Cause-specific Hospital Admissions Research Articles

Longitudinal assessment of the impact of prevalent diabetes on hospital admissions and mortality in the general population: a prospective population-based study with 19 years of follow-up

BackgroundHospitalization indicates the presence of severe disease and constitutes a leading cost in health care. We aimed to prospectively assess if prevalent diabetes mellitus contributes to excess all-cause and cause-specific hospital admissions and mortality at the population level.MethodsWe used a Swedish prospective population-based cohort, including 25,642 individuals of whom 4.2% had prevalent diabetes at baseline (mean age 61.2 ± 6.8 years, age range 44.8–73.4 years). We compared the number of hospitalizations and mortality classified according to the main chapters of the 10th revision of the International Classification of Diseases (ICD-10) during follow-up using nationwide inpatient registries, comparing individuals with and without prevalent diabetes, using multivariate adjusted negative binomial regression (incidence rate ratio, IRR) and Cox regression, respectively.ResultsDuring a median follow-up of 19 years, 18,904 subjects were hospitalized at least once [median 3 (IQR 2–6)] and 6767 (26.4%) individuals died. Overall, subjects with diabetes were hospitalized (IRR 1.83, p < 0.001) more often, and had a higher incidence rate of hospital admissions due to endocrine diseases (IRR 14.6, p < 0.001), dermatological diseases (IRR 3.7, p < 0.001), injuries and poisoning (IRR 2.7, p < 0.001), infectious diseases (IRR 2.5, p < 0.001), psychiatric diseases (IRR 2.0, p < 0.001), but also cardiovascular, hematological, genitourinary, neurologic and respiratory diseases compared with non-diabetic individuals. No difference was observed for hospital admissions due to cancer or musculoskeletal disorders. All-cause mortality was higher (HR 1.77, p < 0.001) in individuals with diabetes, with disease-specific mortality being significant only for cardiovascular and endocrine disease-related death.ConclusionsAt the population level, prevalent diabetes increased the hospitalization burden longitudinally due to diseases of most of the ICD-10 main chapters, except for cancer and musculoskeletal disorders. These novel findings challenge the current view on the spectrum of prevalent diabetes-related conditions and may have implications for screening and treatment strategies in diabetes.Permission of graphical illustrationsSource: Pixabay.com. No permission or acknowledgement is required.

Association of health status and hospitalization risk for peripheral artery disease in the PORTRAIT registry.

Healthcare utilization for patients with peripheral artery disease (PAD) is high, but stratifying patients' risk of hospitalization at initial evaluation is challenging. We examined the association between health status at PAD presentation and risk of (1) combined all-cause hospital admissions and emergency department (ED) visits and (2) all-cause hospital admissions. Patients with claudication enrolled at US sites in the PORTRAIT registry were included. Health status was assessed using the Peripheral Artery Questionnaire (PAQ), a PAD-specific patient-reported outcome measure. Crude overall and cause-specific hospital admissions and ED visits were reported by PAQ overall summary score (PAQ-OS) ranges (0-24, 25-49, 50-74, and 75-100). Kaplan-Meier survival and unadjusted and adjusted Cox proportional hazards models examined the association between baseline PAQ scores and (1) combined all-cause hospital admissions or ED visits and (2) all-cause hospital admissions over 12 months. Of 796 patients, 349 (44%) had a hospital admission or ED visit over 12 months. Patients in the lowest (PAQ-OS = 0-24) versus the highest range (PAQ-OS = 75-100) had higher rates of 12-month (53.3% vs 22.4%) hospital admission and ED visits. In the adjusted model, each 10-point decrease in PAQ-OS was associated with a higher risk of all-cause hospital admission and ED visits (HR = 1.1, 95% CI 1.1-1.2, p < 0.0010) and all-cause hospital admission (HR = 1.1, 95% CI 1.1-1.2, p < 0.0010) at 12 months. PAD-specific health status is associated with an increased risk of healthcare utilization. Baseline health status may help stratify risk in patients with PAD, although replication and further validation of results are necessary.

Heat Exposure and Cause-Specific Hospital Admissions in Spain: A Nationwide Cross-Sectional Study.

