Excess Visits Research Articles

Povezanost med vročinskimi valovi in obiski na Internistični prvi pomoči Univerzitetnega kliničnega centra Ljubljana v obdobju 2013–2017

Background: Heatwaves have a severe impact on the number of deaths and emergency department visits, making them the most hazardous natural disaster due to climate change in many regions of the world. Our aim was to assess the short-term association between emergency department visits and heat waves from 2013 to 2017 to see whether any difference in the number of visits occurred at the Emergency Department in Ljubljana University Medical Centre during that period. Methods: The design of our study is a retrospective cross-sectional epidemiologic study. We estimated relative risks (RR) for a number of ED visits during heatwave days and reference period days for the observed diagnoses (all causes, diseases of the circulatory system, respiratory system, endocrine diseases, diseases of the digestive system and genitourinary diseases) sex, and age (from 19 to 74 years old, 75 years old and older), as well as 99.6% confidence intervals (CI) and excess ED visits in percent (%) associated with heatwaves occurring in the years from 2014 to 2017. Data were analyzed for the patients arriving at the Emergency Department of the Ljubljana University Medical Centre during summer time, from May to September. The region covers around 550,000 people and is considered an urban and rural area. Results: The results of our study showed that there was no statistically significant increase in number of ED visits during heatwaves for all causes in all observed years. We noticed even statistically significant protective phenomena between heatwaves and the number of ED visits. These happened in the years 2015 and 2017 for both sexes and circulatory system diseases, in 2016 for men, circulatory system diseases, and in 2015 for respiratory system diseases. We showed a statistically significant association between heatwaves and the number of visits in the ED for endocrine diseases in 2013. Conclusion: Despite the increased heat load in the last observed years, the number of ED visits in Ljubljana has remained stable or even decreased. Further studies on how each intervention affects the behavior of the observed population are needed to clarify whether public health measures and inter-sectoral cooperation impact the number of ED visits.

Trends in Substance Use Disorder-Related Emergency Department Visits in California: An Analysis of 46 Million Visits From 2006 to 2011.

To better understand the development of the growing opioid crisis in the early 21st century, the authors studied trends in substance use disorder among 46,132,211 emergency department (ED) visit discharges in California between 2006 and 2011. Utilizing the California State Emergency Department Database, the authors identified substance use based on International Classification of Diseases, Ninth Revision codes. Tabular and multivariable analysis methods were applied. ED visits were considered clustered at the level of patient. The authors observed a notable increase in substance use prevalence from 7.32 ± 6.07 to 12.21 ± 9.35 per 1000 ED visits. Nonopioid substance use was more prevalent among individuals aged ≤ 50 years old. Opioid use disorder (OUD) was associated with a higher mortality rate in the ED. In 2011, OUD was significantly higher among American Indians visiting the ED. A multivariable analysis revealed that OUD was an independent predictor for increased ED visits after controlling for demographic factors. Despite an overall decrease in mortality rate, opioid-related ED visits showed a higher mortality rate, underscoring the grave consequences of OUD. Nonopioid substance use was prevalent among younger age groups, suggesting a need for age-specific interventions. A major finding was the elevated OUD among American Indians, indicating persistent health disparities impacting this demographic. OUD was an independent risk factor for excess ED visits, which could strain health care systems. The authors suggest strategies like nonopioid pain management, community-level programs, and bridging ED with outpatient treatment facilities to mitigate the opioid crisis and ED overutilization. These findings advocate for tailored public health strategies, addressing the underlying disparities to combat the opioid epidemic effectively.

Impact of extreme weather events on healthcare utilization and mortality in the United States.

Climate change is intensifying extreme weather events. Yet a systematic analysis of post-disaster healthcare utilization and outcomes for severe weather and climate disasters, as tracked by the US government, is lacking. Following exposure to 42 US billion-dollar weather disasters (severe storm, flood, flood/severe storm, tropical cyclone and winter storm) between 2011 and 2016, we used a difference-in-differences (DID) approach to quantify changes in the rates of emergency department (ED) visits, nonelective hospitalizations and mortality between fee-for-service Medicare beneficiaries in affected compared to matched control counties in post-disaster weeks 1, 1-2 and 3-6. Overall, disasters were associated with higher rates of ED utilization in affected counties in post-disaster week 1 (DID of 1.22% (95% CI, 0.20% to 2.25%; P < 0.020)) through week 2. Nonelective hospitalizations were unchanged. Mortality was higher in affected counties in week 1 (DID of 1.40% (95% CI, 0.08% to 2.74%; P = 0.037)) and persisted for 6 weeks. Counties with the greatest loss and damage experienced greater increases in ED and mortality rates compared to all affected counties. Thus, billion-dollar weather disasters are associated with excess ED visits and mortality in Medicare beneficiaries. Tracking these outcomes is important for adaptation that protects patients and communities, health system resilience and policy.

