Hospitalizations for heat-stress illness varies between rural and urban areas: an analysis of Illinois data, 1987-2014

A scoping review of the impact of extreme weather events on health outcomes and healthcare utilization in rural and remote areas

BACKGROUND

Extreme weather events affect health by directly and indirectly increasing illness burdens and changing healthcare usage patterns. These effects can be especially severe in rural and remote areas, exacerbating existing health disparities, and necessitating urgent mitigation or adaptation strategies. Despite increased research on health and climate change, studies focusing on rural and remote populations remain limited. This study aimed to review the relationships among extreme weather events, healthcare utilization, and health outcomes in rural and remote populations, identify research gaps, and inform policy development for adaptation and disaster management in these settings.

METHODS

A systematic scoping review was registered and conducted following the PRISMA-ScR guidelines. The search databases included PubMed, Web of Science, Scopus, the Cochrane Library, ProQuest, and the WHO IRIS. The included studies were primary research, focused on rural or remote areas, and investigated the effects of extreme weather events on either health outcomes or healthcare utilization. There were no methodological, date or language restrictions. We excluded protocols, reviews, letters, editorials, and commentaries. Two reviewers screened and extracted all data, other reviewers were invited to resolve conflicts. Findings are presented numerically or narratively as appropriate.

RESULTS

The review included 135 studies from 31 countries, with most from high-income countries. Extreme weather events exacerbate communicable and noncommunicable diseases, including cardiorespiratory, mental health, and malnutrition, and lead to secondary impacts such as mass migration and increased poverty. Healthcare utilization patterns changed during these events, with increased demand for emergency services but reduced access to routine care due to disrupted services and financial constraints.

CONCLUSIONS

The results highlighted the essential role of community and social support in rural and remote areas during extreme weather events and the importance of primary healthcare services in disaster management. Future research should focus on developing and implementing effective mitigation and adaptation programs tailored to the unique challenges faced by these populations.

Association between summertime emergency department visits and maximum daily heat index in rural and non-rural areas of Virginia (2015-2022)

There is growing evidence that high ambient temperatures are associated with a range of adverse health outcomes. Further evidence suggests differences in rural versus non-rural populations' vulnerability to heat-related adverse health outcomes. The current project aims to 1) refine estimated associations between maximum daily heat index (HI) and emergency department (ED) visits in regions of Virginia, and 2) compare associations between maximum daily HI and ED visits in rural versus non-rural areas of Virginia and within those areas, for persons 65 years of age and older versus those younger than 65 years. Our study utilized 16,873,213 healthcare visits from Virginia facilities reporting to the Virginia Department of Health syndromic surveillance system between May and September 2015-2022. Federal Office of Rural Health Policy defined rural areas were assigned to patient home ZIP code. The estimated daily maximum HI at which ED visits begin to rise varies between 25 °C and 33 °C across climate zones and regions of Virginia. Across all regions, estimated ED visits attributable to days with maximum HI above 25.7 °C were higher in rural areas (3.7%, 95% CI: 3.5%, 3.9%) versus in non-rural areas (3.1%, 95% CIs: 3.0%, 3.2%). Patients aged 0-64 years had a higher estimated heat attributable fraction of ED visits (4.2%, 95% CI: 4.0%, 4.3%) than patients 65 years and older (3.1%, 95% CI: 2.9%, 3.4%). Rural patients older than 65 have a higher estimated fraction of heat attributable ED visits (2.7%, 95% CI: 2.2%, 3.1%) compared to non-rural patients 65 years and older (1.5%, 95% CI: 1.3%, 1.8%). State-level syndromic surveillance data can be used to optimize heat warning messaging based on expected changes in healthcare visits given a set of meteorological variables, and can be further refined based on climate, rurality and age.

Application of the socioecological model to mitigate risks of heat illness

BACKGROUND

The socio-ecological model (SEM) is a widely used framework that can be applied to heat-related illness (HRI) in the context of multiple influencing factors that exist in society. Leaders and policymakers must intervene to mitigate the deleterious effects of climate change on those at risk.