More frequent and intense exposure to extreme heat conditions poses a serious threat to public health. However, evidence on the association between heat and specific diagnoses of morbidity is still limited. We aimed to comprehensively assess the short-term association between cause-specific hospital admissions and high temperature, including the added effect of temperature variability and heat waves and the effect modification by humidity and air pollution. We used data on cause-specific hospital admissions, weather (i.e., temperature and relative humidity), and air pollution [i.e., fine particulate matter with aerodynamic diameter (), fine particulate matter with aerodynamic diameter (), , and ozone ()] for 48 provinces in mainland Spain and the Balearic Islands between 1 January 2006 and 31 December 2019. The statistical analysis was performed for the summer season (June-September) and consisted of two steps. We first applied quasi-Poisson generalized linear regression models in combination with distributed lag nonlinear models (DLNM) to estimate province-specific temperature-morbidity associations, which were then pooled through multilevel univariate/multivariate random-effect meta-analysis. High temperature had a generalized impact on cause-specific hospitalizations, while the added effect of temperature variability [i.e., diurnal temperature range (DTR)] and heat waves was limited to a reduced number of diagnoses. The strongest impact of heat was observed for metabolic disorders and obesity [relative risk (RR) = 1.978; 95% empirical confidence interval (eCI): 1.772, 2.208], followed by renal failure (1.777; 95% eCI: 1.629, 1.939), urinary tract infection (1.746; 95% eCI: 1.578, 1.933), sepsis (1.543; 95% eCI: 1.387, 1.718), urolithiasis (1.490; 95% eCI: 1.338, 1.658), and poisoning by drugs and nonmedicinal substances (1.470; 95% eCI: 1.298, 1.665). We also found differences by sex (depending on the diagnosis of hospitalization) and age (very young children and the elderly were more at risk). Humidity played a role in the association of heat with hospitalizations from acute bronchitis and bronchiolitis and diseases of the muscular system and connective tissue, which were higher in dry days. Moreover, heat-related effects were exacerbated on high pollution days for metabolic disorders and obesity () and diabetes (, ). Short-term exposure to heat was found to be associated with new diagnoses (e.g., metabolic diseases and obesity, blood diseases, acute bronchitis and bronchiolitis, muscular and connective tissue diseases, poisoning by drugs and nonmedicinal substances, complications of surgical and medical care, and symptoms, signs, and ill-defined conditions) and previously identified diagnoses of hospital admissions. The characterization of the vulnerability to heat can help improve clinical and public health practices to reduce the health risks posed by a warming planet. https://doi.org/10.1289/EHP13254.

Non-COVID-19 hospitalization and mortality during the COVID-19 pandemic in Iran: a longitudinal assessment of 41 million people in 2019-2022.

During a COVID-19 pandemic, it is imperative to investigate the outcomes of all non-COVID-19 diseases. This study determines hospital admissions and mortality rates related to non-COVID-19 diseases during the COVID-19 pandemic among 41 million Iranians. This nationwide retrospective study used data from the Iran Health Insurance Organization. From September 23, 2019, to Feb 19, 2022, there were four study periods: pre-pandemic (Sept 23-Feb 19, 2020), first peak (Mar 20-Apr 19, 2020), first year (Feb 20, 2020-Feb 18, 2021), and the second year (Feb 19, 2021-Feb 19, 2022) following the pandemic. Cause-specific hospital admission and in-hospital mortality are the main outcomes analyzed based on age and sex. Negative binomial regression was used to estimate the monthly adjusted Incidence Rate Ratio (IRR) to compare hospital admission rates in aggregated data. A logistic regression was used to estimate the monthly adjusted in-hospital mortality Odds Ratio (OR) for different pandemic periods. During the study there were 6,522,114 non-COVID-19 hospital admissions and 139,679 deaths. Prior to the COVID-19 outbreak, the standardized hospital admission rate per million person-month was 7115.19, which decreased to 2856.35 during the first peak (IRR 0.40, [0.25-0.64]). In-hospital mortality also increased from 20.20 to 31.99 (OR 2.05, [1.97-2.13]). All age and sex groups had decreased admission rates, except for females at productive ages. Two years after the COVID-19 outbreak, the non-COVID-19 hospital admission rate (IRR 1.25, [1.13-1.40]) and mortality rate (OR 1.05, [1.04-1.07]) increased compared to the rates before the pandemic. The respiratory disease admission rate decreased in the first (IRR 0.23, [0.17-0.31]) and second years (IRR 0.35, [0.26-0.47] compared to the rate before the pandemic. There was a significant reduction in hospitalizations for pneumonia (IRR 0.30, [0.21-0.42]), influenza (IRR 0.04, [0.03-0.06]) and COPD (IRR 0.39, [0.23-0.65]) during the second year. There was a significant and continuous rise in the hematological admission rate during the study, reaching 186.99 per million person-month in the second year, reflecting an IRR of 2.84 [2.42-3.33]compared to the pre-pandemic period. The mortality rates of mental disorders (OR 2.15, [1.65-2.78]) and musculoskeletal (OR 1.48, [1.20-1.82), nervous system (OR 1.42, [1.26-1.60]), metabolic (OR 1.99, [1.80-2.19]) and circulatory diseases (OR 1.35, [1.31-1.39]) increased in the second year compare to pre-pandemic. Myocardial infarction (OR 1.33, [1.19-1.49]), heart failure (OR 1.59, [1.35-1.87]) and stroke (OR 1.35, [1.24-1.47]) showed an increase in mortality rates without changes in hospitalization. In the era of COVID-19, the changes seem to have had a long-term effect on non-COVID-19 diseases. Countries should prepare for similar crises in the future to ensure medical services are not suspended.