Effects of socioeconomic status and greenspace on respiratory emergency department visits under short-term temperature variations: An age-stratified case time-series study

IntroductionNeighborhood socioeconomic status (SES) and greenspace can affect respiratory health. However, it is unclear whether effects of neighborhood SES and greenspace on respiratory health still exist regardless of temperature variations. MethodsThis paper conducted a two-stage, age-stratified case time-series study. The first goal is to examine the associations between two temperature metrics (daily mean temperature [DMT] and diurnal temperature range [DTR]) and respiratory emergency department (ED) visits among four age groups in New York City. The second goal is to evaluate whether neighborhood SES and greenspace would be determinants of respiratory ED visits independent from temperature varying factors. A distributed lag nonlinear model was applied on ED data from 135 zip codes (October 2016 - February 2020). ResultsOur first-stage analysis indicated that older adults aged 65+ had higher risk of ED visits (RR=2.78, 95% eCI: 2.41, 3.22; with 7 days of lag) on days with low DMT (-10°C), followed by adults aged 18-64 (RR=2.48, 95% eCI: 2.32, 2.65), children and youth aged 5-17 (RR=1.38, 95% eCI: 1.24, 1.53), and young children aged 0-4 (RR=1.04, 95% eCI: 0.96, 1.13). However, no excess respiratory ED visits were observed on days with high DMT (30°C). Higher DTR was associated with higher risk, with children and youth more susceptible when DTR was high (DTR 20°C; RR=5.70, 95% eCI: 3.42, 9.49; with 7 days of lag). The second-stage analysis indicated neighborhood SES and greenspace had significant associations with respiratory ED visits regardless of temperature variations. Specifically, Higher income and greenspace exposure were negatively associated with ED visits among all age groups. ConclusionsNeighborhood SES and greenspace could affect respiratory morbidity regardless of weather conditions. Daily temperature variations accelerated the short-term risk among population subgroups under different weather conditions (e.g., higher risk of days with low DMT among older adults, higher risk of days with high DTR among children and youth aged 5-17), which could create co-effects with neighborhood SES and greenspace on respiratory health.

Can Patient Reported Outcomes be Used to Eliminate Unnecessary Follow Up Clinic Visits after Surgery?

Category: Other; Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: Patient reported outcomes (PROs) have been a powerful tool to inform clinicians on the success or failure of various treatments including surgery. Patient-Reported Outcome Measurement Information System (PROMIS) is a suite of validated symptom-based questions designed to be asked and answered directly by the patient to track treatment progress quickly and accurately. This study uses PROMIS to determine the duration between foot and ankle surgery and assessment of a successful outcome. Additionally, we retrospectively calculate the savings that would be realized by eliminating unnecessary office visits if this model was implemented in clinical practice. Methods: Retrospective PROMIS Pain Interference (PI) data were obtained for common elective foot (n=832) and ankle (n=851) surgical procedures. Patients were categorized into quartiles of their pre-operative PI score - quartile 1 (Q1) being 25% of patients with the lowest PI scores. Minimal clinically important difference (MCID) was defined by the ½ standard-deviation of the pre- operative pain interference t-scores. A patient was considered recovered after observing two consecutive MCID decreases in post-operative pain interference t-scores. A cox proportional hazards model stratified by preoperative PI score quartile was used to predict probability patient recovery after adjusting for age, race, ethnicity, gender, and primary payor. The average and total potential savings for the cohort was derived using the number of patient-visits post-recovery. Results: Two consecutive decreases in MCID measured by PI PROMIS t-scores were achieved 90 days post-operatively by 16%, 16%, 17%, and 23% of post-operative ankle patients in quartiles 1-4 respectively; post-operative foot patients achieved 18%, 11%, 20%, and 26% in quartiles 1-4 respectively (see Figure 1). Days 30-60 recorded the greatest rate of improvement across quartiles with Q4 showing the greatest improvement. The least improvement occurred between days 90-120 across all quartiles. Patients were seen by the orthopedics departments on average 2.84 times after achieving two consecutive MCID improvements, totaling to $243.63 in expenses to institutional payers per patient. Avoiding these excess visits even after MCID achievement could result in savings ranging from $38,593 to $122,002. Conclusion: PI PROMIS t-scores can be used to assess the need for ongoing follow up for surgical patients. If there is evidence that the patient has improved a clinically meaningful amount on two successive visits additionally follow-up may not be needed. Using PROs in clinical decision-making pathways as suggested in this research will eliminate unnecessary visits and save healthcare dollars and valuable resources

