The Association between Ambient Heat Exposure and Pediatric Mental Health, Modified by Individual Socioeconomic Status Restricted; Files Only

Lockwood, Sophie (Spring 2023)

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Purpose: This study examined the association between ambient heat exposure and acute mental health events among children aged 5-17 years in Los Angeles County, California between 2005 and 2019, and evaluated individual socioeconomic status as an effect measure modifier.

Methods: Patient-level data of mental health-related emergency department (ED) visits was obtained from the California Office of Statewide Health Planning and Development and meteorological data recorded at the Los Angeles International Airport Weather Station was obtained from the National Oceanic and Atmospheric Administration’s National Center for Environmental Information Integrated Surface Database. A case-crossover study design was used where control days were selected from the same day, week, and calendar year as the observed case day. Distributed lag non-linear models were fit to assess the cumulative effect of mean and maximum daily temperature on the odds of ED visit for nine categories of mental health outcomes. Stratification on payor status was used to evaluate effect measure modification by individual socioeconomic status.

Results: The findings suggest that the cumulative effect of increasing mean daily temperature was associated with increased odds of ED visits for anxiety, cognitive, mood, and suicide and self-harm disorders and that this association is slightly stronger among children covered by California’s Medicaid program compared to those covered by private insurance for anxiety disorders and suicide and self-harm. Effect measure modification was not consistently identified among other mental health outcomes or by considering exposure to daily maximum temperature.

Conclusions: This study provides evidence that increasing ambient temperature is associated increased risk of suicide and self-harm and anxiety, cognitive, and mood disorders among children and that these effects are stronger among Medicaid-covered patients for several outcomes. Future work in this field should address additional methods of measuring socioeconomic status and mental health burden. 

Table of Contents

Background 1

Methods 4

Results 7

Discussion 15

Conclusion 18

References 19

Appendix 22

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