Air pollution, mortality, and hospital admissions in Scotland: A 16 years register-based study

Abstract Background Air pollution is associated with poor health and higher mortality. However, studies that link high spatial resolution air pollution data for several pollutants to individual-level data over prolonged period (&amp;gt;10 years) and assess multiple health outcomes are limited. In this study, we investigated the association between 16-years exposure to air pollution and all-cause and cause-specific (cardiovascular, respiratory, cancer, infectious, and mental/behavioural disorders) mortality and hospital admissions in Scotland. Methods Individual-level data from the “Scottish Longitudinal Study” for 202,237 individuals (2002-2017) were linked to yearly concentrations of NO2, SO2, PM10, and PM2.5 pollutants at 1-Km2 spatial resolution using the individual's residential postcode. The association between air pollution and mortality and hospital admissions was examined using Cox Proportional-Hazards and multilevel mixed-effects negative binomial models, respectively. Results Increasing concentrations of PM2.5, PM10, and NO2 pollutants were associated with higher rates of all-cause, cardiovascular, respiratory, cancer, and infectious mortality and hospital admissions. Mortality from respiratory diseases increased by 6.2% (95%CI=2.8%−9.6%), 2.5% (95%CI=0.5%−4.5%), and 1.2% (95%CI=0.5%−1.9%) per 1 µg/m3 increase in PM2.5, PM10 and NO2 pollutants, respectively. Exposure to SO2 was mainly linked to mental/behavioural disorders mortality (HR = 1.05; 95%CI=1.02-1.07) and respiratory hospital admissions (IRR=1.02; 95%CI=1.01-1.03). Conclusions This study revealed a positive association between air pollution and mortality and hospital admissions in Scotland. Interventions on air pollution through stricter environmental regulations could help ease the mortality and hospital admission burden, for both physical and mental illness. Key messages • Air pollution is associated with a higher risk of mortality and hospital admissions for both physical and mental health-related outcomes. • Policymakers are urged to provide incentives for the usage of greener energy sources to reduce air pollution emissions.

Increase in summertime ambient temperature is associated with decreased sick leave risk in Helsinki, Finland

ObjectivesClimate change has increased attention to the health effects of high ambient temperatures and heatwaves worldwide. Both cause-specific mortality and hospital admissions are studied widely, mainly concentrating on warmer climates, but studies focusing on more subtle health effects and cold climates lack. This study investigated the effect of summertime daily ambient temperatures and heatwaves on sick leaves in the employed population in Helsinki, Finland, a Nordic country with a relatively cold climate. MethodsWe obtained from the City of Helsinki personnel register data on sick leaves for the summer months (June–August) of 2002–2017. We estimated the overall cumulative association of all and short (maximum 3-day) sick leaves with daily mean temperature over a 21-day lag period using a negative binomial regression model coupled with a penalized distributed lag non-linear model (penalized DLNM). The association of sick leaves with heatwaves (cut-off temperature 20.8 °C), and prolonged heatwaves, was estimated using a negative binomial regression model coupled with DLNM. We adjusted the time series model for potential confounders, such as air pollution, relative humidity, time trends, and holidays. ResultsIncreasing daily temperature tended to be associated with decreased overall cumulative risk of sick leaves and short sick leaves over a 21-day lag period. In addition, heatwaves and prolonged heatwaves were associated with decreased overall cumulative risk of sick leaves compared to all other summer days: RR 0.87 (95 % CI 0.78 to 0.97) and RR 0.83 (95 % CI 0.70 to 0.98), respectively. ConclusionsThis research suggests that summertime daily temperatures that are high for this northern location have protective effects on the health of the working population.

