Impacts of High Temperatures on Cause-Specific Emergency Department Visits in North Carolina Public Deposited

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  • March 19, 2019
Creator
  • Lippmann, Steven
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Background: High ambient temperature is associated with a number of physiological and psychological responses that may influence the occurrence of emergency department visits. This dissertation project uses a cause-specific approach to assess the exposure-response associations between high ambient temperature and a wide range of disease and injury types, with the aim of more fully describing the impact of heat on emergency department visits in North Carolina. The first aim of this dissertation focuses on temperature and injury-related emergency visits. The second aim focuses on temperature and a nearly comprehensive set of diagnosis groups. Methods: Data on emergency department visits in North Carolina between April 1st and October 31st in 2008-2013 were ascertained from a statewide surveillance system. County-specific daily mean temperature data were obtained from meteorological archives. For Aim 1, injury visits were classified by intent and mechanism using external cause of injury codes. For Aim 2, visits were categorized into diagnosis groups using the Clinical Classification Software system. Age- and sex-stratified exposure-response trends for the associations between temperature and emergency department visits were quantified using Poisson regression. Results: Over 13 million emergency department visits were categorized. In the first aim, unintentional injuries due to drowning among children were positively associated with temperature, as were bites and stings and excessive heat in all age groups. Adverse medical effects increased markedly with temperature among older adults. Intentional assault among adolescents and young adults was positively associated with temperature. In the second aim, Injury/Poisoning and Symptoms/Signs were leading causes of ED visits in all ages, and Circulatory diagnoses ranked highest in patients ≥65 years old. The exposure-response patterns for nearly all age and diagnosis combinations were reasonably well described by a linear function of temperature and most of these associations were positive. Mental illness was the only diagnosis group that was inversely associated with temperature in all age groups. Conclusions: This study offers strong evidence of positive associations between daily mean temperatures and wide range of conditions resulting in emergency care, and highlights the importance of injury morbidity as a contributor to the overall population health impact of heat.
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  • In Copyright
Advisor
  • Richardson, David
  • Konrad, Charles
  • Proescholdbell, Scott
  • Poole, Charles
  • Waller, Anna
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2015
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  • Chapel Hill, NC
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