Universal thermal climate index associations with mortality, hospital admissions, and road accidents in Bavaria

Temperature directly correlates with emergency surgical case admissions independent of seasonality

Weather parameters impact patient admission to emergency departments (EDs) and due to pressures of overcrowding, it is imperative to better forecast admission levels. This retrospective single-centre study aimed to assess whether ambient temperature independently predicts emergency department (ED) admissions, beyond typical seasonal variation. We analysed 150,751 admissions to the ED of the University Hospital Klinikum rechts der Isar (MRI) in Munich, Germany from 2019-2022. Patients were divided into either surgical or internal medicine groups. Their post-treatment status as well as discharge type ('outpatient' versus 'inpatient') was also recorded. Descriptive statistics as well as linear models were used to identify and test statistically significant correlations of ED and weather variables. Patient admissions of the surgery group were directly correlated with changes in ambient temperature. This relationship persisted consistently across all seasons, suggesting a temperature effect that is independent of typical seasonal fluctuations. Whilst ED patient intake of the internal medicine group decreased during some holidays, spring as well as on weekends, sharp increases could be seen during the Oktoberfest period and Christmas. Despite minor variances, this was not the case in the surgery group. Here, the overall direct correlation of temperature and surgical patient levels for the period between 2019-22 seems highly significant. Temperature changes lead to more surgical cases irrespective of the season and more outpatient discharges, whilst inpatient admissions generally seem rather unresponsive to weather changes. A better allocation of resources in ED departments results from superior understandings of trigger factors and temperature has thus been rendered a particularly potent one.

Risk, Attributable Fraction and Attributable Number of Cause-Specific Heat-Related Emergency Hospital Admissions in Switzerland

Objectives

We assessed the relationship between heat and emergency hospital admissions (EHAs) in Switzerland using clinically relevant metrics.

Methods

Applying distributed lag non-linear models, we investigated temperature-admission associations between May and September 1998-2019 for various disease groups, by age class and gender. We estimated the relative risk (RR) for moderate (29°C) and extreme (34°C) daily maximum temperatures relative to disease-specific optimum temperature, and calculated attributable fractions (AFs) for hot days and the following week. We also calculated the total number of heat-related EHAs.

Results

We attributed 31,387 (95% confidence interval: 21,567-40,408) EHAs to above-optimal temperatures, 1.1% (0.7%-1.4%) of the total. Extreme temperatures increased the EHA risk for mental, infectious and neurological diseases. We observed particularly high AFs due to extreme heat for dehydration (85.9%, 95% CI: 82.4%-88.8%) and acute kidney injury (AKI, 56.1%, 95% CI: 45.3%-64.7%). While EHA risk generally increased with age, we also found high RRs for infectious diseases in children (0-15 years) and AKI in young adults (15-64 years).

Conclusion

Hot weather increases the EHA risk in Switzerland. Therefore a comprehensive clinical and public health response is needed.

Thermal stress information as a tourism-oriented climate product: Performance analysis for selected urban destinations in Romania and Italy

The study addresses the characteristics of a climate service targeting tourists and discusses the evaluation of its products with a particular focus on the thermal stress information. Furthermore, an assessment of the impact of input data on the accuracy and relevance of the thermal stress product is presented. The thermal stress is expressed through UTCI (Universal Thermal Climate Index) and it is computed from UERRA regional reanalysis and E-OBS gridded dataset, for summer season during 2011-2018. The analysis targets 10 cities with different characteristics located in Romania and Italy. It focuses on the impact of three temperature-related input data (instantaneous temperature at 12:00 UTC, daily maximum and daily mean temperature) on the thermal stress intensity. The results show that differences up to 4 days in the pronounced thermal stress category may appear when employing daily maximum temperature compared to the use 12:00 UTC instantaneous temperature, while the use of daily mean temperature leads to strong underestimation of thermal stress in this category. The findings are of interest in defining the technical choices of products to be incorporated in a climate service for tourism in order to assure a good user uptake.

Impact of seasonal variation on hospital admission and in-hospital mortality of acute cardiovascular diseases: a contemporary nationwide database study

PURPOSE

Whether acute cardiovascular diseases (CVDs), such as acute heart failure (AHF), acute myocardial infarction (AMI), and acute aortic dissection (AAD), have distinct seasonal variations in the number of hospitalizations and in-hospital mortality was investigated using a nationwide database in Japan.

METHODS

The hospitalized patients with AHF, AMI, and AAD between April 2012 and March 2020 were identified. Multilevel mixed-effects logistic regression was conducted and adjusted odds ratio (aOR) was calculated. Also, the Poisson regression model was conducted to calculate the peak-to-trough ratio (PTTR) with peak month.

RESULTS

Patients identified were as follows: 752,434 AHF patients (median age, 82 years; male, 52.2%), 346,110 AMI patients (median age, 71 years; male, 72.2%), and 118,538 AAD patients (median age, 72 years; male, 58.0%). The monthly proportion of hospitalized patients was the highest in winter and the lowest in summer in all three diseases. Based on aOR, 14-day mortality was the lowest in spring for AHF, summer for AMI, and spring for AAD. Furthermore, the PTTRs with peak month were 1.24 for AHF in February, 1.34 for AMI in January, and 1.33 for AAD in February.

CONCLUSIONS

A clear seasonal pattern was observed in the number of hospitalizations and in-hospital mortality of all acute CVDs, independent of confounders.

Association of Air Pollution and Weather Factors with Traffic Injury Severity: A Study in Taiwan

Exposure to air pollutants may elevate the injury severity scores (ISSs) for road traffic injuries (RTIs). This multicenter cross-sectional study aimed to investigate the associations between air pollution, weather conditions, and RTI severity. This retrospective study was performed in Taiwan in 2018. The location of each road traffic accident (RTA) was used to determine the nearest air quality monitoring and weather station, and the time of each RTA was matched to the corresponding hourly air pollutant concentration and weather factors. Five multiple logistic regression models were used to compute the risk of sustaining severe injury (ISS ≥ 9). Of the 14,973 patients with RTIs, 2853 sustained severe injury. Moderate or unhealthy air quality index, higher exposure to particulate matter ≤2.5 μm in diameter, bicyclists or pedestrians, greater road width, nighttime, and higher temperature and relative humidity were significant risk factors for severe injury. Exposure to nitrogen oxide and ozone did not increase the risk. Auto occupants and scene-to-hospital time were the protective factors. Sensitivity analyses showed consistent results between air pollutants and the risk of severe injury. Poor air quality and hot and humid weather conditions were associated with severe RTIs. Active commuters were at higher risk of sustaining severe RTI.