The Role of Cooling Centers in Protecting Vulnerable Individuals from Extreme Heat.

The Role of Cooling Centers in Protecting Vulnerable Individuals from Extreme Heat.

Emergency department visits for self-harm in adolescents after release of the Netflix series '13 Reasons Why'.

Objective:To determine whether the release of the first season of the Netflix series ‘13 Reasons Why’ was associated with changes in emergency department presentations for self-harm.Methods:Healthcare utilization databases were used to identify emergency department and outpatient presentations according to age and sex for residents of Ontario, Canada. Data from 2007 to 2018 were used in autoregressive integrated moving average models for time series forecasting with a pre-specified hypothesis that rates of emergency department presentations for self-harm would increase in the 3-month period following the release of 13 Reasons Why (1 April 2017 to 30 June 2017). Chi-square and t tests were used to identify demographic and health service use differences between those presenting to emergency department with self-harm during this epoch compared to a control period (1 April 2016 to 30 June 2016).Results:There was a significant estimated excess of 75 self-harm-related emergency department visits (+6.4%) in the 3 months after 13 Reasons Why above what was predicted by the autoregressive integrated moving average model (standard error = 32.4; p = 0.02); adolescents aged 10–19 years had 60 excess visits (standard error = 30.7; p = 0.048), whereas adults demonstrated no significant change. Sex-stratified analyses demonstrated that these findings were largely driven by significant increases in females. There were no differences in demographic or health service use characteristics between those who presented to emergency department with self-harm in April to June 2017 vs April to June 2016.Conclusions:This study demonstrated a significant increase in self-harm emergency department visits associated with the release of 13 Reasons Why. It adds to previously published mortality, survey and helpline data collectively demonstrating negative mental health outcomes associated with 13 Reasons Why.

Excess emergency department visits for cardiovascular and respiratory diseases during the 2019–20 bushfire period in Australia: A two-stage interrupted time-series analysis

The health effects of the unprecedented bushfires in Australia in 2019–20 have not been fully examined. We aimed to examine the excess emergency department (ED) visits related to the 2019–20 bushfires in New South Wales (NSW). We obtained weekly data of ED visits for cardiovascular and respiratory diseases in all the 28 Statistical Area Level 4 (SA4) regions in NSW during the bushfire seasons from 2017 to 2020. A two-stage interrupted time-series analysis was applied to quantify the excess risk for ED visits in 2019–20. The total number of excess ED visits, excess percentages, and their empirical confidence intervals (eCIs) were calculated to estimate the impacts of the bushfire season. A total of 416,057 records of cardiorespiratory ED visits were included in our analysis. The bushfire season in 2019–20 was significantly associated with a 6.0% increase (95% eCI: 1.9, 10.3) in ED visits for respiratory diseases and a 10.0% increase (95% eCI: 5.0, 15.2) for cardiovascular diseases, corresponding to 6177 (95% eCI: 1989, 10,166) and 3120 (95% eCI: 1628, 4544) excess ED visits, respectively. The percentage of excess ED visits was higher in regions with lower SES and high fire density. In the context of climate change, more targeted strategies should be developed to prevent adverse bushfire effects and recover from such extreme environmental events.

Short-term Exposure to Air Pollution and Attributable Risk of Kidney Diseases: A Nationwide Time-series Study.

