Extreme heat and paediatric emergency department visits in Southwestern Ontario.
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ABSTRACT: Objective
The risk of adverse health events is expected to increase with hotter temperatures, particularly among the most vulnerable groups such as elderly persons and children. The objective of this study was to assess the association between extreme heat and daily emergency department visits among children (0 to 17 years) in Southwestern Ontario.Methods
We examined the average maximum temperature, relative humidity, and daily paediatric emergency department visits in June through August of 2002 to 2019. We reviewed emergency department visits from two academic hospitals. Daily meteorological data from the local weather station were obtained from Environment and Climate Change Canada.Results
Extreme heat, defined as the 99th percentile of the maximum temperature distribution, occurred at 33.1°C and was associated with an overall 22% increase in emergency department visits, compared to the reference temperature of 21°C. This association was mostly found between the second and fifth day after the exposure, suggesting a slightly delayed effect. The results of the sub-group analysis indicate that the risk of an emergency department visit due to infectious disease increases by 35% and the most pronounced association was noted in children aged 1 to 12 years.Conclusions
Extreme heat is associated with an increased incidence of emergency department visits in children. As temperatures continue to increase, strategies to mitigate heat-related health risks among children should be developed.
SUBMITTER: Wilk P
PROVIDER: S-EPMC8318534 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectivesDespite unregulated amphetamine use increasing, there are limited data on related emergency department (ED) visits in Canada. Our primary objective was to examine trends in amphetamine-related ED visits over time in Ontario, including by age and sex. Secondary objectives were to examine whether patient characteristics were associated with ED revisit within 6 months.MethodsUsing administrative claims and census data, we calculated annual patient- and encounter-based rates of amphetamine-related ED visits from 2003 to 2020 among individuals 18+ years of age. We also performed a retrospective cohort study of individuals with amphetamine-related ED visits between 2019 and 2020 to determine whether select factors were associated with ED revisit within 6 months. Multivariable logistic regression modelling was used to measure associations.ResultsThe population-based rate of amphetamine-related ED visits increased nearly 15-fold between 2003 (1.9/100,000 Ontarians) and 2020 (27.9/100,000 Ontarians). Seventy-five percent of individuals returned to the ED for any reason within 6 months. Psychosis and use of other substances were both independently associated with ED revisit for any reason within 6 months (psychosis: AOR = 1.54, 95% CI = 1.30-1.83; other substances: AOR = 1.84, 95% CI = 1.57-2.15), whereas having a primary care physician was negatively associated with ED revisit (AOR = 0.77, 95% CI = 0.60-0.98).ConclusionsIncreasing rates of amphetamine-related ED visits in Ontario are cause for concern. Diagnoses of psychosis and the use of other substances may serve to identify individuals who are most likely to benefit from both primary and substance-specific care.
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Project description:InterventionOntario's Harmonized Heat Warning and Information System (HWIS) brings harmonized, regional heat warnings and standard heat-health messaging to provincial public health units prior to periods of extreme heat.Research questionWas implementation of the harmonized HWIS in May 2016 associated with a reduction in emergency department (ED) visits for heat-related illness in urban locations across Ontario, Canada?MethodsWe conducted a population-based interrupted time series analysis from April 30 to September 30, 2012-2018, using administrative health and outdoor temperature data. We used autoregressive integrated moving average models to examine whether ED rates changed following implementation of the harmonized HWIS, adjusted for maximum daily temperature. We also examined whether effects differed in heat-vulnerable groups (≥65 years or <18 years, those with comorbidities, those with a recent history of homelessness), and by heat warning region.ResultsOver the study period, heat alerts became more frequent in urban areas (6 events triggered between 2013 and 2015 and 14 events between 2016 and 2018 in Toronto, for example). The mean rate of ED visits was 47.5 per 100,000 Ontarians (range 39.7-60.1) per 2-week study interval, with peaks from June to July each year. ED rates were particularly high in those with a recent history of homelessness (mean rate 337.0 per 100,000). Although rates appeared to decline following implementation of HWIS in some subpopulations, the change was not statistically significant at a population level (rate 0.04, 95% CI: -0.03 to 0.1, p=0.278).ConclusionIn urban areas across Ontario, ED encounters for heat-related illness may have declined in some subpopulations following HWIS, but the change was not statistically significant. Efforts to continually improve HWIS processes are important given our changing Canadian climate.
