Warm Season and Emergency Department Visits to U.S. Children's Hospitals.
Warm Season and Emergency Department Visits to U.S. Children's Hospitals.
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DOI：
10.1289/ehp8083
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发表时间：
2022-01
影响因子：
10.4
通讯作者：
Wellenius GA
中科院分区：
文献类型：
--
作者：
Bernstein AS;Sun S;Weinberger KR;Spangler KR;Sheffield PE;Wellenius GA
随着气候变化，极端高温暴露正在增加。对成年人的健康影响有很好的记录，但对儿童的风险没有很好的描述。我们估计了温暖季节(5月至9月)气温与美国儿童和青少年特定原因的急诊科(ED)就诊之间的关系。这项多中心时间序列研究利用了2016至2018年5月至9月年龄段儿童和青少年到美国47家儿童医院急诊室就诊的管理数据。使用时空模型估计了医院所在县的每日最高环境温度。我们使用具有准泊松分布的分布滞后非线性模型来估计日最高气温与ED就诊的相对风险(RR)之间的关联，并对时间趋势进行了调整。然后，我们使用随机效应荟萃分析模型来估计总体累积关联性。与医院特定的最低发病温度相比，酷热与全原因急诊的RR为1.17(95%CI：1.12，1.21)相关。与中暑有关的疾病包括脱水和电解质紊乱(1.83；95%CI：1.31，2.57)、细菌性肠炎(1.35；95%CI：1.02，1.79)以及中耳炎和外耳炎(1.30；95%CI：1.11，1.52)的相关性更明显。总而言之，高于最低发病温度的温度估计占任何原因暖季急诊的11.8%[95%经验95%可信区间：9.9%，13.3%]，占因高温相关疾病急诊的31.0%(95%ECI：17.9%，36.5%)。在温暖的季节，气温较高的日子与儿童医院急诊室的就诊率较高有关。较高的环境温度可能会在美国儿童和青少年中造成相当大比例的急诊室就诊。Https://doi.org/10.1289/EHP8083
Extreme heat exposures are increasing with climate change. Health effects are well documented in adults, but the risks to children are not well characterized. We estimated the association between warm season (May to September) temperatures and cause-specific emergency department (ED) visits among U.S. children and adolescents. This multicenter time-series study leveraged administrative data on ED visits by children and adolescents of age to the EDs of 47 U.S. children’s hospitals from May to September from 2016 to 2018. Daily maximum ambient temperature was estimated in the county of the hospital using a spatiotemporal model. We used distributed-lag nonlinear models with a quasi-Poisson distribution to estimate the association between daily maximum temperature and the relative risk (RR) of ED visits, adjusting for temporal trends. We then used a random-effects meta-analytic model to estimate the overall cumulative association. Extreme heat was associated with an RR of all-cause ED visits of 1.17 (95% CI: 1.12, 1.21) relative to hospital-specific minimum morbidity temperature. Associations were more pronounced for ED visits due to heat-related illness including dehydration and electrolyte disorders ( 1.83; 95% CI: 1.31, 2.57), bacterial enteritis (1.35; 95% CI: 1.02, 1.79), and otitis media and externa (1.30; 95% CI: 1.11, 1.52). Taken together, temperatures above the minimum morbidity temperature accounted for an estimated 11.8% [95% empirical 95% confidence interval (eCI): 9.9%, 13.3%] of warm season ED visits for any cause and 31.0% (95% eCI: 17.9%, 36.5%) of ED visits for heat-related illnesses. During the warm season, days with higher temperatures were associated with higher rates of visits to children’s hospital EDs. Higher ambient temperatures may contribute to a significant proportion of ED visits among U.S. children and adolescents. https://doi.org/10.1289/EHP8083