Vulnerability to extreme-heat-associated hospitalization in three - - PowerPoint PPT Presentation

Vulnerability to extreme-heat-associated hospitalization in three counties in Michigan, USA.

Presented by Adesuwa Ogbomo smade@umich.edu

STUDY AIM IM

To evaluate the effect of extreme high temperature on hospital admissions and how demographic factors like age, sex, race and income could modify the association between extreme heat and hospitalization in three counties in Michigan.

STUDY ARE REA AND DATA SO SOURCES

• Study covers May-September, 2000-

2009 time period for Wayne, Washtenaw and Ingham Counties

• Daily hospitalizations: Michigan

Inpatient Database

• Subsets into specific diagnostic code causes
• Daily temperatures: National Climatic

Data Center

• Local airports and outdoor monitors
• Daily outdoor ozone pollution levels
• US Environmental Protection Agency data base

STUDY DESIG IGN AND STATISTIC ICAL ANALYSIS

• Case-crossover: short term associations of heat with admissions
• Conditional logistic regression
• Exposure =97th percentile of mean daily temperature,
• Outcome =Cardiovascular dx, Respiratory dx, Renal dx, Acute

myocardial infarction (Cardiac arrest), Diabetes mellitus and All cause hospitalisation.

• Effect modification=Interaction between the extreme heat and patient

characteristic indicator variables.

• Pooled individual county results in an inverse-variance weighted fixed

effects meta-analysis.

EXPOSURE

95th percentile of daily mean temp=26.11oC (79.00oF) 97th percentile of daily mean temp=26.67oC (80.01oF) 99th percentile of daily mean temp=27.78oC (82.00oF)

Table 1: 1: Odds ratios and 95 95% % Con Confidence Interval for the e association between hospital admissions and extreme hea eat using only the e principal diagnosis.

Models Cardiovascular diseases OR (95%CI) Respiratory diseases OR (95%CI) Diabetes mellitus OR (95%CI) Renal diseases OR (95%CI) Acute Myocardial infarction OR (95%CI) All cause OR (95%CI)

Wayne Model 1 0.97 (0.94-0.99) 0.98 (0.95-1.02) 0.96 (0.89-1.04) 1.22 (1.12-1.33) 1.04 (0.96-1.12) 0.99 (0.98-1.00) Model 2 0.97 (0.95-0.99) 1.00 (0.96-1.03) 0.96( 0.89-1.05) 1.17 (1.07-1.28) 1.04 (0.96-1.12) 0.99 (0.98-1.00) Washtenaw Model 1 0.89 (0.82-0.98) 1.03 (0.90-1.19) 1.01 (0.75-1.36) 0.94 (0.68-1.30) 0.90 (0.68-1.20) 0.99 (0.95-1.02) Model 2 0.89 (0.81-0.98) 1.02 (0.89-1.18) 1.07 (0.79-1.44) 0.89 (0.64-1.24) 0.88 (0.66-1.18) 0.99 (0.96-1.04) Ingham Model 1 0.98 (0.87-1.11) 0.96 (0.46-1.99) 1.00 (0.70-1.44) 0.87 (0.44-1.67) 1.14(0.77-1.70) 1.03 (0.98-1.09) Model 2 0.98 (0.86-1.11) 1.00 (0.83-1.21) 1.03 (0.71-1.49) 0.82 (0.42-1.61) 1.16 (0.78-1.74) 1.03 (0.98-1.08) Pooled Model 1 0.96 (0.94-0.99) 0.99 (0.95-1.02) 0.97 (0.90-1.04) 1.19 (1.10-1.29) 1.03 (0.96-1.11) 0.99 (0.98-1.00) Model 2 0.97 (0.94-0.99) 1.00 (0.96-1.04) 0.97 (0.90-1.05) 1.11 (1.05-1.25) 1.03 (0.95-1.10) 0.99 (0.98-1.00)

Model1= Logit[Pr(admission=1]=α1 +α2+…….+α19172+β1hitemp Model2= Logit[Pr(admission=1]=α1 +α2+…….+α19172+β1hitemp+β2ozone0

Figu Figure 1: 1: Odd ratio and 95% 95% confidence interval for the e association between extreme hea eat and cardiovascular diseases hospitalization using the e principal + + sec econdary diagnosis for 1, 1, 2, 2, 3 3 and 4 4 consecutive days of f extreme hea eat exp xposure.