Air pollution, mortality, and hospital admissions in Scotland: A 16 years register-based study

BackgroundAir pollution is associated with poor health and higher mortality. However, studies that link high spatial resolution air pollution data for several pollutants to individual-level data over prolonged period (&gt;10 years) and assess multiple health outcomes are limited. In this study, we investigated the association between 16-years exposure to air pollution and all-cause and cause-specific (cardiovascular, respiratory, cancer, infectious, and mental/behavioural disorders) mortality and hospital admissions in Scotland.&#x0D; MethodsIndividual-level data from the “Scottish Longitudinal Study” for 202,237 individuals (2002-2017) were linked to yearly concentrations of NO2, SO2, PM10, and PM2.5 pollutants at 1-Km2 spatial resolution using the individual’s residential postcode. The association between air pollution and mortality and hospital admissions was examined using Cox Proportional-Hazards and multilevel mixed-effects negative binomial models, respectively.&#x0D; ResultsIncreasing concentrations of PM2.5, PM10, and NO2 pollutants were associated with higher rates of all-cause, cardiovascular, respiratory, cancer, and infectious mortality and hospital admissions. Mortality from respiratory diseases increased by 6.2% (95%CI=2.8%-9.6%), 2.5% (95%CI=0.5%-4.5%), and 1.2% (95%CI=0.5%-1.9%) per 1 µg/m3 increase in PM2.5, PM10 and NO2 pollutants, respectively. Exposure to SO2 was mainly linked to mental/behavioural disorders mortality (HR=1.05; 95%CI=1.02-1.07) and respiratory hospital admissions (IRR=1.02; 95%CI=1.01-1.03).&#x0D; ConclusionsThis study revealed a positive association between air pollution and mortality and hospital admissions in Scotland. Interventions on air pollution through stricter environmental regulations could help ease the mortality and hospital admission burden, for both physical and mental illness.

Impact of ultrafine particles and total particle number concentration on five cause-specific hospital admission endpoints in three German cities

IntroductionNumerous studies have shown associations between daily concentrations of fine particles (e.g., particulate matter with an aerodynamic diameter ≤2.5 µm; PM2.5) and morbidity. However, evidence for ultrafine particles (UFP; particles with an aerodynamic diameter of 10–100 nm) remains conflicting. Therefore, we aimed to examine the short-term associations of UFP with five cause-specific hospital admission endpoints for Leipzig, Dresden, and Augsburg, Germany. Material and methodsWe obtained daily counts of (cause-specific) cardiorespiratory hospital admissions between 2010 and 2017. Daily average concentrations of UFP, total particle number (PNC; 10–800 nm), and black carbon (BC) were measured at six sites; PM2.5 and nitrogen dioxide (NO2) were obtained from monitoring networks. We assessed immediate (lag 0–1), delayed (lag 2–4, lag 5–7), and cumulative (lag 0–7) effects by applying station-specific confounder-adjusted Poisson regression models. We then used a novel multi-level meta-analytical method to obtain pooled risk estimates. Finally, we performed two-pollutant models to investigate interdependencies between pollutants and examined possible effect modification by age, sex, and season. ResultsUFP showed a delayed (lag 2–4) increase in respiratory hospital admissions of 0.69% [95% confidence interval (CI): −0.28%; 1.67%]. For other hospital admission endpoints, we found only suggestive results. Larger particle size fractions, such as accumulation mode particles (particles with an aerodynamic diameter of 100–800 nm), generally showed stronger effects (respiratory hospital admissions & lag 2–4: 1.55% [95% CI: 0.86%; 2.25%]). PM2.5 showed the most consistent associations for (cardio-)respiratory hospital admissions, whereas NO2 did not show any associations. Two-pollutant models showed independent effects of PM2.5 and BC. Moreover, higher risks have been observed for children. ConclusionsWe observed clear associations with PM2.5 but UFP or PNC did not show a clear association across different exposure windows and cause-specific hospital admissions. Further multi-center studies are needed using harmonized UFP measurements to draw definite conclusions on the health effects of UFP.

The Scorching Truth: Investigating the Impact of Heatwaves on Selangor's Elderly Hospitalisations.