PURPOSE

The purpose is to introduce the SEM as a framework to address the complex factors contributing to the impact of excess heat.

METHODS

Conceived through the SEM, the compounding and cumulative impact of excess heat resulting in HRI is operationalized.

DISCUSSION

The SEM provides a structure for understanding the complex nature of climate change and HRI and proposed interventions. The prevention of HRI is dependent on actions, related to practice, education, research, and advocacy across multiple levels of the SEM. The SEM has the potential to target HRI at all levels of society to reduce the harm of excess heat.

Hot Topic: A Systematic Review and Content Analysis of Heat-Related Messages During the 2021 Heat Dome in Canada

CONTEXT

During the summer of 2021, western Canada experienced a deadly heat event. From the first heat alert to postevent reporting, thousands of media articles were published that reference the heat event. However, a gap remains in understanding how this communication chain-from the release of a public heat alert to information shared through media outlets to the public-currently operates to disseminate heat-related messaging across Canada.

OBJECTIVE

To understand the role of digital media in delivering heat-health messaging during an extreme heat event in Canada.

DESIGN

A qualitative content analysis was conducted using Canadian news articles published on the 2021 Heat Dome between June 2021 and February 2022 (n = 2909). The coding frame was designed to align with the basic framework for information gathering used in journalism (who, what, where, when, and how) and included both concept-driven and data-driven codes.

RESULTS

Overall, 2909 unique media articles discussing the 2021 Heat Dome were identified, with the majority (74%) published by online news agencies (how). The highest article count was on June 29, 2021 (n = 159), representing 5% of the total data set (n = 2909) spanning 260 days (when); 57% of the identified locations were in British Columbia (where). Although we found that the top voices providing media-based heat-health messages are government officials (who), only 23% of articles included heat-health messaging that aligns with the government health alert bulletins released during extreme heat. In addition, heat-health messaging frequently included contradictory content, inconsistent language, or incorrect advice (what).

CONCLUSION

The findings demonstrate clear opportunities to improve health communication related to extreme heat, perhaps most importantly, including updates to mass media messaging educating the public on heat-protective behaviors.

Health effects from heat waves in France: an economic evaluation

BACKGROUND

Scarcity of data on the health impacts and associated economic costs of heat waves may limit the will to invest in adaptation measures. We assessed the economic impact associated with mortality, morbidity, and loss of well-being during heat waves in France between 2015 and 2019.

METHODS

Health indicators monitored by the French national heat wave plan were used to estimate excess visits to emergency rooms and outpatient clinics and hospitalizations for heat-related causes. Total excess mortality and years of life loss were considered, as well as the size of the population that experienced restricted activity. A cost-of-illness and willingness-to-pay approach was used to account for associated costs.

RESULTS

Between 2015 and 2019, the economic impact of selected health effects of heat waves amounts to €25.5 billion, mainly in mortality (€23.2 billion), minor restricted activity days (€2.3 billion), and morbidity (€0.031 billion).

CONCLUSION

The results highlight a significant economic burden on the French health system and the population. A better understanding of the economic impacts of climate change on health is required to alert decision-makers to the urgency of mitigation and to support concrete adaptation actions.

Determinants of Electrical and Thermal Energy Consumption in Hospitals According to Climate Zones in Poland

