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Health effects of the September 2009 dust storm in Sydney, Australia: did emergency department visits and hospital admissions increase?

ABSTRACT: BACKGROUND: During September 2009, a large dust storm was experienced in Sydney, New South Wales, Australia. Extremely high levels of particulate matter were recorded, with daily average levels of coarse matter (<10 ?m) peaking over 11,000 ?g/m3 and fine (<2.5 ?m) over 1,600 ?g/m3. We conducted an analysis to determine whether the dust storm was associated with increases in all-cause, cardiovascular, respiratory and asthma-related emergency department presentations and hospital admissions. METHODS: We used distributed-lag Poisson generalized models to analyse the emergency department presentations and hospital admissions adjusted for pollutants, humidity, temperature and day of week and seasonal effects to obtain estimates of relative risks associated with the dust storm. RESULTS: The dust storm period was associated with large increases in asthma emergency department visits (relative risk 1.23, 95% confidence interval 1.10-1.38, p?

SUBMITTER: Merrifield A

PROVIDER: S-EPMC3639126 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Health effects of the September 2009 dust storm in Sydney, Australia: did emergency department visits and hospital admissions increase?

Merrifield Alistair A Schindeler Suzanne S Jalaludin Bin B Smith Wayne W

Environmental health : a global access science source 20130416

<h4>Background</h4>During September 2009, a large dust storm was experienced in Sydney, New South Wales, Australia. Extremely high levels of particulate matter were recorded, with daily average levels of coarse matter (<10 μm) peaking over 11,000 μg/m3 and fine (<2.5 μm) over 1,600 μg/m3. We conducted an analysis to determine whether the dust storm was associated with increases in all-cause, cardiovascular, respiratory and asthma-related emergency department presentations and hospital admissions ...[more]

PMID: 23587335

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Project description:BACKGROUND:Although homelessness and opioid overdose are major public health issues in the U.S., evidence is limited as to whether homelessness is associated with an increased risk of opioid overdose. OBJECTIVE:To compare opioid-related outcomes between homeless versus housed individuals in low-income communities. DESIGN, SETTING, AND PARTICIPANTS:Cross-sectional analysis of individuals who had at least one ED visit or hospitalization in four states (Florida, Maryland, Massachusetts, and New York) in 2014. MEASUREMENTS:Risk of opioid overdose and opioid-related ED visits/hospital admissions were compared between homeless versus low-income housed individuals, adjusting for patient characteristics and hospital-specific fixed effects (effectively comparing homeless versus low-income housed individuals treated at the same hospital). We also examined whether risk of opioid-related outcomes varied by patients' sex and race/ethnicity. RESULTS:A total of 96,099 homeless and 2,869,230 low-income housed individuals were analyzed. Homeless individuals had significantly higher risk of opioid overdose (adjusted risk, 1.8% for homeless vs. 0.3% for low-income housed individuals; adjusted risk difference [aRD], +1.5%; 95%CI, +1.0% to +2.0%; p < 0.001) and opioid-related ED visit/hospital admission (10.4% vs. 1.5%; aRD, +8.9%; 95%CI, +7.2% to +10.6%; p < 0.001) compared to low-income housed individuals. Non-Hispanic White females had the highest risk among the homeless population, whereas non-Hispanic White males had the highest risk among the low-income housed population. LIMITATIONS:Individuals with no ED visit or hospitalization in 2014 were not included. CONCLUSION:Homeless individuals had disproportionately higher adjusted risk of opioid-related outcomes compared to low-income housed individuals treated at the same hospital. Among homeless individuals, non-Hispanic White females incurred the highest risk. These findings highlight the importance of recognizing the homeless population-especially the non-Hispanic White female homeless population-as a high-risk population for opioid overdose.

Project description:BACKGROUND:Migrant health has become an essential part of public health. According to the World Health Organization, many health systems in Europe have not yet adapted adequately to the needs of asylum-seekers, which might result in untimely and inefficient health care for asylum-seeking patients. The aim of this study was to assess the number of preventable hospital admissions and emergency department visits in asylum-seeking and non-asylum-seeking pediatric patients. METHODS:This is a retrospective, hospital-based study. The study was done at the University Children's Hospital Basel in Switzerland. Patients admitted or presenting to the emergency department were included and split into the groups of asylum-seeking and non-asylum-seeking patients. All admissions and emergency-department visits were extracted from the administrative electronic health records from 1st Jan 2016-31st Dec 2017. The main outcome was the proportion of admissions due to ambulatory-care-sensitive conditions (which refer to conditions for which admission can be prevented by early interventions in primary care) in asylum-seeking and non-asylum-seeking patients. Ambulatory-care-sensitive conditions were defined by a validated list of ICD-10 codes. The secondary objective was to assess the number of preventable emergency-department visits by asylum-seeking patients defined as proportion of visits with a non-urgent triage score. RESULTS:A total of 75'199 hospital visits were included, of which 63'405 were emergency department visits and 11'794 were admissions. Ambulatory-care-sensitive conditions accounted for 12.1% (18/149) of asylum-seeking and 10.9% (1270/11645) of non-asylum seeking patients' admissions. Among the emergency department visits by asylum-seeking patients, non-urgent conditions accounted for 82.2% (244/297). CONCLUSIONS:Admissions due to ambulatory-care-sensitive conditions are comparable in asylum-seeking and non-asylum-seeking children, suggesting few delayed presentations to ambulatory care facilities. Strategies to prevent non-urgent visits at pediatric emergency department facilities are needed.

