INTRODUCTION

Unintentional falls are a leading cause of injury-related hospital visits among Canadians, especially seniors. While certain meteorological conditions are suspected risk factors for fall-related injuries, few studies have quantified these associations across a wider range of age groups and with population-based datasets.

METHODS

We applied a time-stratified case-crossover study design to characterize associations of highly-spatially-resolved meteorological factors and emergency department (ED) visits for falls, in Ontario, among those aged 5 years and older during the winter months (November to March) between 2011 and 2015. Conditional logistic models were used to estimate the odds ratios (ORs) and their 95% confidence intervals (CIs) for these visits in relation to daily snowfall accumulation, including single-day lags of up to one week before the visit, and daily mean temperature on the day of the visit. Analyses were stratified by age and sex.

RESULTS

We identified 761 853 fall-related ED visits. The odds for these visits was increased for most days up to a week after a snowfall of 0.2 cm or greater (OR = 1.05-1.08) compared to days with no snowfall. This association was strongest among adults aged 30 to 64 years (OR = 1.16-1.19). The OR for fall-related ED visits on cold days (less than -9.4 °C) was reduced by 0.05 relative to days with an average daily temperature of 3.0 °C or higher (OR = 0.95; 95% CI: 0.94, 0.96), and this pattern was evident across all ages. There were no substantive differences in the strength of this association by sex.

CONCLUSION

Snowfall and warmer winter temperatures were associated with an increased risk of fall-related ED visits during Ontario winters. These findings are relevant for developing falls prevention strategies and ensuring timely treatment.

Seasonal variation in fall-related emergency department visits by location of fall - United States, 2015

INTRODUCTION

In the United States, fall-related emergency department (ED) visits among older adults (age 65 and older) have increased over the past decade. Studies document seasonal variation in fall injuries in other countries, while research in the United States is inconclusive. The objectives of this study were to examine seasonal variation in older adult fall-related ED visits and explore if seasonal variation differs by the location of the fall (indoors vs. outdoors), age group, and sex of the faller.

METHODS

Fall-related ED visit data from the National Electronic Injury Surveillance System-All Injury Program were analyzed by season of the ED visit, location of the fall, and demographics for adults aged 65 years and older.

RESULTS

Total fall-related ED visits were higher during winter compared with other seasons. This seasonal variation was found only for falls occurring outdoors. Among outdoor falls, the variation was found among males and adults aged 65 to 74 years. The percentages of visits for weather-related outdoor falls were also higher among males and the 65-74 year age group.

CONCLUSIONS

In 2015, there was a seasonal variation in fall-related ED visits in the United States. Weather-related slips and trips in winter may partially account for the seasonal variation.

PRACTICAL IMPLICATIONS

These results can inform healthcare providers about the importance of screening all older adults for fall risk and help to identify specific patients at increased risk during winter. They may encourage community-based organizations serving older adults to increase fall prevention messaging during winter.

Universal thermal climate index associations with mortality, hospital admissions, and road accidents in Bavaria

When meteorological conditions deviate from the optimal range for human well-being, the risks of illness, injury, and death increase, and such impacts are feared in particular with more frequent and intense extreme weather conditions resulting from climate change. Thermal indices, such as the universal thermal climate index (UTCI), can better assess human weather-related stresses by integrating multiple weather components. This paper quantifies and compares the seasonal and spatial association of UTCI with mortality, morbidity, and road accidents in the federal state of Bavaria, Germany. Linear regression was applied to seasonally associate daily 56 million hospital admissions and 2.5 million death counts (1995-2015) as well as approximately 930,000 road accidents and 1.7 million people injured (2002-2015) with spatially interpolated same day- and lagged- (up to 14 days) average UTCI values. Additional linear regressions were performed stratifying by age, gender, region, and district. UTCI effects were clear in all three health outcomes studied: Increased UTCI resulted in immediate (1-2 days) rises in morbidity and even more strongly in mortality in summer, and lagged (up to 14 days) decreases in fall, winter, and spring. The strongest UTCI effects were found for road accidents where increasing UTCI led to immediate decreases in daily road accidents in winter but pronounced increases in all other seasons. Differences in UTCI effects were observed e.g. between in warmer north-western regions (Franconia, more districts with heat stress-related mortality, but hospital admissions for lung, heart and external reasons decreasing with summer heat stress), the touristic alpine regions in the south (immediate effect of increasing UTCI on road accidents in summer), and the colder south-eastern regions (increasing hospital admissions for lung, heart and external reasons in winter with UTCI). Districts with high percentages of elderly suffered from higher morbidity and mortality, particularly in winter. The influences of UTCI as well as the spatial and temporal patterns of this influence call for improved infrastructure planning and resource allocation in the health sector.

Tropical cyclone exposure is associated with increased hospitalization rates in older adults

Hurricanes and other tropical cyclones have devastating effects on society. Previous case studies have quantified their impact on some health outcomes for particular tropical cyclones, but a comprehensive assessment over longer periods is currently missing. Here, we used data on 70 million Medicare hospitalizations and tropical cyclone exposures over 16 years (1999-2014). We formulated a conditional quasi-Poisson model to examine how tropical cyclone exposure (days greater than Beaufort scale gale-force wind speed; ≥34 knots) affect hospitalizations for 13 mutually-exclusive, clinically-meaningful causes. We found that tropical cyclone exposure was associated with average increases in hospitalizations from several causes over the week following exposure, including respiratory diseases (14.2%; 95% confidence interval [CI]: 10.9-17.9%); infectious and parasitic diseases (4.3%; 95%CI: 1.2-8.1%); and injuries (8.7%; 95%CI: 6.0-11.8%). Average decadal tropical cyclone exposure in all impacted counties would be associated with an estimated 16,772 (95%CI: 8,265-25,278) additional hospitalizations. Our findings demonstrate the need for targeted preparedness strategies for hospital personnel before, during, and after tropical cyclones.