0.2 0.4 0.6 0.8 1 1.2 1.4 CVD

L95CI U95CI HazardRatios

Wayne1= Wayne County, 1 day of extreme heat Wayne2 = Wayne County, 2 consecutive days of extreme heat Wayne3 = Wayne County, 3 consecutive days of extreme heat Wayne4 = Wayne County, 4 consecutive days of extreme heat Ingham = Ingham County Washtenaw = Washtenaw County Pooled= 3 counties combined Ingham County did not have 4 consecutive days of mean daily temperature above the 97th percentile during the study period.

Figu Figure 2: Odd ratio and 95% 95% confidence interval for the e association between extreme hea eat and ren enal disease hospitalization using the e principal + + sec econdary diagn gnosis for 1, 1, 2, 2, 3 3 and 4 4 consecutive days of f extreme hea eat exp xposure

0.5 1 1.5 2 2.5 3 REN

L95CI U95CI HazardRatios

Wayne1= Wayne County, 1 day of extreme heat Wayne2 = Wayne County, 2 consecutive days of extreme heat Wayne3 = Wayne County, 3 consecutive days of extreme heat Wayne4 = Wayne County, 4 consecutive days of extreme heat Ingham = Ingham County Washtenaw = Washtenaw County Pooled= 3 counties combined Ingham County did not have 4 consecutive days of mean daily temperature above the 97th percentile during the study period.

Figu Figure 3: 3: Odd ratio and 95% 95% confidence interval for the e association between extreme hea eat and resp espiratory diseases hospitalization using the e principal + + sec econdary diagnosis for 1, 1, 2, 2, 3 3 and 4 4 consecutive days for extreme hea eat exp xposure

0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 RESP

L95CI U95CI HazardRatios

Wayne1= Wayne County, 1 day of extreme heat Wayne2 = Wayne County, 2 consecutive days of extreme heat Wayne3 = Wayne County, 3 consecutive days of extreme heat Wayne4 = Wayne County, 4 consecutive days of extreme heat Ingham = Ingham County Washtenaw = Washtenaw County Pooled =3 counties combined Ingham County did not have 4 consecutive days of mean daily temperature above the 97th percentile during the study period.

Table le 2.

• 2. Odd

dd rati atio

• and

nd 95 95% % confi fidenc nce interval l for

• r the

he ass ssocia iatio tion be between ho hospit pital l adm dmis issio ion n for

• r cause spe

specific ific di diseases and nd extr treme he heat t wi with thin in categor

• rie

ies of age, sex, race and nd inc ncom

• me in

n thr hree countie ties in n Michig igan an us using ng only nly pr princip ipal l di diag agnos

• sis
• is. (Poo
• ole

led result ult)

Cardiovascular diseases OR (95%CI) Respiratory diseases OR (95%CI) Diabetes Mellitus OR (95%CI) Renal diseases OR (95%CI) Acute Myocardial infarction OR (95%CI) All cause OR (95%CI) Age < 65 years

0.97 (0.94-1.01) 0.98 (0.93-1.03) 0.93 (0.85-1.02) 1.14 (1.00-1.30) 0.99 (0.88-1.11) 0.99 (0.98-1.01)

>= 65 years

0.96 (0.93-0.99) 1.02 (0.97-1.08) 1.09 (0.95-1.26) 1.17 (1.12-1.28) 1.06 (0.96-1.17) 1.00 (0.98-1.01)

Sex Male

0.99 (0.95-1.04) 1.03 (0.96-1.11) 1.07 (0.93-1.16) 1.10 (0.98-1.24) 1.08 (0.95-1.23) 1.02 (1.00-1.02)

Female

0.95 (0.91-0.99) 1.02 (0.95-1.09) 1.00 (0.89-1.10) 1.19 (1.06-1.34) 0.98 (0.85-1.12) 1.03 (1.01-1.05)

Race White

0.90 ( 0.87-0.94) 0.97 (0.91-1.03) 1.02 (0.87-1.19) 0.96 (0.85-1.10) 0.97 (0.86-1.09) 0.95 (0.93-0.97)

Non-white

1.08 (1.03-1.13)* 1.10 (1.02-1.18) 0.97 (0.87-1.05) 1.32 (1.18-1.48)* 1.15 (0.98-1.35) 1.13 (1.11-1.16)*

Income High

0.96 (0.92-1.00) 0.96 (0.91-1.02) 0.96 (0.86-1.06) 1.11 (0.96-1.29) 0.98 (0.87-1.01) 0.99 (0.97-1.00)

Low

0.97 (0.94-0.99) 1.03 (0.98-1.08) 1.00 (0.89-1.12) 1.16 (1.04-1.29) 1.06 (0.96-1.16) 1.00 (0.98-1.01)

*significant (p < 0.05); Indicates significant difference between 2 categories

Table le 3.