Project description:Background Identification of stroke patients at increased risk of emergency department (ED) visits or hospital admissions allows implementation of mitigation strategies. We evaluated the ability of the Patient-Reported Outcomes Information Measurement System (PROMIS) patient-reported outcomes (PROs) collected as part of routine care to predict 1-year emergency department (ED) visits and admissions when added to other readily available clinical variables. Methods and Results This was a cohort study of 1696 patients with ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, or transient ischemic attack seen in a cerebrovascular clinic from February 17, 2015, to June 11, 2018, who completed the following PROs at the visit: Patient Health Questionnaire-9, Quality of Life in Neurological Disorders cognitive function, PROMIS Global Health, sleep disturbance, fatigue, anxiety, social role satisfaction, physical function, and pain interference. A series of logistic regression models was constructed to determine the ability of models that include PRO scores to predict 1-year ED visits and all-cause and unplanned admissions. In the 1 year following the PRO encounter date, 1046 ED visits occurred in 548 patients; 751 admissions occurred in 453 patients. All PROs were significantly associated with future ED visits and admissions except PROMIS sleep. Models predicting unplanned admissions had highest optimism-corrected area under the curve (range, 0.684-0.724), followed by ED visits (range, 0.674-0.691) and then all-cause admissions (range, 0.628-0.671). PROs measuring domains of mental health had stronger associations with ED visits; PROs measuring domains of physical health had stronger associations with admissions. Conclusions PROMIS scales improve the ability to predict ED visits and admissions in patients with stroke. The differences in model performance and the most influential PROs in the prediction models suggest differences in factors influencing future hospital admissions and ED visits.

Project description:BackgroundLow back pain is the leading cause of disability worldwide and a common presentation to emergency departments, often resulting in subsequent admissions to hospital. There have been several studies investigating the cost of low back pain to society, but few specific to the emergency department and inpatient setting, especially in Australia. The aim was to describe the cost of low back pain in Australian public hospital emergency departments, and inpatient settings, and explore healthcare costs associated with different care pathways.MethodsIn this retrospective observational study, we explored the costs associated with an episode of care for low back pain in adults that attended three emergency departments in Sydney between 1 July 2014 and 30 June 2019. Systematised Nomenclature of Medicine-Clinical Terms (SNOMED) diagnosis codes were used to identify episodes of care where the patients had been diagnosed with non-specific low back pain or lumbosacral radicular syndromes. Serious spinal pathologies were excluded. We determined the costs for different treatment pathways involving the ambulance service, emergency department and inpatient ward care. Hospital costs were adjusted for inflation to 2019 Australian dollars (AUD).FindingsThere were 12,399 non-serious low back pain episodes of care during the study period. 4006 (32%) arrived by ambulance and 2067 (17%) were admitted for inpatient care. The total costs of inpatient and emergency department care across the 5-year period were AUD$36.7 million, with a mean of AUD$2959 per episode of care. The mean cost for a patient who had a non-ambulance presentation to the emergency department and was discharged was AUD$584. Patients presenting to the emergency department via ambulance and were discharged had a mean cost of AUD$1022. Patients who presented without the need of an ambulance and were admitted had a mean cost of $13,137. The most expensive care pathway was for patients arriving by ambulance with subsequent admission, with a mean cost of AUD$14,949.InterpretationThe common practice of admitting patients with non-serious low back pain for inpatient care comes at great cost to the healthcare system. In a resource constrained environment, our data highlights the economic need to implement innovative, evidence-based strategies to reduce the inpatient management of these patients.FundingNil.

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Health effects of the September 2009 dust storm in Sydney, Australia: did emergency department visits and hospital admissions increase?

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Health effects of the September 2009 dust storm in Sydney, Australia: did emergency department visits and hospital admissions increase?

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