Time-Series Analysis of Heat Waves and Emergency Department Visits in Atlanta, 1993 to 2012 Open Access

Abstract

Heat waves are extreme weather events that have been associated with adverse health outcomes. However, there is limited knowledge of their impact on population morbidity such as emergency department (ED) visits. We investigated associations between heat waves and ED visits for 17 outcomes in Atlanta over a 20-year period, 1993-2012. Associations were estimated using Poisson log-linear models controlling for continuous temperature, dew-point temperature, day-of-week, holidays, and time trends. We defined heat waves as periods of greater than or equal to 2 consecutive days with temperatures beyond the 98^th percentile of the temperature distribution over the period (1945-2012). We considered 6 heat wave definitions using maximum, minimum, and average temperature and apparent temperature. Effect modification by heat wave characteristics was examined. Among all outcome-heat wave combinations, associations were strongest among ED visits for fluid and electrolyte imbalance and heat waves defined by minimum temperature at lag 0 [relative risk (RR): 1.07, 95% confidence interval (CI): 1.03-1.12], ED visits for acute renal failure and heat waves defined by minimum apparent temperature at lag 1 (RR: 1.14, 95% CI: 1.04-1.24), and ED visits for intestinal infection and heat waves defined by minimum temperature at lag 1 (RR: 1.07, 95% CI: 1.00-1.13). No significant associations were found for respiratory outcomes, and associations with cardiovascular outcomes were weak with little consistency across lags and heat wave definitions.

Table of Contents

1 Introduction.........................................................................................1

2 Materials and Methods..........................................................................4

2.1 Data Sources......................................................................................4

2.2 Statistical Analysis.............................................................................5

3 Results.................................................................................................8

4 Discussion...........................................................................................11

5 Conclusions.........................................................................................15

6 Appendices..........................................................................................24

7 Supplemental Material.........................................................................28

About this Master's Thesis

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School	Rollins School of Public Health
Department	Biostatistics and Bioinformatics
Subfield / Discipline	Biostatistics - MPH & MSPH
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Biology, Biostatistics Health Sciences, Public Health Environmental Health
Keyword	time-series heat wave emergency department visits
Committee Chair / Thesis Advisor	Chang, Howard, Emory University
Committee Members	Sarnat, Stefanie Ebelt, Emory University

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