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Project description:Emerging research suggests that internet search patterns may provide timely, actionable insights into adverse health impacts from, and behavioral responses to, days of extreme heat, but few studies have evaluated this hypothesis, and none have done so across the United States. We used two-stage distributed lag nonlinear models to quantify the interrelationships between daily maximum ambient temperature, internet search activity as measured by Google Trends, and heat-related emergency department (ED) visits among adults with commercial health insurance in 30 US metropolitan areas during the warm seasons (May to September) from 2016 to 2019. Maximum daily temperature was positively associated with internet searches relevant to heat, and searches were in turn positively associated with heat-related ED visits. Moreover, models combining internet search activity and temperature had better predictive ability for heat-related ED visits compared to models with temperature alone. These results suggest that internet search patterns may be useful as a leading indicator of heat-related illness or stress.
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Project description:BackgroundShort-term associations between extreme heat events and adverse health outcomes are well-established in epidemiologic studies. However, the use of different exposure definitions across studies has limited our understanding of extreme heat characteristics that are most important for specific health outcomes or subpopulations.MethodsLogic regression is a statistical learning method for constructing decision trees based on Boolean combinations of binary predictors. We describe how logic regression can be utilized as a data-driven approach to identify extreme heat exposure definitions using health outcome data. We evaluated the performance of the proposed algorithm in a simulation study, as well as in a 20-year time-series analysis of extreme heat and emergency department visits for 12 outcomes in the Atlanta metropolitan area.ResultsFor the Atlanta case study, our novel application of logic regression identified extreme heat exposure definitions that were associated with several heat-sensitive disease outcomes (e.g., fluid and electrolyte imbalance, renal diseases, ischemic stroke, and hypertension). Exposures were often characterized by extreme apparent minimum temperature or maximum temperature over multiple days. The simulation study also demonstrated that logic regression can successfully identify exposures of different lags and duration structures when statistical power is sufficient.ConclusionLogic regression is a useful tool for identifying important characteristics of extreme heat exposures for adverse health outcomes, which may help improve future heat warning systems and response plans.
| S-EPMC8077733 | biostudies-literature
Project description:BackgroundCannabis-related emergency department visits can be an entry point for youths to mental health and substance use care systems. We aimed to examine trends in cannabis-related emergency department visits as a function of youths' age and sex.MethodsUsing administrative data, we examined all visits to emergency departments in Ontario, Canada, from 2003 to 2017, by youth aged 10-24 years (grouped as 10-13, 14-18 and 19-24 yr) to determine trends in cannabis-related emergency department visits. Cannabis-related visits were identified using International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes for cannabis poisoning and mental disorders due to cannabinoids. We categorized presentations as "less severe" versus "more severe" using scores assigned by nurses at triage.ResultsWe examined 14 697 778 emergency department visits. Cannabis-related visits increased from 3.8 per 10 000 youths (95% confidence interval [CI] 3.5-4.0) in 2003 to 17.9 (95% CI 17.4-18.4) in 2017, a 4.8-fold increase (95% CI 4.4-5.1). Rates increased for both sexes and each age group. Males were more likely to have a visit than females (rate ratios ≥ 1.5 in 2003 and 2017). The number of cannabis-related visits in 2017 was 25.0 per 10 000 (95% CI 24.0-25.9) among youth aged 19-24 years, 21.9 per 10 000 (95% CI 20.9-22.9) among those aged 14-18 years, and 0.8 per 10 000 (95% CI 0.5-1.0) among those aged 10-13 years. In 2017, 88.2% (95% CI 87.3%-89.0%) of cannabis-related visits and 58.1% (95% CI 58.0%-58.2%) of non-cannabis-related visits were triaged as "more severe," (rate ratio 1.52, 95% CI 1.50-1.53). Similarly, in 2017, 19.0% (95% CI 18.0%-20.1%) of cannabis-related visits and 5.8% (95% CI 5.7%-5.8%) of non-cannabis-related visits resulted in hospital admission (rate ratio 3.3, 95% CI 3.1-3.5).InterpretationRates of cannabis-related emergency department visit by youths aged 10-24 years increased almost fivefold from 2003 to 2017, with increases in visit severity and hospital admissions. These trends describe an emerging public health problem, and research is needed to identify the causes of this increase and the health and social consequences of cannabis-related visits for these youths.