Energy use in hospitals is higher than in other public buildings, so improving energy efficiency in healthcare buildings is a significant challenge in this sector of engineering. For this, it is necessary to know the various determinants of energy consumption. Until now, the main factor affecting energy consumption in healthcare facilities studied in the literature was hospital capacity. However, the commonly used variables connected with hospital size and the number of beds do not take into account the medical activities carried out in these buildings. Assuming that energy consumption in hospitals is multiple and shaped by many factors that overlap, not only on an individual level but also on a higher scale level, this study devises a more integrated approach to its determinants. This study aims to investigate the determinants of electrical energy costs (EEC) and thermal energy costs (TEC) in Polish hospitals with regard to factors related to their size, work intensity and climate zones. The analysis was carried out using financial and resource data from all Polish hospitals for the years 2010–2019. The study used a multivariate backward stepwise regression analysis. In order to use climate as a moderating variable, a sample of Polish hospitals from 16 Polish NUTS 2 was divided into four climate zones. This article provides new empirical evidence on the determinants of electricity consumption in Polish hospitals related to their size and medical activity, taking into account climate zone as a moderating variable. The results of the analysis show that both electricity and heat consumption in hospitals are positively related to the number of doctors, beds and the number of medical operations performed. As expected, larger hospitals seem to use more energy. Moreover, there is regional heterogeneity in energy consumption in hospitals related to the climatic zone in which they operate. The conducted analysis shows that Polish hospitals located in the warmest climatic zone are characterized by higher energy consumption than hospitals in the coldest zone. It especially regards EEC in surgery hospitals. The warmer the climate zones, the higher intensity in terms of the number of surgeries, the higher EEC. In terms of nonsurgical hospitals, the influence of climate zone on EEC was not observed. Knowing the factors influencing energy consumption in hospitals can facilitate the correct adoption of an energy-saving strategy in the health sector, which is a reasonable response to climate change and supports a healthy and sustainable future.

Attributable risks of hospitalizations for urologic diseases due to heat exposure in Queensland, Australia, 1995-2016

BACKGROUND

Heat exposure is a risk factor for urologic diseases. However, there are limited existing studies that have examined the relationship between high temperatures and urologic disease. The aim of this study was to examine the associations between heat exposure and hospitalizations for urologic diseases in Queensland, Australia, during the hot seasons of 1995-2016 and to quantify the attributable risks.

METHODS

We obtained 238 427 hospitalized cases with urologic diseases from Queensland Health between 1 December 1995 and 31 December 2016. Meteorological data were collected from the Scientific Information for Land Owners-a publicly accessible database of Australian climate data that provides daily data sets for a range of climate variables. A time-stratified, case-crossover design fitted with the conditional quasi-Poisson regression model was used to estimate the associations between temperature and hospitalizations for urologic diseases at the postcode level during each hot season (December-March). Attributable rates of hospitalizations for urologic disease due to heat exposure were calculated. Stratified analyses were performed by age, sex, climate zone, socio-economic factors and cause-specific urologic diseases.

RESULTS

We found that a 1°C increase in temperature was associated with a 3.3% [95% confidence interval (CI): 2.9%, 3.7%] increase in hospitalization for the selected urologic diseases during the hot season. Hospitalizations for renal failure showed the strongest increase 5.88% (95% CI: 5.25%, 6.51%) among the specific causes of hospital admissions considered. Males and the elderly (≥60 years old) showed stronger associations with heat exposure than females and younger groups. The sex- and age-specific associations with heat exposure were similar across specific causes of urologic diseases. Overall, nearly one-fifth of hospitalizations for urologic diseases were attributable to heat exposure in Queensland.

CONCLUSIONS

Heat exposure is associated with increased hospitalizations for urologic disease in Queensland during the hot season. This finding reinforces the pressing need for dedicated public health-promotion campaigns that target susceptible populations, especially for those more predisposed to renal failure. Given that short-term climate projections identify an increase in the frequency, duration and intensity of heatwaves, this public health advisory will be of increasing urgency in coming years.

Factors That Influence Climate Change-Related Mortality in the United States: An Integrative Review

Global atmospheric warming leads to climate change that results in a cascade of events affecting human mortality directly and indirectly. The factors that influence climate change-related mortality within the peer-reviewed literature were examined using Whittemore and Knafl’s framework for an integrative review. Ninety-eight articles were included in the review from three databases—PubMed, Web of Science, and Scopus—with literature filtered by date, country, and keywords. Articles included in the review address human mortality related to climate change. The review yielded two broad themes in the literature that addressed the factors that influence climate change-related mortality. The broad themes are environmental changes, and social and demographic factors. The meteorological impacts of climate change yield a complex cascade of environmental and weather events that affect ambient temperatures, air quality, drought, wildfires, precipitation, and vector-, food-, and water-borne pathogens. The identified social and demographic factors were related to the social determinants of health. The environmental changes from climate change amplify the existing health determinants that influence mortality within the United States. Mortality data, national weather and natural disaster data, electronic medical records, and health care provider use of International Classification of Disease (ICD) 10 codes must be linked to identify climate change events to capture the full extent of climate change upon population health.

