BACKGROUND: Several studies have identified strong effects of high temperatures on mortality at population level; however, individual vulnerability factors associated with heat-related in-hospital mortality are largely unknown. The objective of the study was to evaluate heat-related in-hospital mortality using a multi-city case-crossover analysis. METHODS: We studied residents of four Italian cities, aged 65+ years, who died during 1997-2004. For 94,944 individuals who died in hospital and were hospitalised two or more days before death, demographics, chronic conditions, primary diagnoses of last event and hospital wards were considered. A city-specific case-crossover analysis was performed to evaluate the association between apparent temperature and mortality. Pooled odds ratios (OR) of dying on a day with a temperature of 30 degrees C compared to a day with a temperature of 20 degrees C were estimated with a random-effects meta-analysis. RESULTS: We estimated an overall OR of 1.32 (95% confidence interval: 1.25, 1.39). Age, marital status and hospital ward were important risk indicators. Patients in general medicine were at higher risk than those in high and intensive care units. A history of psychiatric disorders and cerebrovascular diseases gave a higher vulnerability. Mortality was greater among patients hospitalised for heart failure, stroke and chronic pulmonary diseases. CONCLUSIONS: In-hospital mortality is strongly associated with high temperatures. A comfortable temperature in hospitals and increased attention to vulnerable patients during heatwaves, especially in general medicine, are necessary preventive measures.
BACKGROUND: Several studies have identified strong effects of high temperatures on mortality at population level; however, individual vulnerability factors associated with heat-related in-hospital mortality are largely unknown. The objective of the study was to evaluate heat-related in-hospital mortality using a multi-city case-crossover analysis. METHODS: We studied residents of four Italian cities, aged 65+ years, who died during 1997-2004. For 94,944 individuals who died in hospital and were hospitalised two or more days before death, demographics, chronic conditions, primary diagnoses of last event and hospital wards were considered. A city-specific case-crossover analysis was performed to evaluate the association between apparent temperature and mortality. Pooled odds ratios (OR) of dying on a day with a temperature of 30 degrees C compared to a day with a temperature of 20 degrees C were estimated with a random-effects meta-analysis. RESULTS: We estimated an overall OR of 1.32 (95% confidence interval: 1.25, 1.39). Age, marital status and hospital ward were important risk indicators. Patients in general medicine were at higher risk than those in high and intensive care units. A history of psychiatric disorders and cerebrovascular diseases gave a higher vulnerability. Mortality was greater among patients hospitalised for heart failure, stroke and chronic pulmonary diseases. CONCLUSIONS: In-hospital mortality is strongly associated with high temperatures. A comfortable temperature in hospitals and increased attention to vulnerable patients during heatwaves, especially in general medicine, are necessary preventive measures.
Authors: F K de'Donato; M Stafoggia; M Rognoni; S Poncino; N Caranci; L Bisanti; M Demaria; F Forastiere; P Michelozzi; R Pelosini; C A Perucci Journal: Int J Biometeorol Date: 2007-11-21 Impact factor: 3.787
Authors: Patrizia Schifano; Giovanna Cappai; Manuela De Sario; Paola Michelozzi; Claudia Marino; Anna Maria Bargagli; Carlo A Perucci Journal: Environ Health Date: 2009-11-12 Impact factor: 5.984
Authors: Paola Michelozzi; Francesca K de' Donato; Anna Maria Bargagli; Daniela D'Ippoliti; Manuela De Sario; Claudia Marino; Patrizia Schifano; Giovanna Cappai; Michela Leone; Ursula Kirchmayer; Martina Ventura; Marta di Gennaro; Marco Leonardi; Fabrizio Oleari; Annamaria De Martino; Carlo A Perucci Journal: Int J Environ Res Public Health Date: 2010-05-06 Impact factor: 3.390
Authors: Colleen E Reid; Marie S O'Neill; Carina J Gronlund; Shannon J Brines; Daniel G Brown; Ana V Diez-Roux; Joel Schwartz Journal: Environ Health Perspect Date: 2009-06-10 Impact factor: 9.031