Global climate change has contributed to the intensity, frequency, and duration of heatwave events. The association between heatwaves and elderly mortality is highly researched in developed countries. In contrast, heatwave impact on hospital admissions has been insufficiently studied worldwide due to data availability and sensitivity. In our opinion, the relationship between heatwaves and hospital admissions is worthwhile to explore as it could have a profound impact on healthcare systems. Therefore, we aimed to investigate the associations between heatwaves and hospitalisations for the elderly by age group in Selangor, Malaysia, from 2010 to 2020. We further explored the impact of heatwaves on the risks of cause-specific hospital admissions across age groups within the elderly. This study applied generalized additive models (GAMs) with the Poisson family and distributed lag models (DLMs) to estimate the effect of heatwaves on hospitalisations. According to the findings, there was no significant increase in hospitalisations for those aged 60 and older during heatwaves; however, a rise in mean apparent temperature (ATmean) by 1 °C significantly increased the risk of hospital admission by 12.9%. Heatwaves had no immediate effects on hospital admissions among elderly patients, but significant delay effects were identified for ATmean with a lag of 0-3 days. The hospital admission rates of the elderly groups started declining after a 5-day average following the heatwave event. Females were found to be relatively more vulnerable than males during heatwave periods. Consequently, these results can provide a reference to improve public health strategies to target elderly people who are at the greatest risk of hospitalisations due to heatwaves. Development of early heatwave and health warning systems for the elderly would assist with preventing and reducing health risks while also minimising the burden on the whole hospital system in Selangor, Malaysia.

Multi-pollutant case-crossover models of all-cause and cause-specific mortality and hospital admissions by age group in 47 Canadian cities

Most of the existing epidemiological studies have investigated adverse health effects of multiple air pollutants for a limited number of cities, thus the evidence of the health impacts is limited and it is challenging to compare these results because of different modeling approaches and potential publication bias. In this paper, we expand the number of Canadian cities, with the use of the most recent available health data. A multi-pollutant model in a case-crossover design is used to investigate the short-term impacts of air pollution on various health outcomes in 47 Canadian main cities, comparing three age groups (all-age, senior (age 66+), non-senior). The main findings are that a 14 ppb increase of O3 was associated with a 0.17%–2.78% (0.62%–1.46%) increase in the odds of all-age respiratory mortality (hospitalization). A 12.8 ppb increase of NO2 was associated with a 0.57%–1.47% (0.68%–1.86%) increase in the odds of all-age (non-senior) respiratory hospitalization. A 7.6 μgm−3 increase of PM2.5 was associated with a 0.19%–0.69% (0.33%–1.1%) increase in the odds of all-age (non-senior) respiratory hospitalization.

Short-term effects of heat on respiratory mortality and morbidity in Germany – small-area analysis in the framework of the EXHAUSTION project

Background and Aim: Short-term associations between heat and respiratory mortality and morbidity have been well recognized. However, most studies were conducted in major cities, whereas evidence for more rural areas is limited. In this study, we assessed the short-term associations between air temperature and cause-specific respiratory mortality and hospital admissions in the warm season (May-September) in Germany at a small-area level. Methods: Daily counts of mortality and hospital admissions for respiratory diseases, chronic obstructive pulmonary disease, asthma, lower respiratory tract infections, and pneumonia from 2000 to 2016 were obtained for Germany at the small-area level. Small areas were defined as districts for mortality data and municipalities for hospital admission data. Daily mean air temperatures estimated by a spatio-temporal model were assigned to each small area. We first applied small area-specific Poisson regression allowing for overdispersion, using Distributed Lag Non-linear Models to assess the heat effects at lag 0-1 days (average of same- and previous-day temperatures). Random-effects meta-analysis was then used to pool the small area-specific estimates. Besides, we conducted subgroup analyses to investigate effect modification by age and sex. Results: We observed increased risks for all investigated cause-specific respiratory mortality and hospital admissions associated with heat. The strongest heat effect was found for pneumonia. For an increment from the 75th to the 99th percentile of the temperature distribution, the pooled risk ratio was 1.49 (95% CI: 1.42, 1.57) for pneumonia mortality and 1.20 (95% CI: 1.19, 1.22) for pneumonia hospital admissions. The heat effects were stronger among the elderly (75+ years) and females. Conclusions: Using data from both urban and rural areas, our study suggests the adverse heat effects on respiratory mortality and morbidity in the warm season in Germany. These heat effects were more pronounced among the elderly and females. Keywords: Air temperature, heat, respiratory, mortality, hospital admissions

General health in a cohort of children conceived after assisted reproductive technology in the United Kingdom: a population-based record-linkage study