Advancing Gerontological Nursing Science in Climate Change

Older adults have unique health risks related to climate change. This commentary addresses the health impacts of climate change for older adults, identifies gaps in gerontological nursing research, and highlights areas for research to address the significant gap in nursing science. Climate risks of extreme weather events, such as heat, rain, flooding, and wildfires, as well as poor air quality, vector-borne diseases, interruptions of services, and treatment plans all place older adults at risk of experiencing greater morbidity and early mortality. Despite these risks, there is a gap in nursing research related to climate change and aging. Nurse scientists can address this gap with an interdisciplinary approach. There are climate resources and theoretical frameworks to support scientific inquiry. Funding sources must be made available to assure rigorous scholarship of climate-related health impacts for older adults. Gerontological nurse researchers must build capacity to address climate change and health. [Research in Gerontological Nursing, 13(1), 6-12.].

Increasing impacts of temperature on hospital admissions, length of stay, and related healthcare costs in the context of climate change in Adelaide, South Australia

BACKGROUND

A growing number of studies have investigated the effect of increasing temperatures on morbidity and health service use. However, there is a lack of studies investigating the temperature-attributable cost burden.

OBJECTIVES

This study examines the relationship of daily mean temperature with hospital admissions, length of hospital stay (LoS), and costs; and estimates the baseline temperature-attributable hospital admissions, and costs and in relation to warmer climate scenarios in Adelaide, South Australia.

METHOD

A daily time series analysis using distributed lag non-linear models (DLNM) was used to explore exposure-response relationships and to estimate the aggregated burden of hospital admissions for conditions associated with temperatures (i.e. renal diseases, mental health, diabetes, ischaemic heart diseases and heat-related illnesses) as well as the associated LoS and costs, for the baseline period (2010-2015) and different future climate scenarios in Adelaide, South Australia.

RESULTS

During the six-year baseline period, the overall temperature-attributable hospital admissions, LoS, and associated costs were estimated to be 3915 cases (95% empirical confidence interval (eCI): 235, 7295), 99,766 days (95% eCI: 14,484, 168,457), and AU$159 million (95% eCI: 18.8, 269.0), respectively. A climate scenario consistent with RCP8.5 emissions, and including projected demographic change, is estimated to lead to increases in heat-attributable hospital admissions, LoS, and costs of 2.2% (95% eCI: 0.5, 3.9), 8.4% (95% eCI: 1.1, 14.3), and 7.7% (95% eCI: 0.3, 13.3), respectively by mid-century.

CONCLUSIONS

There is already a substantial temperature-attributable impact on hospital admissions, LoS, and costs which are estimated to increase due to climate change and an increasing aged population. Unless effective climate and public health interventions are put into action, the costs of treating temperature-related admissions will be high.

Urban Heat Island Monitoring and Impacts on Citizen’s General Health Status in Isfahan Metropolis: A Remote Sensing and Field Survey Approach

Urban heat islands (UHIs) are one of the urban management challenges, especially in metropolises, which can affect citizens’ health and well-being. This study used a combination of remote sensing techniques with field survey to investigate systematically the effects of UHI on citizens’ health in Isfahan metropolis, Iran. For this purpose, the land surface temperature (LST) over a three-year period was monitored by Landsat-8 satellite imagery based on the split window algorithm. Then, the areas where UHI and urban cold island (UCI) phenomena occurred were identified and a general health questionnaire-28 (GHQ-28) was applied to evaluate the health status of 800 citizens in terms of physical health, anxiety and sleep, social function, and depression in UHI and UCI treatments. The average LST during the study period was 45.5 ± 2.3 °C and results showed that the Zayandeh-Rood river and the surrounding greenery had an important role in regulating the ambient temperature and promoting the citizens’ health. Citizens living in the suburban areas were more exposed to the UHIs phenomena, and statistical analysis of the GHQ-28 results indicated that they showed severe significant (P < 0.05) responses in terms of non-physical health sub-scales (i.e., anxiety and sleep, social functioning, and depression). Therefore, it can be concluded that not all citizens in the Isfahan metropolis are in the same environmental conditions and city managers and planners should pay more attention to the citizens living in the UHIs. The most important proceedings in this area would be the creation and development of parks and green belts, as well as the allocation of health-medical facilities and citizen education.