| S-EPMC9259464 | biostudies-literature
Project description:Urban areas have complex thermal distribution. We examined the association between extreme temperature and mortality in urban Ontario, using two temperature data sources: high-resolution and weather station data. We used distributed lag non-linear Poisson models to examine census division-specific temperature-mortality associations between May and September 2005-2012. We used random-effect multivariate meta-analysis to pool results, adjusted for air pollution and temporal trends, and presented risks at the 99th percentile compared to minimum mortality temperature. As additional analyses, we varied knots, examined associations using different temperature metrics (humidex and minimum temperature), and explored relationships using different referent values (most frequent temperature, 75th percentile of temperature distribution). Weather stations yielded lower temperatures across study months. U-shaped associations between temperature and mortality were observed using both high-resolution and weather station data. Temperature-mortality relationships were not statistically significant; however, weather stations yielded estimates with wider confidence intervals. Similar findings were noted in additional analyses. In urban environmental health studies, high-resolution temperature data is ideal where station observations do not fully capture population exposure or where the magnitude of exposure at a local level is important. If focused upon temperature-mortality associations using time series, either source produces similar temperature-mortality relationships.
| S-EPMC8046761 | biostudies-literature
Project description:BackgroundThe number of paediatric emergency department (ED) visits and hospital admissions was recorded in a tertiary referral centre during the first year of the COVID-19, March 2020-February 2021, and compared with those of the preceding year.MethodsThe number of visits and admissions and the reason of visit and admission were prospectively recorded from 15,087 patients' files.ResultsA substantial decline in the total number of visits and increase in the admission rate were documented during the COVID-19 year compared to the preceding year (10691 vs 4396 patients, 22.59% vs 18.15% (OR: 1.316, CI 95%: 1.208-2.242, p < 0.0001), respectively). Fever and/or respiratory symptoms were the commonest reported symptoms in both periods. Possible explanations include: (i) restricted overall infection transmission due to confinement and self-protective measures, (ii) avoidance of unnecessary hospital visits in the absence of severe symptoms and (iii) reduced or delayed access to medical care due to parental fear of children's exposure to COVID-19.ConclusionThis study is the first worldwide to investigate the impact of COVID-19 on ED visits and admissions throughout the whole year of the pandemic, and to highlight the need for re-evaluation of future protective strategies to infections, adjustment of health-care systems and parental education so that medical care in a health-care setting is sought in a more appropriate manner.ImpactA significant decline in paediatric ED visits and increase in the admission rate was observed during the first year of COVID-19 in a tertiary referral centre, possibly due to reduced overall infection transmission, limited ED overuse, but also ED underuse due to parental fear of children's exposure to SARS-CoV-2. COVID-19 may serve as an opportunity for societies to re-evaluate future strategies to infections, adjust health-care systems accordingly, and reinforce parents to seek medical care more appropriately. Although the incidence of critical illness in children due to COVID-19 and in general is low, special attention should be devoted to identifying children at risk early.
