Association Between Ambient Heat and Risk of Emergency Department Visits for Mental Health Among US Adults, 2010 to 2019.
Association Between Ambient Heat and Risk of Emergency Department Visits for Mental Health Among US Adults, 2010 to 2019.
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DOI：
10.1001/jamapsychiatry.2021.4369
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发表时间：
2022-04-01
期刊：
影响因子：
25.8
通讯作者：
Wellenius GA
中科院分区：
文献类型：
--
作者：
Nori-Sarma A;Sun S;Sun Y;Spangler KR;Oblath R;Galea S;Gradus JL;Wellenius GA
这项交叉病例研究考察了较高的暖季气温与美国成年人购买医疗保险的心理健康相关急诊科就诊次数之间的关系。在有医疗保险的美国成年人中，环境温度较高的时期是否与因精神健康问题而去急诊科(ED)就诊的增加有关？在这项病例交叉研究中，对2个 243个 395个个体中的3个 496 762次急诊进行了研究，暖季温度较高与任何精神健康状况和特定精神健康状况的急救就诊风险增加相关。这些信息可以帮助提供精神健康服务的临床医生在预计极端炎热的时候为个人和医疗保健系统增加的压力做好准备。极端高温对身体健康结果的影响已经有了很好的记录。然而，环境温度升高和特定精神健康状况之间的联系仍然知之甚少。调查环境高温和精神健康相关急诊科(ED)就诊之间的关系，在邻近的美国，总体上和潜在的敏感亚群之间。这项病例交叉研究使用了从OptomLabs Data Warehouse(OLDW)获得的医疗索赔数据，以确定从2010年到2019年暖季月份(5月至9月)有一次或二次出院精神诊断的急诊室就诊索赔。这项分析包括居住在美国2775个县的18岁或18岁以上拥有商业或联邦医疗保险优势医疗保险的成年人的索赔。如果临床分类软件代码表明急诊科就诊是为了筛查精神健康结果和冲动控制障碍，则排除急诊科就诊。使用独立坡度参数-高程关系模型估计了连续尺度上特定县的日最高环境温度。极端高温被定义为县域暖季温度分布的第95个百分位数。通过使用初级和二级出院诊断国际疾病分类第九次修订和国际疾病和相关健康问题统计分类第十次修订代码确定ED就诊申请，评估特定原因精神健康诊断的每日发生率和任何精神健康诊断的复合终点。用条件Logistic回归模型估计每日体温与急诊率之间的发生率比(IRR)和95%的CI。在2个 243 395个独立个体中的3个 496 762 ED访问的数据被确定(56.8%[1274456]女性；平均[SD]年龄51.0[18.8]岁)；在这些个体中，14.3%的年龄在18到26岁，25.6%的人在27到44岁，33.3%的人在45岁到，26.8%的人在65岁或以上。对于任何精神健康问题的急诊科就诊，酷暑天数与1.08(95%可信区间，1.07-1.09)的IRR相关。在特定的精神健康状况下，极端高温与ED就诊有关，包括物质使用障碍(IRR，1.08；95%CI，1.07-1.10)；焦虑、压力相关和躯体形式障碍(IRR，1.07；95%CI，1.05-1.09)；情绪障碍(IRR，1.07；95%CI，1.05-1.09)；精神分裂症、分裂型和妄想性障碍(IRR，1.05；95%CI，1.03-1.07)；自我伤害(IRR，1.06；儿童起病的行为障碍(IRR，1.11；95%CI，1.05-1.18)。此外，男性(IRR，1.10；95%CI，1.08-1.12)和美国东北部(IRR，1.10；95%CI，1.07-1.13)、中西部(IRR，1.11；95%CI，1.09-1.13)和西北部(IRR，1.12；95%CI，1.03-1.21)地区的关联性更高。在这项对大量拥有医疗保险的美国成年人进行的交叉研究中，极端炎热的日子与较高的精神健康相关急诊率相关。这一发现可能对在极端炎热时期提供心理健康服务的临床医生提供信息，以便为预计极端炎热时期的卫生服务需求增加做好准备。
This case-crossover study examines the association between higher warm-season temperatures and the number of mental health–related emergency department visits by US adults with health insurance. Are periods of higher ambient temperature associated with an increase in emergency department (ED) visits for mental health conditions among US adults with health insurance? In this case-crossover study of 3 496 762 ED visits among 2 243 395 unique individuals, higher warm-season temperatures were associated with an increased risk of ED visits for any mental health condition and for specific mental health conditions. This information could aid clinicians providing services for mental health in preparing for increased stress on individuals and the health care system during times when extreme heat is anticipated. The implications of extreme heat for physical health outcomes have been well documented. However, the association between elevated ambient temperature and specific mental health conditions remains poorly understood. To investigate the association between ambient heat and mental health–related emergency department (ED) visits in the contiguous US among adults overall and among potentially sensitive subgroups. This case-crossover study used medical claims data obtained from OptumLabs Data Warehouse (OLDW) to identify claims for ED visits with a primary or secondary discharge psychiatric diagnosis during warm-season months (May to September) from 2010 through 2019. Claims for adults aged 18 years or older with commercial or Medicare Advantage health insurance who were living in 2775 US counties were included in the analysis. Emergency department visits were excluded if the Clinical Classifications Software code indicated that the visits were for screening for mental health outcomes and impulse control disorders. County-specific daily maximum ambient temperature on a continuous scale was estimated using the Parameter-Elevation Relationships on Independent Slopes model. Extreme heat was defined as the 95th percentile of the county-specific warm-season temperature distribution. The daily incidence rate of cause-specific mental health diagnoses and a composite end point of any mental health diagnosis were assessed by identifying ED visit claims using primary and secondary discharge diagnosis International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. Conditional logistic regression models were used to estimate the incidence rate ratio (IRR) and 95% CIs for the association between daily temperature and incidence rates of ED visits. Data from 3 496 762 ED visits among 2 243 395 unique individuals were identified (56.8% [1 274 456] women; mean [SD] age, 51.0 [18.8] years); of these individuals, 14.3% were aged 18 to 26 years, 25.6% were aged 27 to 44 years, 33.3% were aged 45 to 64 years, and 26.8% were aged 65 years or older. Days of extreme heat were associated with an IRR of 1.08 (95% CI, 1.07-1.09) for ED visits for any mental health condition. Associations between extreme heat and ED visits were found for specific mental health conditions, including substance use disorders (IRR, 1.08; 95% CI, 1.07-1.10); anxiety, stress-related, and somatoform disorders (IRR, 1.07; 95% CI, 1.05-1.09); mood disorders (IRR, 1.07; 95% CI, 1.05-1.09); schizophrenia, schizotypal, and delusional disorders (IRR, 1.05; 95% CI, 1.03-1.07); self-harm (IRR, 1.06; 95% CI, 1.01-1.12); and childhood-onset behavioral disorders (IRR, 1.11; 95% CI, 1.05-1.18). In addition, associations were higher among men (IRR, 1.10; 95% CI, 1.08-1.12) and in the US Northeast (IRR, 1.10; 95% CI, 1.07-1.13), Midwest (IRR, 1.11; 95% CI, 1.09-1.13), and Northwest (IRR, 1.12; 95% CI, 1.03-1.21) regions. In this case-crossover study of a large population of US adults with health insurance, days of extreme heat were associated with higher rates of mental health–related ED visits. This finding may be informative for clinicians providing mental health services during periods of extreme heat to prepare for increases in health service needs when times of extreme heat are anticipated.
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DOI：
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期刊：
Lancet (London, England)
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