Abstract

Background:

Extreme heat exposures are increasing with climate change. Health effects are well documented in adults, but the risks to children are not well characterized.

Objectives:

We estimated the association between warm season (May to September) temperatures and cause-specific emergency department (ED) visits among U.S. children and adolescents.

Methods:

This multicenter time-series study leveraged administrative data on $3.8\text{\hspace{0.17em}million}$ ED visits by children and adolescents $\le 18\text{\hspace{0.17em}years}$ of age to the EDs of 47 U.S. children’s hospitals from May to September from 2016 to 2018. Daily maximum ambient temperature was estimated in the county of the hospital using a spatiotemporal model. We used distributed-lag nonlinear models with a quasi-Poisson distribution to estimate the association between daily maximum temperature and the relative risk (RR) of ED visits, adjusting for temporal trends. We then used a random-effects meta-analytic model to estimate the overall cumulative association.

Results:

Extreme heat was associated with an RR of all-cause ED visits of 1.17 (95% CI: 1.12, 1.21) relative to hospital-specific minimum morbidity temperature. Associations were more pronounced for ED visits due to heat-related illness including dehydration and electrolyte disorders ($\text{RR}=$ 1.83; 95% CI: 1.31, 2.57), bacterial enteritis (1.35; 95% CI: 1.02, 1.79), and otitis media and externa (1.30; 95% CI: 1.11, 1.52). Taken together, temperatures above the minimum morbidity temperature accounted for an estimated 11.8% [95% empirical 95% confidence interval (eCI): 9.9%, 13.3%] of warm season ED visits for any cause and 31.0% (95% eCI: 17.9%, 36.5%) of ED visits for heat-related illnesses.

Conclusion:

During the warm season, days with higher temperatures were associated with higher rates of visits to children’s hospital EDs. Higher ambient temperatures may contribute to a significant proportion of ED visits among U.S. children and adolescents. https://doi.org/10.1289/EHP8083

中文翻译：

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温暖季节和急诊科访问美国儿童医院

摘要

背景：

随着气候变化，极端高温暴露在增加。对成人的健康影响有充分的记录，但对儿童的风险并未得到很好的描述。

目标：

我们估计了美国儿童和青少年的温暖季节（5 月至 9 月）温度与特定原因急诊科 (ED) 就诊之间的关联。

方法：

这项多中心时间序列研究利用了$3.8\text{\hspace{0.17em}百万}$儿童和青少年就诊$\le 18\text{\hspace{0.17em}年}$2016 年至 2018 年 5 月至 9 月，美国 47 家儿童医院急诊科的年龄。使用时空模型估计了医院所在县的每日最高环境温度。我们使用具有准泊松分布的分布滞后非线性模型来估计每日最高温度与 ED 就诊的相对风险 (RR) 之间的关联，并根据时间趋势进行调整。然后，我们使用随机效应元分析模型来估计整体累积关联。

结果：

相对于医院特定的最低发病温度，极端高温与全因 ED 就诊的 RR 为 1.17 (95% CI: 1.12, 1.21) 相关。由于与热相关的疾病，包括脱水和电解质紊乱，就诊的相关性更为明显（$\text{RR}=$1.83; 95% CI：1.31、2.57）、细菌性肠炎（1.35；95% CI：1.02、1.79）以及中耳炎和外耳炎（1.30；95% CI：1.11、1.52）。总之，温度高于最低发病温度估计占暖季 ED 就诊的 11.8% [95% 经验 95% 置信区间 (eCI)：9.9%、13.3%] 和 31.0% (95% eCI: 17.9 %, 36.5%) 的 ED 就诊中热相关疾病。

结论：

在温暖的季节，气温较高的日子与较高的儿童医院急诊就诊率相关。较高的环境温度可能导致美国儿童和青少年就诊的比例很大。https://doi.org/10.1289/EHP8083