Increase In Emergency Hospital Admissions Research Articles

Short-term exposure to particulate matter and effects on emergency hospital admissions for Alzheimer’s disease and Parkinson’s disease: an ecological study from an aged European metropolis

Alzheimer’s disease (AD) and Parkinson’s disease (PD) are important neurodegenerative disorders, especially in an aging population context that prevails in high-developed countries and Europe in particular. It is known that exposure to particulate matter (PM) leads to the production and deposition of aggregate clusters of proteins, which are linked to neurological disorders and impediments. Nonetheless, only a few works study the short-term exposure to PM and its association with hospital admissions or mortality due to AD or PD. This study assesses the association between exposure to PM and emergency hospital admissions for AD and PD in an aging metropole, serving as a case study for most European big cities. Daily emergency hospital admissions due to AD and PD data were obtained for the 2012 to 2015 period and multivariate Poisson regression models were used to evaluate the association between PM and admissions while controlling for the day of the week, seasonality, and environmental factors. Furthermore, lagged observations were assessed. Results show that an increase in exposure to PM2.5 resulted in a percentage increase in emergency hospital admissions due to AD and PD. Also, age was an effect modifier for PD admissions. Additionally, greater effects were felt at shorter lags for AD and delayed/longer lags for PD. This study found a relationship between short-term exposure to PM and AD and PD hospital admissions in an urban context, drawing attention to the importance of air pollution for urban health, especially in areas with an aged population structure.

Short-term impact of noise, other air pollutants and meteorological factors on emergency hospital mental health admissions in the Madrid region

BackgroundA number of environmental factors, such as air pollution, noise in urbanised settings and meteorological-type variables, may give rise to important effects on human health. In recent years, many studies have confirmed the relation between various mental disorders and these factors, with a possible impact on the increase in emergency hospital admissions due to these causes. The aim of this study was to analyse the impact of a range of environmental factors on daily emergency hospital admissions due to mental disorders in the Madrid Autonomous Region (MAR), across the period 2013–2018. MethodologyLongitudinal ecological time series study analysed by Generalised Linear Models with Poisson regression, with the dependent variable being daily Emergency Hospital Mental Health Admissions (EHMHA) in the MAR, and the independent variable being mean daily concentrations of chemical pollutants, noise levels and meteorological variables. ResultsEHMHA were related statistically significantly in the short term with diurnal noise levels. Relative risks (RRs) for total admissions due to mental disorders and self-inflicted injuries, in the case of diurnal noise was RR: 1.008 95%CI (1.003 1.013). Admissions attributable to diurnal noise account for 5.5% of total admissions across the study period. There was no association between hospital admissions and chemical air pollution. ConclusionNoise is a variable that shows a statistically significant short-term association with EHMHA across all age groups in the MAR region. The results of this study may serve as a basis for drawing up public health guidelines and plans, which regard these variables as risk factors for mental disorders, especially in the case of noise, since this fundamentally depends on anthropogenic activities in highly urbanised areas with high levels of traffic density.

The risk of unexpected hospital admissions and primary care visits after an elective day-case gastroscopy: a cohort study within England.

SummaryAimTo determine the excess of acute medical contacts following a day‐case diagnostic gastroscopy.MethodsCohort study using English linked primary, secondary care and death registry electronic health data. We included 277,535 diagnostic day‐case gastroscopies in 225,304 people between 1998 and 2016 and followed up for 30 days. 1,383,535 30‐day periods without a gastroscopy within 991,249 people frequency matched on year, gender and decade of birth. Non‐cancer deaths, emergency non‐cancer admissions and cardio, vascular or respiratory (CVR) primary care consultations were identified and adjusted for each other as competing risks. Outcomes related to possible indications for gastroscopy were censored.Results5.1% of day‐case diagnostic gastroscopies were followed by emergency hospital admission, 0.4% for a CVR diagnosis. Adjusted for age, sex, morbidity, time trends, indications and competing risks, there was a 0.1% excess of CVR‐related hospital admissions compared to controls. This reduced to 0.05% (95% confidence interval 0.04–0.06%) in people under 40 years without morbidity and increased to 1.1% (0.6%–1.6%) in people over 90 years with high comorbidity. Similarly, by 30 days, 3.8% had a primary care consultation for a CVR problem, with an excess after adjustment ranging from 0.13% (0.11%–0.16%) to 0.31% (0.14%–0.50%). Overall numbers needed to harm ranged from 1 in 294 gastroscopies to 1 in 67 gastroscopies.ConclusionsThere was an excess of vascular and respiratory events associated with a diagnostic gastroscopy. In younger patients, this risk manifested as an increase in primary care consultations while in older patients there was an increase in emergency hospital admissions.