Several studies have shown that long-term exposure to air pollution is associated with reduced kidney function. However, less is known about effects of short-term exposure to air pollution on kidney disease aggravation and resultant emergency room (ER) burden. This study aimed to estimate excess ER visits attributable to short-term air pollution and to provide evidence relevant to air pollution standards to protect kidney patients. We conducted time-series analysis using National Health Insurance data covering all persons in South Korea (2003-2013). We collected daily data for air pollutants (particulate matter ≤10 µm [PM10], ozone [O3], carbon monoxide [CO], and sulfur dioxide [SO2]) and ER visits for total kidney and urinary system disease, acute kidney injury (AKI), and chronic kidney disease (CKD). We performed a two-stage time-series analysis to estimate excess ER visits attributable to air pollution by first calculating estimates for each of 16 regions, and then generating an overall estimate. For all kidney and urinary disease (902,043 cases), excess ER visits attributable to air pollution existed for all pollutants studied. For AKI (76,330 cases), we estimated the highest impact on excess ER visits from O3, while for CKD (210,929 cases), the impacts of CO and SO2 were the highest. The associations between air pollution and kidney ER visits existed for days with air pollution concentrations below current World Health Organization guidelines. This study provides quantitative estimates of ER burdens attributable to air pollution. Results are consistent with the hypothesis that stricter air quality standards benefit kidney patients.

Short-term Exposure to Air pollution and the Attributable Risk of Emergency Room Visits for Kidney Diseases

BACKGROUND AND AIM: Several existing studies have shown that long-term exposure to air pollution is associated with reduced kidney function. However, less is known about the effects of short-term exposure to air pollution on kidney disease aggravation and resultant emergency department burden. This study aimed to estimate the excess emergency room (ER) visits attributable to the short-term air pollution and to suggest evidence on better air pollution standards to protect kidney patients. METHODS: We conducted a time-series study using the National Health Insurance data covering all persons in South Korea (2003-2013). We collected daily data for air pollutants (particulate matter 10µm [PM10], ozone [O3], carbon monoxide [CO], and sulfur dioxide [SO2]) and ER visits for total kidney disease, acute kidney injury (AKI), and chronic kidney disease (CKD), respectively. We performed a distributed lag model analyses to estimate excess ER visits attributable to air pollution. RESULTS:For all kidney disease, excess ER visits attributable to air pollution were statistically significant for all air pollutants. While, for AKI, O3 showed the highest impacts on excess ER visits compared to other pollutants. On the other hand, the impacts of CO and SO2 were the highest for CKD compared to O3 and PM10. We also found that the positive association between air pollution and kidney ER visits existed for days with air pollution concentrations below the current WHO air quality guidelines. CONCLUSIONS:This study provides estimates of excess ER burdens attributable to air pollution and suggests that stricter air quality standards would benefit kidney disease patients. KEYWORDS: Kidney disease, Emergency Room Burden, Short term exposure, Air pollution, WHO air quality guideline

Health effects from heat waves in France: an economic evaluation.

BackgroundScarcity of data on the health impacts and associated economic costs of heat waves may limit the will to invest in adaptation measures. We assessed the economic impact associated with mortality, morbidity, and loss of well-being during heat waves in France between 2015 and 2019.MethodsHealth indicators monitored by the French national heat wave plan were used to estimate excess visits to emergency rooms and outpatient clinics and hospitalizations for heat-related causes. Total excess mortality and years of life loss were considered, as well as the size of the population that experienced restricted activity. A cost-of-illness and willingness-to-pay approach was used to account for associated costs.ResultsBetween 2015 and 2019, the economic impact of selected health effects of heat waves amounts to €25.5 billion, mainly in mortality (€23.2 billion), minor restricted activity days (€2.3 billion), and morbidity (€0.031 billion).ConclusionThe results highlight a significant economic burden on the French health system and the population. A better understanding of the economic impacts of climate change on health is required to alert decision-makers to the urgency of mitigation and to support concrete adaptation actions.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10198-021-01357-2.

Smoking-Attributable Doctor Visits and Emergency Room Utilization and Costs by California’s Lesbian, Gay, and Bisexual Community

ABSTRACT The lesbian, gay, and bisexual (LGB) community is known to smoke at greater rates than the general population, but there has been no study estimating the impact of cigarette smoking on healthcare utilization and costs in the LGB population. Using data from the 2005–2014 California Health Interview Surveys, we determine smoking-attributable healthcare utilization and costs among California’s LGB-identified community. Our findings indicate that lesbian/bisexual women who smoke incur excess doctor visits and emergency room visits compared to their never smoking counterparts. No statistically significant differences were found for gay/bisexual men. Annual smoking-attributable costs were $58.3 million for the California LGB community (2019 dollars).

Trend of pneumonia diagnosis in emergency departments as a COVID-19 surveillance system: a time series study

ObjectiveIn Italy, the first diagnosis of COVID-19 was confirmed on 20 February 2020 in the Lombardy region. Given the rapid spread of the infection in the population, it was suggested...

