Ambient Heat is associated with higher risk of emergency department visits among US children with health insurance

Abstract

BACKGROUND AND AIM: Extreme heat is a recognized threat to public health and the effect of high outdoor temperatures on adults is well characterized. Children are thought to be particularly susceptible to heat, but the evidence remains scarce. Accordingly, we aimed to estimate the association between warm-season temperatures and cause-specific emergency department (ED) visits in US children. METHODS: We leveraged national de-identified ED visits between May and September of 2016-2020 among children 18 years of age with commercial health insurance using the OptumLabs® Data Warehouse. We estimated daily population-weighted county average maximum temperature using a validated gridded climate dataset. We used a time-stratified case-crossover study design with a distributed lag nonlinear model to estimate the association between daily maximum temperature and relative rate of ED visits for each of 22 major disease categories, adjusting for relative humidity and federal holidays. RESULTS:We identified a total of ~1.3 million ED visits for any cause among children with commercial health insurance living in 2,987 US counties. A 10 °C increase in daily maximum temperature was associated with a 25% (95% CI: 18%, 32%) higher rate of ED visits for heat-related illness, a 9% (5%, 13%) higher rate of ED visits for otitis media and externa, and a 9% (3%, 15%) higher rate of ED visits for skin and soft tissue infections. Temperature was not associated with all-cause ED visits and potentially protective associations were observed for multiple outcomes, including respiratory system diseases and mental health. CONCLUSIONS:In this large, national study of children with health insurance, we found that heat is associated with higher rates of emergency department visits for a range of conditions. These results suggest that children are susceptible to heat and may inform public health and clinical efforts to protect this vulnerable population. KEYWORDS: extreme heat, children's health, climate, emergency department