Impact of Extreme Temperatures on Emergency Hospital Admissions by Age and Socio-Economic Deprivation in England

Climate change poses an unprecedented challenge to population health and health systems' resilience. While earlier studies have estimated morbidity attributable to hot or cold weather across cities, we provide the first large-scale, population-wide assessment of extreme temperatures on inequalities in excess emergency hospital admissions in England. We used a panel dataset of emergency hospital admissions across hospitals between 2001-2012 in England combined with meteorological data to exploit daily variation in temperature experienced by hospitals and a 30-day lag period. We used a distributed lag model with multiple fixed-effects controlling for seasonal factors, to examine interaction effects across diseases with age and indicators of deprivation. We assessed hospital impacts across age groups and levels of deprivation for six disease categories identified as being the most weather-sensitive. Our results showed an increase in emergency hospital admissions with extreme temperatures that were more prominent among older and socially-deprived populations. We estimated larger hospitalisation impacts associated with extreme cold temperatures than with extreme hot temperatures, net of secular trends and local variation.

Impact of the warm summer 2015 on emergency hospital admissions in Switzerland

BackgroundOnly a few studies have examined the impact of a particular heat event on morbidity. The aim of this study was to evaluate the impact of the warm summer 2015 on emergency hospital admissions (EHA) in Switzerland. The summer 2015 ranks as the second hottest after 2003 in the history of temperature observation in Switzerland.MethodsDaily counts of EHA for various disease categories during summer 2015 were analyzed in relation to previous summers in Switzerland. Excess EHA for non-external causes during summer 2015 (June–August) were estimated by age group, gender, geographic region and disease category by comparing observed and expected cases. The latter were predicted from strata-specific quasi-Poisson regression models fitted to the daily counts of EHA for years 2012–2014.ResultsOver the three summer months in 2015, an estimated 2.4% (95% confidence interval [CI] 1.6–3.2%) increase in EHA (non-external causes) occurred corresponding to 2,768 excess cases. Highest excess EHA estimates were found in the warmest regions (Ticino [8.4%, 95% CI 5.1–11.7%] and the Lake Geneva region [4.8%, 95% CI 3.0–6.7%]) and among the elderly population aged ≥75 years (5.1%, 95% CI 3.7–6.5%). Increased EHA during days with most extreme temperatures were observed for influenza and pneumonia, certain infectious diseases and diseases of the genitourinary system.ConclusionsSummer 2015 had a considerable impact on EHA in Switzerland. The daily number of EHA mainly increased due to diseases not commonly linked to heat-related mortality. No excess morbidity was found for cardiovascular and most respiratory diseases. This suggests that current public health interventions should be reevaluated to prevent both heat-related illness and deaths.

Did government spending cuts to social care for older people lead to an increase in emergency hospital admissions? An ecological study, England 2005–2016

ObjectivesGovernment spending on social care in England reduced substantially in real terms following the economic crisis in 2008, meanwhile emergency admissions to hospitals have increased. We aimed to assess the...

Effects and costs of implementing predictive risk stratification in primary care: a randomised stepped wedge trial

AimWe evaluated the introduction of a predictive risk stratification model (PRISM) into primary care. Contemporaneously National Health Service (NHS) Wales introduced Quality and Outcomes Framework payments to general practices to...