Excess Patient Visits for Cough and Pulmonary Disease at a Large US Health System in the Months Prior to the COVID-19 Pandemic: Time-Series Analysis.

BackgroundAccurately assessing the regional activity of diseases such as COVID-19 is important in guiding public health interventions. Leveraging electronic health records (EHRs) to monitor outpatient clinical encounters may lead to the identification of emerging outbreaks.ObjectiveThe aim of this study is to investigate whether excess visits where the word “cough” was present in the EHR reason for visit, and hospitalizations with acute respiratory failure were more frequent from December 2019 to February 2020 compared with the preceding 5 years.MethodsA retrospective observational cohort was identified from a large US health system with 3 hospitals, over 180 clinics, and 2.5 million patient encounters annually. Data from patient encounters from July 1, 2014, to February 29, 2020, were included. Seasonal autoregressive integrated moving average (SARIMA) time-series models were used to evaluate if the observed winter 2019/2020 rates were higher than the forecast 95% prediction intervals. The estimated excess number of visits and hospitalizations in winter 2019/2020 were calculated compared to previous seasons.ResultsThe percentage of patients presenting with an EHR reason for visit containing the word “cough” to clinics exceeded the 95% prediction interval the week of December 22, 2019, and was consistently above the 95% prediction interval all 10 weeks through the end of February 2020. Similar trends were noted for emergency department visits and hospitalizations starting December 22, 2019, where observed data exceeded the 95% prediction interval in 6 and 7 of the 10 weeks, respectively. The estimated excess over the 3-month 2019/2020 winter season, obtained by either subtracting the maximum or subtracting the average of the five previous seasons from the current season, was 1.6 or 2.0 excess visits for cough per 1000 outpatient visits, 11.0 or 19.2 excess visits for cough per 1000 emergency department visits, and 21.4 or 39.1 excess visits per 1000 hospitalizations with acute respiratory failure, respectively. The total numbers of excess cases above the 95% predicted forecast interval were 168 cases in the outpatient clinics, 56 cases for the emergency department, and 18 hospitalized with acute respiratory failure.ConclusionsA significantly higher number of patients with respiratory complaints and diseases starting in late December 2019 and continuing through February 2020 suggests community spread of SARS-CoV-2 prior to established clinical awareness and testing capabilities. This provides a case example of how health system analytics combined with EHR data can provide powerful and agile tools for identifying when future trends in patient populations are outside of the expected ranges.

State and federal abortion restrictions increase risk of COVID-19 exposure by mandating unnecessary clinic visits

ObjectiveTo quantify the number of medically unnecessary clinical visits and in-clinic contacts monthly caused by US abortion regulations. Study DesignWe estimated the number of clinical visits and clinical contacts (any worker a patient may come into physical contact with during their visit) under the current policy landscape, compared to the number of visits and contacts if the following regulations were repealed: (1) State mandatory in-person counseling visit laws that necessitate two visits for abortion, (2) State mandatory-ultrasound laws, (3) State mandates requiring the prescribing clinician be present during mifepristone administration, (4) Federal Food and Drug Administration Risk Evaluation and Mitigation Strategy for mifepristone. If these laws were repealed, “no-test” telemedicine abortion would be possible for some patients. We modeled the number of visits averted if a minimum of 15 percent or a maximum of 70 percent of medication abortion patients had a “no-test” telemedicine abortion. ResultsWe estimate that 12,742 in-person clinic visits (50,978 clinical contacts) would be averted each month if counseling visit laws alone were repealed, and 31,132 visits (142,910 clinical contacts) would be averted if all four policies were repealed and 70 percent of medication abortion patients received no-test telemedicine abortions. Over 2 million clinical contacts could be averted over the projected 18-month COVID-19 pandemic. ConclusionMedically unnecessary abortion regulations result in a large number of excess clinical visits and contacts. Policy ImplicationsRepeal of medically unnecessary state and federal abortion restrictions in the United States would allow for evidence-based telemedicine abortion care, thereby lowering risk of SARS-CoV-2 transmission.

Increase in Pediatric Respiratory Visits Associated with Santa Ana Wind-Driven Wildfire Smoke and PM2.5 Levels in San Diego County.

