The Comparison of Heat-Related Health Outcomes between Patients Reporting/Not-Reporting a Social Security Number

Abstract

This study quantified the relationship between air temperature and five different types of heat sensitive health outcomes (cardiovascular disease, dehydration, heat-related illness, renal disease, and respiratory disease) with daily emergency (ED) visits and hospitalizations in Florida, U.S. We examined whether the associations of heat exposure with health outcomes were modified by birth sex, age, or race/ethnicity. Finally, health disparities between patients reporting/not reporting a masked social security number (SSN) were investigated. The study focused on the warm season (May through September) from 2008 to 2012 in Florida. We devised separate case-crossover models for each health outcome, type of healthcare visit (emergency department, hospitalization), and patients reporting/not reporting SSN. We used a bidirectional time-stratified design with a rolling 28 day comparison window. Referent periods were extracted from ±7, ±14, and ±21 days to remove the weekly and seasonal cycles of health outcomes. A conditional logistic regression then calculated heat exposure’s odds ratios (ORs) for a unit risk factor change. Each stratified model also considered potential effect modification by birth sex, age, or race/ethnicity. The results show that most relationships between extreme heat and health outcomes were similar between subpopulations. However, we found differential risks of ED visits by birth sex and some evidence of inequalities between patients reporting/not reporting a SSN. Birth sex modified the effect of heat exposure on dehydration ED visits (Males: 1.078, 95% CI: 1.074~1.082; Females: 1.060, 95% CI: 1.056~1.063) and hospitalizations (Males: 1.063, 95% CI: 1.060~1.066; Females: 1.054, 95% CI: 1.052~1.057). Patients not reporting a SSN between the ages of 25 and 44 exhibited a higher dehydration ED visit OR (1.139, 95% CI: 1.103~1.177) than the patients reporting a SSN (1.079, 95% CI: 1.073~1.084). This study provides insights on the health disparities between people reporting/not reporting a SSN.