The Effect of High Summer Temperatures on Emergency Hospital Admissions in Switzerland: A Comparison to Heat-Related Mortality

Background. While previous studies showed a clear association between high temperatures and mortality in Switzerland, the effect of heat on morbidity is less well understood. To evaluate how hot weather affects morbidity in Switzerland and how it compares to heat-related mortality, we assessed a) cause-specific morbidity during the hot summer 2015, and b) the relationship between heat and emergency hospital admissions (EHA) between 2006 and 2015.Methods. Daily EHA during the summer 2015 (June-August) were analysed in relation to comparison periods. For aim b) daily relationships between day-time maximum (Tmax) temperature and EHA during the warm season (May-September) 2006 to 2015 were assessed for different diagnoses and age groups by applying conditional Poisson regression models combined with Non-Linear Distributed lag models. Results were compared to our similar analyses on heat-related mortality.Results. Overall, we estimated an increase in EHA (non-external causes) by 2.6% (95%CI: 0.2-5.0) during the summer 2015. For the same period, an excess mortality of 5.4% (3.0-7.9%) was estimated. Between 2006 and 2015 an increase in Tmax from the median (22°C) to the 98th percentile (33°C) was associated with an overall 3% increase in EHA over the following four days (relative risk (RR) of 1.03 (95% CI: 1.02-1.05)). Larger increases were observed for respiratory (1.20 (1.09-1.31)) and renal diseases (1.21 (1.04-1.40)) in people aged ≥74 years, and for infection-related EHA, mainly in children <15 years old (1.24 (1.11-1.37)). In contrast to heat-related mortality, no significant association between Tmax and cardiovascular EHA was found.Conclusions. Our results indicate that increases in ambient temperature during summer months have important impacts on morbidity. In general, the impact was smaller than what was observed for heat-related mortality. Nevertheless, current public health strategies can greatly be improved when targeting measures to both groups of outcomes.

Increased risk of emergency hospital admissions for children with renal diseases during heatwaves in Brisbane, Australia

Heatwaves have a significant impact on population health including both morbidity and mortality. In this study we examined the association between heatwaves and emergency hospital admissions (EHAs) for renal diseases in children (aged 0-14 years) in Brisbane, Australia. Daily data on EHAs for renal diseases in children and exposure to temperature and air pollution were obtained for Brisbane city from January 1, 1996 to December 31, 2005. A time-stratified case-crossover design was used to compare the risks for renal diseases between heatwave and non-heatwave periods. There were 1565 EHAs for renal diseases in children during the study period. Heatwaves exhibited a significant impact on EHAs for renal diseases in children after adjusting for confounding factors (odds ratio: 3.6; 95% confidence interval: 1.4-9.5). The risk estimates differed with lags and the use of different heatwave definitions. There was a significant increase in EHAs for renal diseases in children during heatwaves in Brisbane, a subtropical city where people are well accustomed to warm weather. This finding may have significant implications for pediatric renal care, particularly in subtropical and tropical regions.

Disease Management Programs for Patients With COPD in Germany: A Longitudinal Evaluation of Routinely Collected Patient Records

The primary aim of the disease management program (DMP) for patients with COPD is to improve health outcomes and thereby to reduce overall costs. Six years after its introduction in Germany, no consensus has yet been reached as to whether the DMP has been effective in reaching these goals. The objective of the study was an evaluation of the DMP for COPD in Bavaria using routinely collected subject medical records. A longitudinal population-based study, comparing the total DMP population of up to 86,560 patients with a stable cohort of 17,549 subjects over a period of 5 years. The effect of subject dropout in the cohort is further estimated by means of inverse probability weighting. The proportion of subjects in the total population who were prescribed and received treatment with oral corticosteroids declined at a constant rate of 1.0% per year (P < .001). The proportion of subjects who were given a prescription for theophylline decreased at a constant rate of 2.0% per year (P < .001). By 2012, 15.6% of the total population and 26% of the cohort had undergone self-management education. While the proportion of smokers in the total population remained constant because of the effect of newly enrolled subjects, the proportion of smokers decreased significantly even after dropout adjustment, from 29% to 21%. The occurrence of exacerbations decreased steadily at a rate of 0.9% (total population) or 0.7% (cohort) per year. While the occurrence of emergency hospital admissions decreased in the total population, an increase was observed within the cohort. Summarizing all results leads to the suggestion that the German DMP for COPD has been effective in enhancing the quality of care in regard to an improved adherence to guidelines, pharmacotherapy, exacerbations, and self-management education. However, the DMP was not able to prevent an increase in emergency hospital admissions for the stable population in the cohort.