What do we know about the healthcare costs of extreme heat exposure? A comprehensive literature review

Exposure to extreme heat can lead to a range of heat-related illnesses, exacerbate pre-existing health conditions and cause increased demand on the healthcare system. A projected increase in temperature may lead to greater healthcare expenditure, however, at present the costs of heat-related healthcare utilization is under-researched. This study aims to review the literature on heat-related costs for the healthcare system with a focus on ED visits, hospitalization, and ambulance call-outs. PubMed, Scopus, and Embase were used to search relevant literature from database inception to December 2017 and limited to human studies and English language. After screening, a total of ten papers were identified for final inclusion. In general, the healthcare costs of heat extremes have been poorly investigated in developed countries and not reported in developing countries where the largest heat-vulnerable populations reside. Studies showed that exposure to extreme heat was causing a substantial economic burden on healthcare systems. Females, the elderly, low-income families, and ethnic minorities had the highest healthcare costs on a range of health services utilization. Although a few studies have estimated heat healthcare costs, none of them quantified the temperature-healthcare cost relationship. There is a need to systematically examine heat-attributable costs for the healthcare system in the context of climate change to better inform heat-related policy making, target interventions and resource allocation.

Assessing heatwave impacts on cause-specific emergency department visits in urban and rural communities of Queensland, Australia

BACKGROUND

Heatwave impact on morbidity of people in rural areas has rarely been assessed in prior studies, and recently published literature has documented heatwave impact on a wide spectrum of diseases, for example, ear and eye diseases.

OBJECTIVES

To examine the associations between heatwaves and cause-specific emergency department visits (EDVs) across eight communities in both urban and rural regions throughout Queensland, Australia.

METHODS

Daily data on EDVs, air pollution and climatic conditions during the 1st January 2013 to the 31st December 2015 were obtained from relevant government agencies. Heatwave was defined as ≥ 95th percentile of the mean temperature for three or more consecutive days in each community. A quasi-Poisson generalized additive model with a distributed lag non-linear model was used to assess the heatwave impacts on EDVs. Random effect meta-analysis was performed to investigate the effects of heatwaves on cause-specific EDVs across the urban and rural regions as well as the whole Queensland. The causes of EDVs investigated in this study were infectious and parasitic diseases (ICD code: A00-B99), endocrine, nutritional and metabolic diseases (E00-E90), mental and behavioural disorders (F00-F99), diseases of the nervous system (G00-G99), diseases of the ear and mastoid process (H60-H95), diseases of the circulatory system (I00-I99), diseases of the respiratory system (J00-J99), diseases of the skin and subcutaneous tissue (L00-L99), diseases of the musculoskeletal system and connective tissue (M00-M99), diseases of the genitourinary system (N00-N99), and injury, poisoning and certain other consequences of external causes (S00-T98).

RESULTS

The meta-analysis results showed that there were significant effects of heatwaves on total EDVs and a wide-spectrum of cause-specific EDVs. For example, EDVs for endocrine, nutritional and metabolic diseases (RR: 1.18, 95% CI: 1.04-1.34), diseases of the nervous system (RR: 1.09, 95% CI: 1.02-1.17), and diseases of the genitourinary system (RR: 1.05, 95% CI: 1.00-1.09) increased substantially during heatwave days. The effect of heatwaves on total EDVs was similar for rural (RR: 1.04, 95% CI: 1.01-1.07) and urban regions (RR: 1.04, 95% CI: 1.00-1.07).

CONCLUSIONS

A wide range of diseases were sensitive to heatwave impacts. Residents in urban and rural areas were all vulnerable to heatwave impacts, calling for heat adaptation measures to be undertaken in Queensland, Australia.