Rationale: There is significant evidence of increased healthcare utilization from cardiopulmonary causes in adults from exposure to wildfire smoke, but evidence in pediatric age groups is limited.Objectives: To quantify and examine the healthcare utilization effects of the December 2017 Lilac Fire in San Diego County among pediatric patients at the Rady Children's Hospital (RCH) emergency department and urgent care (UC) clinics.Methods: Using data from 2011 to 2017, including data on daily particulate matter <2.5 μm (PM2.5) in an inverse-distance interpolation model and RCH electronic medical records, we retrospectively analyzed pediatric respiratory visits at the RCH emergency department and UC clinics during the Santa Ana wind (SAW)-driven Lilac Fire from December 7 to 16, 2017. An interrupted time series study design was applied as our primary analysis to compare the observed pediatric respiratory visits from December 7 to 16, 2017 to what would have occurred in a counterfactual situation, namely, if the Lilac Fire had not occurred. A complementary descriptive spatial analysis was also used to evaluate the geographic distribution of respiratory visits in relationship to satellite imaging of the Lilac Fire and the associated wind pattern.Results: The Lilac Fire was associated with 16.0 (95% confidence interval [CI], 11.2-20.9) excess respiratory visits per day at the RCH emergency department across all pediatric age groups. Children aged 0 to 5 years had the highest absolute excess respiratory visits per day with 7.3 (95% CI, 3.0-11.7), whereas those aged 6 to 12 years had the highest relative increase in visits, with 3.4 (95% CI, 2.3-4.6). RCH UC clinics had similar results. The top five ZIP codes in San Diego County with the highest standard deviations of age-adjusted respiratory visits were all located generally downwind of the fire perimeter, as expected for the SAW pattern.Conclusions: We have demonstrated an increase in pediatric respiratory visits during the SAW-driven Lilac Fire in San Diego County in a patterned geographic distribution that is attributable to an increase in PM2.5 exposure. Younger children were particularly affected. Climate change is expected to result in more frequent and extensive wildfires in the region and will require greater preparedness and adaptation efforts to protect vulnerable populations, such as young children.

A Spatial and Temporal Investigation of Medical Surge in Dallas-Fort Worth During Hurricane Harvey, Texas 2017.

When 2017 Hurricane Harvey struck the coastline of Texas on August 25, 2017, it resulted in 88 fatalities and more than US $125 billion in damage to infrastructure. The floods associated with the storm created a toxic mix of chemicals, sewage and other biohazards, and over 6 million cubic meters of garbage in Houston alone. The level of biohazard exposure and injuries from trauma among persons residing in affected areas was widespread and likely contributed to increases in emergency department (ED) visits in Houston and cities receiving hurricane evacuees. We investigated medical surge resulting from these evacuations in Dallas-Fort Worth (DFW) metroplex EDs. We used data sourced from the North Texas Syndromic Surveillance Region 2/3 in ESSENCE to investigate ED visit surge following the storm in DFW hospitals because this area received evacuees from the 60 counties with disaster declarations due to the storm. We used the interrupted time series (ITS) analysis to estimate the magnitude and duration of the ED surge. ITS was applied to all ED visits in DFW and visits made by patients residing in any of the 60 counties with disaster declarations due to the storm. The DFW metropolitan statistical area included 55 hospitals. Time series analyses examined data from March 1, 2017-January 6, 2018 with focus on the storm impact period, August 14-September 15, 2017. Data from before, during, and after the storm were visualized spatially and temporally to characterize magnitude, duration, and spatial variation of medical surge attributable to Hurricane Harvey. During the study period overall, ED visits in the DFW area rose immediately by about 11% (95% CI: 9%, 13%), amounting to ~16 500 excess total visits before returning to the baseline on September 21, 2017. Visits by patients identified as residing in disaster declaration counties to DFW hospitals rose immediately by 127% (95% CI: 125%, 129%), amounting to 654 excess visits by September 29, 2017, when visits returned to the baseline. A spatial analysis revealed that evacuated patients were strongly clustered (Moran's I = 0.35, P < 0.0001) among 5 of the counties with disaster declarations in the 11-day window during the storm surge. The observed increase in ED visits in DFW due to Hurricane Harvey and ensuing evacuation was significant. Anticipating medical surge following large-scale hurricanes is critical for community preparedness planning. Coordinated planning across stakeholders is necessary to safeguard the population and for a skillful response to medical surge needs. Plans that address hurricane response, in particular, should have contingencies for support beyond the expected disaster areas.

