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Medical diagnoses of heat wave-related hospital admissions in older adults.

ABSTRACT: Heat waves have been associated with adverse human health effects, including higher rates of all-cause and cardiovascular mortality, and these health effects may be exacerbated under continued climate change. However, specific causes of hospitalizations associated with heat waves have not been characterized on a national scale. We systematically estimated the risks of cause-specific hospitalizations during heat waves in a national cohort of 23.7 million Medicare enrollees residing in 1943?U.S. counties during 1999-2010. Heat waves were defined as ?2 consecutive days exceeding the county's 99th percentile of daily temperatures, and were matched to non-heat wave periods by county and week. We considered 50 outcomes from broad disease groups previously associated with heat wave-related hospitalizations, and estimated cause-specific relative risks (RRs) of hospital admissions on heat wave days. We identified 11 diagnoses with a higher admission risk on heat wave days, with heat stroke and sunstroke having the highest risk (RR?=?22.5, [95% CI 14.9-34.2]). Other diseases with elevated risks included fluid and electrolyte disorders [(Hyperosmolality RR?=?1.4, [95% CI 1.1-1.3]; Hypoosmolaltiy RR?=?1.2, [95% CI 1.1-1.3])] and acute kidney failure (RR?=?1.1, [95% CI 1.1-1.2]). These risks tended to be higher under more severe heat wave events. In addition, risks were higher among adults in the oldest (?85) category (reference: 65-74) for volume depletion and heat exhaustion. Several causes of hospitalization identified are preventable, and public health interventions, including early warning systems and plans targeting risk factors for these illnesses, could reduce adverse effects of heat in the present and under climate change.

SUBMITTER: Hopp S

PROVIDER: S-EPMC6040588 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Medical diagnoses of heat wave-related hospital admissions in older adults.

Hopp Stephanie S Dominici Francesca F Bobb Jennifer F JF

Preventive medicine 20180208

Heat waves have been associated with adverse human health effects, including higher rates of all-cause and cardiovascular mortality, and these health effects may be exacerbated under continued climate change. However, specific causes of hospitalizations associated with heat waves have not been characterized on a national scale. We systematically estimated the risks of cause-specific hospitalizations during heat waves in a national cohort of 23.7 million Medicare enrollees residing in 1943 U.S. c ...[more]

PMID: 29428173

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Project description:ImportanceHeat exposure is known to have a complex set of physiological effects on multiple organ systems, but current understanding of the health effects is mostly based on studies investigating a small number of prespecified health outcomes such as cardiovascular and respiratory diseases.ObjectivesTo identify possible causes of hospital admissions during extreme heat events and to estimate their risks using historical data.Design, setting, and populationMatched analysis of time series data describing daily hospital admissions of Medicare enrollees (23.7 million fee-for-service beneficiaries [aged ≥65 years] per year; 85% of all Medicare enrollees) for the period 1999 to 2010 in 1943 counties in the United States with at least 5 summers of near-complete (>95%) daily temperature data.ExposuresHeat wave periods, defined as 2 or more consecutive days with temperatures exceeding the 99th percentile of county-specific daily temperatures, matched to non-heat wave periods by county and week.Main outcomes and measuresDaily cause-specific hospitalization rates by principal discharge diagnosis codes, grouped into 283 disease categories using a validated approach.ResultsRisks of hospitalization for fluid and electrolyte disorders, renal failure, urinary tract infection, septicemia, and heat stroke were statistically significantly higher on heat wave days relative to matched non-heat wave days, but risk of hospitalization for congestive heart failure was lower (P < .05). Relative risks for these disease groups were 1.18 (95% CI, 1.12-1.25) for fluid and electrolyte disorders, 1.14 (95% CI, 1.06-1.23) for renal failure, 1.10 (95% CI, 1.04-1.16) for urinary tract infections, 1.06 (95% CI, 1.00-1.11) for septicemia, and 2.54 (95% CI, 2.14-3.01) for heat stroke. Absolute risk differences were 0.34 (95% CI, 0.22-0.46) excess admissions per 100,000 individuals at risk for fluid and electrolyte disorders, 0.25 (95% CI, 0.12-0.39) for renal failure, 0.24 (95% CI, 0.09-0.39) for urinary tract infections, 0.21 (95% CI, 0.01-0.41) for septicemia, and 0.16 (95% CI, 0.10-0.22) for heat stroke. For fluid and electrolyte disorders and heat stroke, the risk of hospitalization increased during more intense and longer-lasting heat wave periods (P < .05). Risks were generally highest on the heat wave day but remained elevated for up to 5 subsequent days.Conclusions and relevanceAmong older adults, periods of extreme heat were associated with increased risk of hospitalization for fluid and electrolyte disorders, renal failure, urinary tract infection, septicemia, and heat stroke. However, the absolute risk increase was small and of uncertain clinical importance.

