Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia.
Emergency Department, UC Davis Medical Center, Sacramento, California, United States of America.
PLoS One. 2019 Mar 28;14(3):e0214242. doi: 10.1371/journal.pone.0214242. eCollection 2019.
Heatwaves have been linked to increased risk of mortality and morbidity and are projected to increase in frequency and intensity due to climate change. The current study uses emergency department (ED) data from Australia, Botswana, Netherlands, Pakistan, and the United States of America to evaluate the impact of heatwaves on ED attendances, admissions and mortality.
Routinely collected time series data were obtained from 18 hospitals. Two separate thresholds (≥4 and ≥7) of the acclimatisation excess heat index (EHIaccl) were used to define "hot days". Analyses included descriptive statistics, independent samples T-tests to determine differences in case mix between hot days and other days, and threshold regression to determine which temperature thresholds correspond to large increases in ED attendances.
In all regions, increases in temperature that did not coincide with time to acclimatise resulted in increases in ED attendances, and the EHIaccl performed in a similar manner. During hot days in California and The Netherlands, significantly more children ended up in the ED, while in Pakistan more elderly people attended. Hot days were associated with more patient admissions in the ages 5-11 in California, 65-74 in Karachi, and 75-84 in The Hague. During hot days in The Hague, patients with psychiatric symptoms were more likely to die. The current study did not identify a threshold temperature associated with particularly large increases in ED demand.
The association between heat and ED demand differs between regions. A limitation of the current study is that it does not consider delayed effects or influences of other environmental factors. Given the association between heat and ED use, hospitals and governmental authorities should recognise the demands that heat can place on local health care systems. These demands differ substantially between regions, with Pakistan being the most heavily affected within our study sample.
热浪与死亡率和发病率的增加有关，并且由于气候变化，预计其频率和强度将会增加。本研究使用来自澳大利亚、博茨瓦纳、荷兰、巴基斯坦和美国的急诊部 (ED) 数据，评估热浪对 ED 就诊、入院和死亡率的影响。
从 18 家医院获得了常规收集的时间序列数据。使用适应期过热指数 (EHIaccl) 的两个单独阈值（≥4 和≥7）来定义“热天”。分析包括描述性统计、独立样本 T 检验，以确定热天和其他天之间的病例组合差异，以及阈值回归，以确定哪些温度阈值对应 ED 就诊量的大幅增加。
在所有地区，与适应时间不匹配的温度升高都会导致 ED 就诊量增加，EHIaccl 的表现方式类似。在加利福尼亚州和荷兰的热天期间，明显有更多的儿童来到 ED，而在巴基斯坦则有更多的老年人就诊。在加利福尼亚州的 5-11 岁、卡拉奇的 65-74 岁和海牙的 75-84 岁年龄段，热天与更多的患者入院相关。在海牙的热天期间，有精神症状的患者更有可能死亡。本研究未确定与 ED 需求特别大幅增加相关的阈值温度。
热与 ED 需求之间的关联在不同地区有所不同。本研究的一个局限性是它没有考虑延迟效应或其他环境因素的影响。鉴于热与 ED 使用之间的关联，医院和政府当局应该认识到热对当地医疗保健系统可能带来的需求。这些需求在不同地区之间存在很大差异，在我们的研究样本中，巴基斯坦受到的影响最大。
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