| S-EPMC8556833 | biostudies-literature
Project description:OBJECTIVE:In Canada, non-traumatic dental conditions (NTDCs) presenting in emergency departments (EDs) are dealt with by non-dental professionals who are generally not equipped to deal with such emergencies, resulting in an inefficient usage of heath care resources. This study aimed to assess the burden of ED visits for NTDCs in Ontario by observing trends from 2006 to 2014. METHODS:Aggregate data for Ontario were obtained from the Canadian Institute for Health Information's National Ambulatory Care Reporting System. Data were examined for the whole of Ontario and stratified by 14 Local Health Integration Networks. Descriptive analysis was conducted for both number of people and number of visits, stratified by sex and age groups (0-5, 6-18, 19-64, and 65+ years). Numbers were also examined by neighbourhood stratifications, including urban/rural, income quintile and immigrant tercile. RESULTS:Over the study period, an upward trend of visiting EDs for NTDCs was observed. Approximately 403 628 people in Ontario made 482 565 visits over the period of nine years. On average, 341 per 100 000 people, per year, visited. Young children, people living in neighbourhoods with lower income and higher immigrant concentration, and people living in the rural regions, visited EDs more for NTDCs during 2006-2014. CONCLUSION:The upward and inequitable trends of utilization of EDs for NTDCs reinforce recognition of the important need for both universal and targeted approaches for primary prevention of dental conditions. To enhance equitable access to dental care, policy advocacy is required for publicly funding essential and emergency dental services for all.
| S-EPMC6972413 | biostudies-literature
Project description:Public Health Ontario is working to estimate the burden of disease from environmental hazards in Ontario, Canada. As part of this effort, we estimated deaths and health care utilization resulting from exposure to pathogens and toxic substances in food. We applied fractions for the proportion of illness attributable to foodborne transmission to the annual (2008-2012) counts of deaths, hospitalizations, emergency department (ED) visits, and physician office visits for 15 diseases (13 pathogen-specific diseases and 2 nonspecific syndromes) captured by administrative health data. Nonspecific gastroenteritis (causative agent unknown) was the dominant disease, accounting for 98% of ED visits, 94% of hospitalizations, and 88% of deaths annually attributed to the 15 diseases. We estimated that foodborne nonspecific gastroenteritis results in ∼137,000 physician office visits (1000/100,000 population), 40,000 ED visits (310/100,000), 6200 hospitalizations (47/100,000), and 59 deaths (0.45/100,000) in Ontario per year (mean estimates). Our results indicate that pathogen-specific approaches to foodborne disease surveillance can substantially underestimate the deaths and illness resulting from exposure to foodborne pathogens and other causes of foodborne illness.
| S-EPMC6434595 | biostudies-literature
Project description:ImportanceOpioids can impair motor skills and may affect the ability to drive; however, the association of opioid use with driving ability is not well established.ObjectiveTo examine the risk of motor vehicle collisions (MVCs) among drivers starting opioid therapy compared with that among drivers starting nonsteroidal anti-inflammatory drug (NSAID) therapy.Design, setting, and participantsThis population-based, retrospective cohort study included all residents of Ontario aged 17 years or older who started new prescription analgesic therapy between March 1, 2008, and March 17, 2019.ExposuresInitiation of opioid therapy or NSAID therapy, ascertained through prescription dispensing records in administrative data.Main outcomes and measuresThe primary outcome was an emergency department visit for injuries sustained as a driver in an MVC during the 14 days after starting analgesic therapy. Inverse probability treatment weighting was used to balance baseline covariates, and weighted Cox proportional hazards regression models were used to assess the association between new analgesic therapy and hazard of an emergency department visit after an MVC.ResultsOf the 1 454 824 individuals included in the study, 765 464 (52.6%) were new opioid recipients and 689 360 (47.4%) were new NSAID recipients. Most participants were aged 65 years or older (75.2%), and 55.2% were women. Of 194 individuals who had emergency department visits for injuries from an MVC within 14 days of initiating therapy, 98 (50.5%) were opioid recipients (3.41 per 1000 person-years; 95% CI, 2.80-4.15 per 1000 person-years) and 96 (49.5%) were NSAID recipients (3.64 per 1000 person-years; 95% CI, 2.98-4.45 per 1000 person-years). There was no significant difference in the risk of an emergency department visit for MVC injuries between opioid and NSAID recipients (weighted hazard ratio, 0.94; 95% CI, 0.70-1.25).Conclusions and relevanceThe findings of this study suggest that the hazard of an emergency department visit for injuries relating to an MVC as a driver is similar between individuals starting prescription opioids and those starting prescription NSAIDs. These results may be useful for patients, clinicians, and caregivers when considering new analgesic therapy.
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