Moderate hot rather than extreme hot is mainly responsible for temperature-related excess outpatient visits for respiratory diseases

TPS 661: Climate change: temperature effects 1, Exhibition Hall, Ground floor, August 26, 2019, 3:00 PM - 4:30 PM Background: Much evidence has revealed that there are significant associations between ambient temperature and human health. However, few studies have assessed the health burden of respiratory disease attributed to different temperature ranges in subtropical region. Methods: Daily outpatient visits, weather variables and air pollution data were collected from January 2013 to July 2017 in a hospital of Dongguan city. A standard time series quasi-Poisson regression with distributed lag non-linear model (DLNM) was applied to estimate the associations between daily mean temperature and morbidity for respiratory diseases, bronchiectasis, chronic obstructive pulmonary disease (COPD) and asthma. Attributable risks were then calculated to quantify the disease burdens from different temperature components. Finally, a stratified analysis by age groups was conducted. Results: Both low and high temperature were associated with an increased risk of morbidity of respiratory diseases. Compared with the optimum temperature, the accumulative relative risk (RR) during 7 lag days was 1.13 with 95% confidence interval (CI) 1.01 to 1.26 for extreme hot, and 1.02 (95%CI: 0.99 to 1.05) for extreme cold. Respiratory morbidity risk for young population mainly caused by hot weather, but a reverse J-shaped was observed for the elderly. About 8.4% (95%CI: 2.8% to 13.3%) of respiratory morbidity was attributed to non-optimal temperature. Out of them, moderate hot was responsible for the major part of excess respiratory visits, accounting for 7.5% (95% CI: 2.4% to 12.2%) of respiratory morbidity. Conclusions: We found that moderate hot contributed most of excess respiratory outpatient visits caused by ambient temperature exposure in subtropical region, which indicates more attention should be paid to this temperature range rather than extreme temperature in subtropical regions.

Estimating age-specific influenza-associated asthma morbidity in Ontario, Canada.

There is a need to quantify the potential benefits of influenza-focused interventions in reducing asthma morbidity at a population level. This study aims to estimate age-specific annual excess asthma morbidity attributable to influenza in Ontario, Canada. Weekly counts of hospitalizations, emergency department (ED) visits and outpatient physician office visits for asthma were obtained from health administrative data in Ontario from 2010 to 2015, for ages 0-14, 15-59 and 60+. Asthma morbidity was modelled as a function of influenza A and B activity using linear regression, controlling for seasonal and long-term trend, mean temperature and respiratory syncytial virus. Excess asthma morbidity attributable to influenza was calculated as the difference between full model predictions and model predictions with influenza A and B variables set to 0. Annually, influenza was associated with the following rates of excess asthma morbidity, per 100,000 people with prevalent asthma: 12.5 hospitalizations for ages 15-59 (95% confidence interval (CI): 1.1-23.5); 35.7 hospitalizations for ages 60+ (95% CI: 3.3-67.1); 114.1 ED visits for ages 15-59 (95% CI: 46.9-181.6); 154.6 ED visits for ages 60+ (95% CI: 86.7-223.3); and 1025.7 outpatient physician office visits for ages 60+ (95% CI: 79.0-1877.3). Influenza was associated with excess asthma hospitalizations and ED visits for ages 15-59 and 60+and outpatient physician office visits for ages 60+. Individuals with asthma aged 15-59 and 60+might be important targets for influenza-focused interventions, to reduce asthma morbidity at the population level.

Benefit of Inactivated Influenza Vaccine in Infants in Iran: A Community based Randomized Control Trial

Background: Influenza in infants and young children is a major medical problem which causes excess medical visits, antibiotic prescriptions and hospitalization even in otherwise healthy children. Many of the developed countries have recommended influenza vaccination for all children (>6month old), but the economic benefit of this strategy is not clear especially for developing countries. Objectives: To find the difference in the incidence of influenza-like illness (ILI) and economic cost related to it between TIV vaccinated and non-vaccinated infants in Mashhad, Iran. Methods: This was a community randomized controlled trial which was started in November 2005 and ended up at May 2006. Each of the study and control groups were composed of 500 infants between 6 month and 20 months old who were brought for routine vaccination. The study group was given two doses of TIV; the control group received routine care without any extra intervention. Both groups were followed by monthly telephone calls (up to six months after the vaccination) and were asked about signs and symptoms of flu like illnesses and any cost related to them. SPSS 11.5 was used for statistical analysis, P