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 =97 th 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 95 th percentile of daily mean temp=26.11oC (79.00oF) 97 th percentile of daily mean temp=26.67oC (80.01oF) 99 th 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 Respiratory diseases Diabetes mellitus Renal diseases Acute Myocardial All cause diseases infarction OR (95%CI) OR (95%CI) OR (95%CI) OR (95%CI) OR (95%CI) 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]= α 1 + α 2 +…….+α 19172 +β 1 hitemp Model2= Logit[Pr(admission=1]= α 1 + α 2 +…….+α 19172 +β 1 hitemp+β 2 ozone0

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. CVD 1.4 1.2 1 0.8 0.6 0.4 0.2 0 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 97 th 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 REN 3 2.5 2 1.5 1 0.5 0 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 97 th 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 RESP 1.6 1.4 1.2 1 0.8 0.6 0.4 0.2 0 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 97 th percentile during the study period.

Table le 2. 2. Odd dd rati atio o and nd 95 95% % confi fidenc nce interval l for or the he ass ssocia iatio tion be between ho hospit pital l adm dmis issio ion n for or cause spe specific ific di diseases and nd extr treme he heat t wi with thin in categor orie ies of age, sex, race and nd inc ncom ome in n thr hree countie ties in n Michig igan an us using ng only nly pr princip ipal l di diag agnos osis is. (Poo oole led result ult) Cardiovascular diseases Respiratory diseases Diabetes Mellitus Renal diseases Acute Myocardial All cause infarction OR (95%CI) OR (95%CI) OR (95%CI) OR (95%CI) OR (95%CI) 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 0.99 (0.97-1.00) 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) 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 or the he ass ssoc ociatio ions ns be between n caus use-sp specific ific ho hosp spit ital l adm dmis ission ions Th and 95 th th , 97 97 Th 99 th th (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 nd the he 99 pe percentil tile for or da daily ily me mean an te temperatu ture. Cardiovascular Respiratory Diabètes Mellites Renal diseases Acute Myocardial All cause diseases diseases Infarction OR(95%CI) OR(95%CI) OR(95%CI) OR(95%CI) OR(95%CI) OR(95%CI) County Wayne 95 th 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) 97 th 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) 99 th 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 95 th 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) 97 th 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) 99 th 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 95 th 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) 97 th 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) 99 th 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 95 th 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) 97 th 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) 99 th 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)