Extreme Heat Stress and Unplanned Hospital Admissions

Wen-Qiang He; Gavin Pereira; Nan Hu; Raghu Lingam; Lindsey Hunt; Adrienne Gordon; Ollie Jay; Natasha Nassar

doi:10.1542/peds.2024-068183

Extreme Heat Stress and Unplanned Hospital Admissions

Pediatrics. 2024 Dec 26:e2024068183. doi: 10.1542/peds.2024-068183. Online ahead of print.

Authors

Wen-Qiang He^{1

2}, Gavin Pereira³, Nan Hu⁴, Raghu Lingam⁴, Lindsey Hunt⁵, Adrienne Gordon^{6

7

8}, Ollie Jay^#⁵, Natasha Nassar^#^{1

2

7}

Affiliations

¹ Child Population and Translational Health Research, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.
² Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.
³ Curtin School of Population Health, Curtin University, Perth, Bentley, Western Australia, Australia.
⁴ School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
⁵ Heat and Health Research Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.
⁶ Discipline of Obstetrics, Gynaecology and Neonatology, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia.
⁷ Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia.
⁸ Royal Prince Alfred Women and Babies, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

^# Contributed equally.

PMID: 39729086
DOI: 10.1542/peds.2024-068183

Abstract

Objectives: The burden and health impact of heat stress on child hospitalization is limited. This study aims to investigate associations between extreme heat stress exposure based on a Universal Thermal Climate Index (UTCI), emergency department (ED) visits, and ED visits that translate into unplanned hospital admissions.

Methods: This population-based case-crossover study included all ED visits and unplanned hospital admissions among children and adolescents aged 0 to 18 years from New South Wales, Australia, from July 2001 to June 2020. Heat stress was measured by heatwave days defined as 2 consecutive days or more with daily maximum UTCI in the 95th percentile or higher. Distributed lag nonlinear regression models with a quasi-Poisson distribution were applied, and the relative risks from the models were presented.

Results: Totals of 8 240 170 ED visits and 1 427 736 unplanned hospital admissions were recorded. Compared with nonheatwave days, heatwave days were associated with an increased risk of ED visits and hospital admissions due to infectious diseases and infectious enteritis by 5% to 17% and heat-related illness by 78% to 104%. Findings were consistent for subgroup analyses. Children aged younger than 1 year and those from the most disadvantaged areas were more vulnerable to heat-related illness on heatwave days. Effects on hospitalization were attenuated using ambient temperature only.

Conclusions: This study provides evidence of the effectiveness of UTCI to more completely demonstrate the harmful impact of extreme heat stress on increased infection and heat-related hospitalizations among children, which were not fully captured by using ambient temperature alone. Findings can inform targeted area-based strategies, particularly among vulnerable groups to mitigate the effects of extreme heat events.