• 3. Odd

dds s ratio atios and nd 95 95% confid fidence interval l for

• r the

he ass ssoc

• ciatio

ions ns be between n caus use-sp specific ific ho hosp spit ital l adm dmis ission ions (pr prin incip ipal al di diagnosis is only nly) ) and nd ext xtreme he heat t de defin fined d as da daily ily me mean an te temperature abo bove the he 95 95th

th, 97

97Th

Th and

nd the he 99 99th

th

pe percentil tile for

• r da

daily ily me mean an te temperatu ture.

County

Cardiovascular diseases OR(95%CI) Respiratory diseases OR(95%CI) Diabètes Mellites OR(95%CI) Renal diseases OR(95%CI) Acute Myocardial Infarction OR(95%CI) All cause OR(95%CI)

Wayne 95th percentile 0.97 (0.95-0.99) 0.99 (0.96-1.02) 0.98 (0.92-1.04) 1.14 (1.07-1.22) 1.01 (0.95-1.07) 0.99 (0.99-1.00) 97th percentile 0.97 (0.94-0.99) 0.98 (0.95-1.02) 0.96 (0.90-1.04) 1.22 (1.17-1.33) 1.03 (0.95-1.01) 0.99 (0.98-1.00) 99th percentile 0.98 (0.95-1.02) 0.99 (0.94-1.05) 0.97 (0.87-1.08) 1.37 (1.21-1.55) 1.12 (1.01-1.25) 1.00 (0.98-1.02) Washtenaw 95th percentile 0.92 (0.86-0.98) 1.06 (0.96-1.17) 1.03 (0.83-1.29) 1.16 (0.91-1.46) 0.86 (0.73-1.02) 1.00 (0.97-1.03) 97th percentile 0.98 (0.87-1.11) 0.95 (0.88-1.02) 1.01 (0.93-1.11) 0.86 (0.44-1.67) 0.91 (0.74-1.12) 0.99 (0.95-1.02) 99th percentile 0.87 (0.74-1.04) 0.97 (0.75-1.26) 0.67 (0.34-1.30) 0.67 (0.34-1.30) 1.06 (0.66-1.70) 0.96 (0.90-1.03) Ingham 95th percentile 0.91 (0.83-0.99) 0.97 (0.85-1.10) 0.34 (0.67-1.15) 0.86 (0.57-1.31) 0.90 (0.70-1.18) 0.96 (0.92-0.99) 97th percentile 0.98 (0.87-1.11) 1.00 (0.83-1.21) 1.00 (0.70-1.44) 1.10 (0.92-1.32) 1.14 (0.77-1.70) 1.04 (0.98-1.09) 99th percentile 0.95 (0.73-1.23) 0.99 (0.64-1.53) 0.65 (0.25-1.69) 1.62 (0.42-6.26) 2.80 (1.27-6.18) 1.07 (0.96-1.20) Pooled 95th percentile 0.96 (0.94-0.98) 0.99 (0.97-1.02) 0.98 (0.92-1.03) 1.14 (1.07-1.21) 1.00 (0.94-1.05) 0.99 (0.98-1.00) 97th percentile 0.96 (0.94-0.99) 0.99 (0.95-1.02) 0.97 (0.90-1.04) 1.06 (0.97-1.15) 1.03 (0.96-1.11) 0.99 (0.98-1.00) 99th percentile 0.98 (0.94-1.01) 0.99 (0.94-1.05) 0.97 (0.87-1.08) 1.34 (1.19-1.52) 1.14 (1.03-1.26) 1.00 (0.98-1.02)

Conclusion

• Significant association between hospital admission for

renal diseases and extreme high temperature.

• Significant decrease in cardiovascular diseases for all levels
• f duration and intensity of exposure.
• Significant increase in hospitalization for acute myocardial

infarction (cardiac arrest) with extreme high temperature.

• Non-whites (African Americans 95%), showed a

significantly higher hospitalization for cardiovascular diseases, renal diseases and all natural cause compared to the white population.

References

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Acknowledgements

• Co-authors: Carina J. Gronlund, Tess Gallagher, Marie S. O’Neill, Lorraine

Cameron, Robert Wahl.

• University of Michigan, Michigan Department of Community health, National

Institute of Health Sciences (NIH), The Center for Diseases Control (CDC).

• The climate change and health: Residential energy-efficiency for comfort and

equity “R21” group.