Assisted reproductive technology use is increasing annually; however, data on long-term child health outcomes including hospital admissions are limited. This study aimed to examine the potential effects of assisted reproductive technology on any and cause-specific hospital admissions unrelated to perinatal diagnoses. This was a population-based record-linkage study that included a previously established cohort of children born after assisted reproductive technology in the United Kingdom between 1997 and 2009 (n=63,877), their naturally conceived siblings (n=11,343), and matched naturally conceived population controls (n=127,544) linked to their postnatal health outcomes up to March 31, 2016 to provide robust risk estimates of the potential effects of assisted reproductive technology on any and cause-specific hospital admissions unrelated to perinatal diagnoses. In addition, comparison of hospital admissions by type of treatment was made. Cox regression was used to estimate the risk of hospital admission, and negative binomial regression was used to compare the number of hospital admissions per year. This study had 1.6 million person-years of follow-up (mean, 12.9 years; range, 0-19 years), and the mean age at the time of first hospital admission was 6.5 years (range, 0-19 years). Singletons born after assisted reproductive technology had increased risk of any hospital admission compared with naturally conceived population controls (hazard ratio, 1.08; 95% confidence interval, 1.05-1.10) but not naturally conceived siblings (hazard ratio, 1.01; 95% confidence interval, 0.94-1.09). We observed increased risk of diagnoses related to neoplasms and diseases of the respiratory, musculoskeletal, digestive, and genitourinary systems, and lower risk of injury, poisoning, and consequences of external causes compared with naturally conceived population controls. Children born after intracytoplasmic sperm injection had a lower risk of hospital admission compared with those born after invitro fertilization, although no such differences were observed between children born after fresh embryo transfers and those born after frozen embryo transfers. Children born after assisted reproductive technology had greater numbers of hospital admissions compared with naturally conceived population controls. Attenuation of these differences in relation to their naturally conceived siblings suggested that this could be partially attributed to the influence of parental subfertility on child health, increased parental concerns, and an actual increase in morbidity in children born after assisted conception.

Assessing short-term impacts of PM2.5 constituents on cardiorespiratory hospitalizations: Multi-city evidence from China.

Apart from concentrations of particulate mass, PM2.5-associated effects on health may largely depend on its chemical components. However, little is known regarding the underlying effects of specific PM2.5 constituents. The study included nearly 1 million hospital admissions from five Chinese cities during 2015-2017. Based on the modified Community Multiscale Air Quality model, our study simulated daily concentrations of PM2.5 and five main components. We used a time-stratified case-crossover design with conditional logistic regression models to estimate short-term effects of PM2.5 constituents on cause-specific hospital admissions. Per interquartile range increase in exposure to PM2.5, elemental carbon, organic carbon, nitrate, sulfate and ammonium at lag 04-day was related to an excess risk (ER%) for non-accidental admissions of 1.6% [95% confidence interval: 1.1-2.0], 1.9% [1.3-2.4], 1.0% [0.5-1.6], 1.2% [0.4-2.0], 1.2% [0.9-1.5] and 1.4% [0.9-1.9], respectively. Great heterogeneities of constituents-admission associations existed in diverse causes and constituents. This study provided multi-center high-quality evidence that hospital admissions, particularly those for ischemic heart disease (ER% ranging from 2.3 to 5.4% at lag 04-day) and pneumonia (1.9-5.1% at lag 4-day), could be triggered by short-term exposures to ambient PM2.5 constituents. Relatively stronger constituents-admission associations were found among females for respiratory causes and the elderly for cardiovascular causes.

Risk and burden of hospital admissions associated with wildfire-related PM2·5 in Brazil, 2000–15: a nationwide time-series study