Effects of Coarse Particulate Matter on Emergency Hospital Admissions for Respiratory Diseases: A Time-Series Analysis in Hong Kong

Background: Many epidemiological studies have linked daily counts of hospital admissions to particulate matter (PM) with an aerodynamic diameter ≤ 10 μm (PM10) and ≤ 2.5 μm (PM2.5), but relatively few have investigated the relationship of hospital admissions with coarse PM (PMc; 2.5–10 μm aerodynamic diameter).Objectives: We conducted this study to estimate the health effects of PMc on emergency hospital admissions for respiratory diseases in Hong Kong after controlling for PM2.5 and gaseous pollutants.Methods: We conducted a time-series analysis of associations between daily emergency hospital admissions for respiratory diseases in Hong Kong from January 2000 to December 2005 and daily PM2.5 and PMc concentrations. We estimated PMc concentrations by subtracting PM2.5 from PM10 measurements. We used generalized additive models to examine the relationship between PMc (single- and multiday lagged exposures) and hospital admissions adjusted for time trends, weather conditions, influenza outbreaks, PM2.5, and gaseous pollutants (nitrogen dioxide, sulfur dioxide, and ozone).Results: A 10.9-μg/m3 (interquartile range) increase in the 4-day moving average concentration of PMc was associated with a 1.94% (95% confidence interval: 1.24%, 2.64%) increase in emergency hospital admissions for respiratory diseases that was attenuated but still significant after controlling for PM2.5. Adjusting for gaseous pollutants and altering models assumptions had little influence on PMc effect estimates.Conclusion: PMc was associated with emergency hospital admissions for respiratory diseases in Hong Kong independent of PM2.5 and gaseous pollutants. Further research is needed to evaluate health effects of different components of PMc.

Effect of Dust Storm Events on Daily Emergency Admissions for Cardiovascular Diseases

Dust storm is a meteorological phenomenon and dust particles have been suspected as harmful to heart and lungs. The aim of this study was to investigate the association between coarse particles and emergency hospital admissions for cardiovascular diseases (CVD) in Hong Kong. Data on mean daily emergency admissions for CVD to major hospitals in Hong Kong, concentrations of air pollutants and meteorological variables from January 1998 to December 2002 were obtained from several government departments. We identified 5 dust storm days during the study period. Independent t-tests were used to compare the mean daily number of admissions on dust storm and non-dust storm days. Case-crossover analysis, using the Poisson regression, was used to examine the effects of coarse particles' concentration on emergency hospital admissions for CVD. A marginally significant increase in emergency hospital admissions for ischemic heart disease (IHD) was found with RR=1.04 (95% confidence interval: 1.00, 1.08) per 10 µg/m(3) increase in the concentration of coarse particles. This study demonstrated a marginally significant increase in emergency hospital admissions for IHD on the day of dust storm events in Hong Kong, when the levels of coarse particles were very high. Further studies are required to assess the role of coarse particles on cardiac health.

Assessment of Heat-Related Health Impacts in Brisbane, Australia: Comparison of Different Heatwave Definitions

BackgroundThere is no global definition of a heatwave because local acclimatisation and adaptation influence the impact of extreme heat. Even at a local level there can be multiple heatwave definitions, based on varying temperature levels or time periods. We investigated the relationship between heatwaves and health outcomes using ten different heatwave definitions in Brisbane, Australia.Methodology/Principal FindingsWe used daily data on climate, air pollution, and emergency hospital admissions in Brisbane between January 1996 and December 2005; and mortality between January 1996 and November 2004. Case-crossover analyses were used to assess the relationship between each of the ten heatwave definitions and health outcomes. During heatwaves there was a statistically significant increase in emergency hospital admissions for all ten definitions, with odds ratios ranging from 1.03 to 1.18. A statistically significant increase in the odds ratios of mortality was also found for eight definitions. The size of the heat-related impact varied between definitions.Conclusions/SignificanceEven a small change in the heatwave definition had an appreciable effect on the estimated health impact. It is important to identify an appropriate definition of heatwave locally and to understand its health effects in order to develop appropriate public health intervention strategies to prevent and mitigate the impact of heatwaves.