Abstract
BackgroundHeatwaves have been linked to increased risk of mortality and morbidity and are projected to increase in frequency and intensity due to climate change. The current study uses emergency department (ED) data from Australia, Botswana, Netherlands, Pakistan, and the United States of America to evaluate the impact of heatwaves on ED attendances, admissions and mortality.MethodsRoutinely collected time series data were obtained from 18 hospitals. Two separate thresholds (≥4 and ≥7) of the acclimatisation excess heat index (EHIaccl) were used to define “hot days”. Analyses included descriptive statistics, independent samples T-tests to determine differences in case mix between hot days and other days, and threshold regression to determine which temperature thresholds correspond to large increases in ED attendances.FindingsIn all regions, increases in temperature that did not coincide with time to acclimatise resulted in increases in ED attendances, and the EHIaccl performed in a similar manner. During hot days in California and The Netherlands, significantly more children ended up in the ED, while in Pakistan more elderly people attended. Hot days were associated with more patient admissions in the ages 5–11 in California, 65–74 in Karachi, and 75–84 in The Hague. During hot days in The Hague, patients with psychiatric symptoms were more likely to die. The current study did not identify a threshold temperature associated with particularly large increases in ED demand.InterpretationThe association between heat and ED demand differs between regions. A limitation of the current study is that it does not consider delayed effects or influences of other environmental factors. Given the association between heat and ED use, hospitals and governmental authorities should recognise the demands that heat can place on local health care systems. These demands differ substantially between regions, with Pakistan being the most heavily affected within our study sample.
Highlights
Heatwaves have been linked to increased risk of mortality and morbidity, and are projected to increase in frequency and intensity due to climate change [1,2,3,4]
This study aims to assess to what extent hot days result in increases in emergency department (ED) attendances, hospital admissions, and mortality
The temperature ranges for the regions of Australia, Botswana, Pakistan and the United States of America (USA) are similar, the Netherlands had cooler temperatures
Summary
Heatwaves have been linked to increased risk of mortality and morbidity, and are projected to increase in frequency and intensity due to climate change [1,2,3,4]. Increased use of healthcare services during periods of extreme heat is a concern to healthcare professionals and policymakers worldwide. This is evident in the implementation of heatwave risk management plans in a range of countries, including Australia, Germany, Italy, Netherlands, Spain, the United Kingdom and the United States of America (USA) [6]. The current study uses hospital data from five different countries (Australia, Botswana, Netherlands, Pakistan, and the USA) on five different continents to evaluate the impact of heatwaves. The current study uses emergency department (ED) data from Australia, Botswana, Netherlands, Pakistan, and the United States of America to evaluate the impact of heatwaves on ED attendances, admissions and mortality
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