In the context of climate change and deforestation, Brazil is facing more frequent and unprecedented wildfires. Wildfire-related PM2·5 is associated with multiple adverse health outcomes; however, the magnitude of these associations in the Brazilian context is unclear. We aimed to estimate the association between daily exposure to wildfire-related PM2·5 and cause-specific hospital admission and attributable health burden in the Brazilian population using a nationwide dataset from 2000 to 2015. In this nationwide time-series analysis, data for daily all-cause, cardiovascular, and respiratory hospital admissions were collected through the Brazilian Unified Health System from 1814 municipalities in Brazil between Jan 1, 2000, and Dec 31, 2015. Daily concentrations of wildfire-related PM2·5 were estimated using the 3D chemical transport model GEOS-Chem at a 2·0° latitude by 2·5° longitude resolution. A time-series analysis was fitted using quasi-Poisson regression to quantify municipality-specific effect estimates, which were then pooled at the regional and national levels using random-effects meta-analyses. Analyses were stratified by sex and ten age groups. The attributable fraction and attributable cases of hospital admissions due to wildfire-related PM2·5 were also calculated. At the national level, a 10 μg/m3 increase in wildfire-related PM2·5 was associated with a 1·65% (95% CI 1·51-1·80) increase in all-cause hospital admissions, a 5·09% (4·73-5·44) increase in respiratory hospital admissions, and a 1·10% (0·78-1·42) increase in cardiovascular hospital admissions, over 0-1 days after the exposure. The effect estimates for all-cause hospital admission did not vary by sex, but were particularly high in children aged 4 years or younger (4·88% [95% CI 4·47-5·28]), children aged 5-9 years (2·33% [1·77-2·90]), and people aged 80 years and older (3·70% [3·20-4·20]) compared with other age groups. We estimated that 0·53% (95% CI 0·48-0·58) of all-cause hospital admissions were attributable to wildfire-related PM2·5, corresponding to 35 cases (95% CI 32-38) per 100 000 residents annually. The attributable rate was greatest for municipalities in the north, south, and central-west regions, and lowest in the northeast region. Results were consistent for all-cause and respiratory diseases across regions, but remained inconsistent for cardiovascular diseases. Short-term exposure to wildfire-related PM2·5 was associated with increased risks of all-cause, respiratory, and cardiovascular hospital admissions, particularly among children (0-9 years) and older people (≥80 years). Greater attention should be paid to reducing exposure to wildfire smoke, particularly for the most susceptible populations. Australian Research Council and Australian National Health and Medical Research Council.

Association between Low Ambient Temperature and Cardiorespiratory Hospital Admissions in Helsinki, Finland

BACKGROUND AND AIM: The relationship between low ambient temperature and hospital admissions is less studied than between high temperature and hospital admissions. Therefore, this study aimed to investigate the association of daily wintertime temperature with cardiorespiratory hospital admissions in the Helsinki metropolitan area, Finland. METHODS: Daily number of hospital admissions for 2001-2017 was obtained from the national hospital discharge register and weather information from the Finnish Meteorological Institute. Time-series quasi-Poisson regression models were fitted controlling for potential confounders such as time trend, weekday, holiday, air pollution, barometric pressure and an indicator for influenza count. A penalized distributed lag linear model with 21 days of lag was used to estimate the association of daily mean temperature with cause-specific cardiorespiratory hospital admissions, stratified by age-groups (All-ages, 18-64, 65-74 and ≥75), during winter months (December-March). RESULTS:The first and 99th percentiles of daily temperature were -19.6 °C and 11.5 °C respectively. Decreased ambient temperature was associated with increased risk of hospitalization for myocardial infarction in the whole population (Risk Ratio [RR] for 1°C decrease in exposure: 1.015, 95% confidence intervals [CIs]: 1.001-1.030), and in the age group 65-74 (RR: 1.035, 95% CIs: 1.003-1.069). There was also an increased risk of hospital admission for chronic obstructive pulmonary disease (RR: 1.026, 95% CIs: 1.002-1.051) and to lesser extent for respiratory diseases in general (RR: 1.006, 95% CI: 0.995-1.017) in the oldest age (≥75). CONCLUSIONS:Cold increases the need for acute hospital care due to both cardiovascular and respiratory causes during winter months. KEYWORDS: respiratory, cardiovascular, winter, hospital admissions, morbidity, weather

Heat alerts associated with higher rates of cause-specific hospital admissions but not lower mortality among older adults in the US

Heat alerts associated with higher rates of cause-specific hospital admissions but not lower mortality among older adults in the US

Assessing the severity of cardiovascular disease in 213 088 patients with coronary heart disease: a retrospective cohort study

ObjectiveMost current cardiovascular disease (CVD) risk stratification tools are for people without CVD, but very few are for prevalent CVD. In this study, we developed and validated a CVD severity...

Outcome trends in people with heart failure, type 2 diabetes mellitus and chronic kidney disease in the UK over twenty years.

