Gillespie Elizabeth, Steiner Abigail, Durfee Josh, Scott Kenneth, Stein Amy, Davidson Arthur J
Denver Health Medical Center, Denver, CO, USA.
University of Colorado School of Medicine, Aurora, CO, USA.
J Gen Intern Med. 2025 May;40(7):1617-1626. doi: 10.1007/s11606-024-09231-6. Epub 2024 Dec 11.
Extreme and inequitable heat exposures cause weather-related deaths. Associations between maximum daily temperature and individual-level healthcare utilization have been inadequately characterized.
To evaluate and compare demographic and clinical associations for an individual's healthcare utilization between high- and low-temperature periods.
Retrospective, 5-year longitudinal study of acute care utilization comparing high-temperature periods (HHP) and low-temperature periods (LHP) defined by local maximum daily temperature. Using duration of observation, cases served as their own controls. Temperature-dependent utilization was reported as unadjusted incident rate ratio (IRR) using Poisson regression and log-transformed variable coefficients. IRRs were adjusted (aIRR) for demographic characteristics, heat-sensitive conditions/diagnoses, and neighborhood heat vulnerability score; false discovery rate p-values were adjusted for multiple comparisons.
Patients aged ≥ 4 years visiting Denver Health between 4/10/2016 and 12/31/2020, with ≥ 2 visits over ≥ 365 days.
Comparison of an individual's acute care visit rates in HHP versus LHP, stratified by demographic characteristics and heat-sensitive clinical conditions.
While acute care utilization occurred at similar or higher rates during LHP compared with HHP, certain groups (i.e., Native Americans and those with congestive heart failure, liver failure, and/or alcohol use) had higher rates of utilization during HHP. Significant associations existed for acute care utilization by age, sex, racial and ethnic groupings, clinical characteristics, and neighborhood heat vulnerability. Adjusting for demographic and environmental covariates, individuals with any heat-sensitive clinical condition had higher HHP vs LHP utilization compared to those without (aIRR = 1.93).
Significant heat-related utilization occurred among individuals with heat-sensitive clinical conditions compared with those without. Demographic characteristics (e.g., older) and specific clinical conditions (e.g., liver failure) demonstrated higher utilization. In real-time, chronic disease management programs could proactively identify at-risk individuals for interventions which reduce heat-related morbidity and healthcare utilization.
极端且不均衡的高温暴露会导致与天气相关的死亡。每日最高气温与个体层面医疗保健利用之间的关联尚未得到充分描述。
评估并比较高温期和低温期个体医疗保健利用的人口统计学和临床关联。
一项回顾性的5年纵向研究，对急性护理利用情况进行比较，研究对象为根据当地每日最高气温定义的高温期（HHP）和低温期（LHP）。利用观察期，病例自身作为对照。使用泊松回归和对数变换变量系数，将温度依赖性利用情况报告为未调整的发病率比（IRR）。对人口统计学特征、热敏感状况/诊断以及社区热脆弱性评分进行IRR调整（aIRR）；对错误发现率p值进行多重比较调整。
2016年4月10日至2020年12月31日期间，年龄≥4岁且在丹佛健康中心就诊≥2次、就诊时间间隔≥365天的患者。
按人口统计学特征和热敏感临床状况分层，比较个体在高温期和低温期的急性护理就诊率。
虽然与高温期相比，低温期的急性护理利用率相似或更高，但某些群体（即美国原住民以及患有充血性心力衰竭、肝功能衰竭和/或酗酒的人群）在高温期的利用率更高。年龄、性别、种族和族裔分组、临床特征以及社区热脆弱性与急性护理利用存在显著关联。在调整人口统计学和环境协变量后，与无热敏感临床状况的个体相比，有任何热敏感临床状况的个体在高温期与低温期的利用率更高（aIRR = 1.93）。
与无热敏感临床状况的个体相比，有热敏感临床状况的个体出现了显著的与高温相关的医疗保健利用情况。人口统计学特征（如年龄较大）和特定临床状况（如肝功能衰竭）显示出更高的利用率。在实时情况下，慢性病管理项目可以主动识别高危个体，以便进行干预，从而降低与高温相关的发病率和医疗保健利用率。