Project description:BackgroundNeoplasm-related pain is often suboptimally treated, contributing to avoidable suffering and increased medical resource use and costs. We hypothesized that dementia may contribute to increased resource use and costs in patients hospitalized for neoplasm-related pain in the United States.AimsTo examine how persons with cancer and dementia use medical resources and expenditures in US hospitals compared to ondividuals without dementia.DesignThis study examined a retrospective cohort.SettingAdmissions to US hospitals for neoplasm-related pain from 2012-2016 PARTICIPANTS/SUBJECTS: METHODS: Data were obtained from the 2012-2016 National Inpatient Sample (NIS). The sample included hospital admissions of individuals aged 60 or older with a primary diagnosis of neoplasm-related pain. Dementia was defined using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), and ICD-10-CM diagnosis codes. Primary outcomes were number of admissions, costs, and length of stay (LOS). Descriptive statistics and multivariable regression models were used to examine the relationships among dementia, costs, and LOS.ResultsOf 12,034 admissions for neoplasm-related pain, 136 (1.1%) included a diagnosis of dementia and 11,898 (98.9%) did not. Constipation was present in 13.2% and 24.5% of dementia and nondementia admissions, respectively. The median LOS was 4 days in persons with dementia and three in those without. Mean costs per admission were higher in persons without dementia ($10,736 vs. $9,022, p = .0304). In adjusted regression results, increased costs were associated with nonelective admissions and longer LOS, and decreased costs with age above the mean. In contrast, decreased LOS was associated with age above the mean and nonelective admissions. Dementia was associated with neither endpoint.ConclusionThis study provides nurses and other health care professionals with data to further explore opportunities for improvement in cancer pain management in patients with and without dementia that may optimize use of medical resources.

Project description:ObjectiveTo examine the effect of optimising drug treatment on drug related hospital admissions in older adults with multimorbidity and polypharmacy admitted to hospital.DesignCluster randomised controlled trial.Setting110 clusters of inpatient wards within university based hospitals in four European countries (Switzerland, Netherlands, Belgium, and Republic of Ireland) defined by attending hospital doctors.Participants2008 older adults (≥70 years) with multimorbidity (≥3 chronic conditions) and polypharmacy (≥5 drugs used long term).InterventionClinical staff clusters were randomised to usual care or a structured pharmacotherapy optimisation intervention performed at the individual level jointly by a doctor and a pharmacist, with the support of a clinical decision software system deploying the screening tool of older person's prescriptions and screening tool to alert to the right treatment (STOPP/START) criteria to identify potentially inappropriate prescribing.Main outcome measurePrimary outcome was first drug related hospital admission within 12 months.Results2008 older adults (median nine drugs) were randomised and enrolled in 54 intervention clusters (963 participants) and 56 control clusters (1045 participants) receiving usual care. In the intervention arm, 86.1% of participants (n=789) had inappropriate prescribing, with a mean of 2.75 (SD 2.24) STOPP/START recommendations for each participant. 62.2% (n=491) had ≥1 recommendation successfully implemented at two months, predominantly discontinuation of potentially inappropriate drugs. In the intervention group, 211 participants (21.9%) experienced a first drug related hospital admission compared with 234 (22.4%) in the control group. In the intention-to-treat analysis censored for death as competing event (n=375, 18.7%), the hazard ratio for first drug related hospital admission was 0.95 (95% confidence interval 0.77 to 1.17). In the per protocol analysis, the hazard ratio for a drug related hospital admission was 0.91 (0.69 to 1.19). The hazard ratio for first fall was 0.96 (0.79 to 1.15; 237 v 263 first falls) and for death was 0.90 (0.71 to 1.13; 172 v 203 deaths).ConclusionsInappropriate prescribing was common in older adults with multimorbidity and polypharmacy admitted to hospital and was reduced through an intervention to optimise pharmacotherapy, but without effect on drug related hospital admissions. Additional efforts are needed to identify pharmacotherapy optimisation interventions that reduce inappropriate prescribing and improve patient outcomes.Trial registrationClinicalTrials.gov NCT02986425.

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Medical diagnoses of heat wave-related hospital admissions in older adults.

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Medical diagnoses of heat wave-related hospital admissions in older adults.

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