BackgroundHeart failure (HF) together with type 2 diabetes (T2D) and chronic kidney disease (CKD) are major pandemics of the twenty first century. It is not known in people with new onset HF, what the distinct and combined associations are between T2D and CKD comorbidities and cause-specific hospital admissions and death, over the past 20 years.MethodsAn observational study using the UK Clinical Practice Research Datalink linked to the Hospital Episode Statistics in England (1998–2017). Participants were people aged ≥30 years with new onset HF. Exposure groups were HF with: (i) no T2D and no CKD (reference group); (ii) CKD-only (estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2); (iii) T2D-only; (iv) T2D and CKD. CKD severity groups were: CKD-3a (eGFR 45–59); CKD-3b (30–44); CKD-4 (15–29); CKD-5 (<15). Outcomes were cardiovascular and non-cardiovascular hospitalisations and all-cause death.FindingsIn 87,709 HF patients (mean age, 78 years; 49% female), 40% had CKD-only, 12% T2D-only, and 16% both. Age-standardised first-year CVD hospitalisation rates were significantly higher in HF patients with CKD-only (46.4; 95% CI 44.9,47.9 per 100 person years) and T2D-only (49.2; 46.7,58.8) than in the reference group (35.1; 34.0,36.1); the highest rate was in patients with T2D-CKD-5: 89.1 (65.8,112.4). Similar patterns were observed for non-CVD hospitalisations and deaths. Group differences remained significant after adjustment for potential confounders. Median survival was highest in the reference (4.4 years) and HF-T2D-only (4.1 years) groups, compared to HF-CKD-only (2.2 years). HF-T2D-CKD group survival ranged from 2.8 (CKD-3a) to 0.7 years (CKD-5). Over time, CVD hospitalisation rates significantly increased for HF-CKD-only (+26%) and reduced (-24%) for HF-T2D-only groups; no reductions were observed in any of the HF-T2D-CKD groups. Trends were similar for non-CVD hospitalisations and death: whilst death rates significantly reduced for HF-T2D-only (-37%), improvement was not observed in any of the T2D-CKD groups.InterpretationIn a cohort of people with new onset HF, hospitalisations and deaths are high in patients with T2D or CKD, and worst in those with both comorbidities. Whilst outcomes have improved over time for patients with HF and comorbid T2D, similar trends were not seen in those with comorbid CKD. Strategies to prevent and manage CKD in people with HF are urgently needed.Funding10.13039/100006662NIHR fellowship [reference: NIHR 30011]

Comparison of Diabetes Recorded in Primary Care with Hospital Admission Data in England

IntroductionIn UK prospective studies, record linkage to national cause-specific hospital admission databases provides unique opportunities for epidemiological investigation, since long-term virtually complete follow-up is possible. However, hospital records would not necessarily detect all newly diagnosed cases of diabetes, which is generally diagnosed and managed in primary care. Objectives and ApproachThe Clinical Practice Research Datalink (CPRD) is a linked database of primary care records, which in 2015 had research-usable data for some 11 million people (7% of the UK population). In 2013 we linked 102,076 (8%) Million Women Study participants in England to CPRD records for the period 1 January 1990–31 December 2012. Among the linked women who had a first record of diabetes in CPRD, we examined the cumulative probability of diabetes being mentioned in national hospital admission data, by time since the first record of diabetes in CPRD. ResultsAfter recruitment into the Million Women Study, 1765 of the linked women without prior diabetes had a first record of diabetes in CPRD. The median year that diabetes was first recorded in CPRD was 2011 (IQR 2007-2012). Seven years after diabetes was first recorded in CPRD, 69.5% (95% CI 67.1% - 71.9%) also had a record of diabetes in hospital admission data. The median time between first mention of diabetes in CPRD and in hospital records was 3.7 (95% CI 3.4-4.1) years. Conclusion / ImplicationsDiabetes first recorded in routinely collected hospital admissions data in England identifies the majority of cases of diabetes recorded in primary care, after a lag of a few years. Hospital admission data can, therefore, be used for epidemiological research into diabetes.

Heat, Heatwaves and Cardiorespiratory Hospital Admissions in Helsinki, Finland.

Background: There is a lack of knowledge concerning the effects of ambient heat exposure on morbidity in Northern Europe. Therefore, this study aimed to evaluate the relationships of daily summertime temperature and heatwaves with cardiorespiratory hospital admissions in the Helsinki metropolitan area, Finland. Methods: Time series models adjusted for potential confounders, such as air pollution, were used to investigate the associations of daily temperature and heatwaves with cause-specific cardiorespiratory hospital admissions during summer months of 2001–2017. Daily number of hospitalizations was obtained from the national hospital discharge register and weather information from the Finnish Meteorological Institute. Results: Increased daily temperature was associated with a decreased risk of total respiratory hospital admissions and asthma. Heatwave days were associated with 20.5% (95% CI: 6.9, 35.9) increased risk of pneumonia admissions and during long or intense heatwaves also with total respiratory admissions in the oldest age group (≥75 years). There were also suggestive positive associations between heatwave days and admissions due to myocardial infarction and cerebrovascular diseases. In contrast, risk of arrhythmia admissions decreased 20.8% (95% CI: 8.0, 31.8) during heatwaves. Conclusions: Heatwaves, rather than single hot days, are a health threat affecting morbidity even in a Northern climate.