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International Journal of Biometeorology

, Volume 56, Issue 1, pp 121–127 | Cite as

Weather conditions and visits to the medical wing of emergency rooms in a metropolitan area during the warm season in Israel: a predictive model

  • Ilya Novikov
  • Ofra Kalter-Leibovici
  • Angela Chetrit
  • Nir Stav
  • Yoram Epstein
Original Paper

Abstract

Global climate changes affect health and present new challenges to healthcare systems. The aim of the present study was to analyze the pattern of visits to the medical wing of emergency rooms (ERs) in public hospitals during warm seasons, and to develop a predictive model that will forecast the number of visits to ERs 2 days ahead. Data on daily visits to the ERs of the four largest medical centers in the Tel-Aviv metropolitan area during the warm months of the year (April–October, 2001–2004), the corresponding daily meteorological data, daily electrical power consumption (a surrogate marker for air-conditioning), air-pollution parameters, and calendar information were obtained and used in the analyses. The predictive model employed a time series analysis with transitional Poisson regression. The concise multivariable model was highly accurate (r 2 = 0.819). The contribution of mean daily temperature was small but significant: an increase of 1°C in ambient temperature was associated with a 1.47% increase in the number of ER visits (P < 0.001). An increase in electrical power consumption significantly attenuated the effect of weather conditions on ER visits by 4% per 1,000 MWh (P < 0.001). Higher daily mean SO2 concentrations were associated with a greater number of ER visits (1% per 1 ppb increment; P = 0.017). Calendar data were the main predictors of ER visits (r 2 = 0.794). The predictive model was highly accurate in forecasting the number of visits to ERs 2 days ahead. The marginal effect of temperature on the number of ER visits can be attributed to behavioral adaptations, including the use of air-conditioning.

Keywords

Urban Heat Island Behavioral Adaptation Electrical Power Consumption Absolute Relative Error Calendar Data 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank the emergency room directors: Dr. Pinchas Halperin, Tel-Aviv Sourasky Medical Center, and Dr. Zvi Rottenberg, Rabin Medical Center; and Prof. Zeev Rotstein, director of the Sheba Medical Center, and Dr Itzhak Berlowitz, director of Wolfson Medical Center, for provision of healthcare utilization data.

References

  1. Baccini M, Biggeri A, Accetta G, Kosatsky T, Katsouyanni K, Analitis A, Anderson HR, Bisanti L, D'Ippoliti D, Danova J, Forsberg B, Medina S, Paldy A, Rabczenko D, Schindler C, Michelozzi P (2008) Heat effects on mortality in 15 European Cities. Epidemiology 19:711–719CrossRefGoogle Scholar
  2. Basu R, Samet JM (2002) Relationship between elevated ambient temperature and mortality: a review of the epidemiologic evidence. Epidemiol Rev 24:190–202CrossRefGoogle Scholar
  3. Bernard SM, Samet JM, Grambsch A, Ebi KL, Romieu I (2001) The potential impacts of climate variability and change on air pollution-related health effects in the United States. Environ Health Perspect 109[Suppl 2]:199–209CrossRefGoogle Scholar
  4. Bouchama A, Dehbi M, Mohamed G, Matthies F, Shoukri M, Menne B (2007) Prognostic factors in heat wave-related deaths. Arch Intern Med 167:2170–2176CrossRefGoogle Scholar
  5. Brumback BA, Ryan LM, Schwartz J, Neas L, Stark P, Burge H (2000) Transitional regression models, with application to environmental time series. J Am Stat Assoc 95:16–27CrossRefGoogle Scholar
  6. Central Bureau of Statistics (2009) Ownership of durable goods in deciles of household (Table 10). June 7, 2009. http://www.cbs.gov.il/publications09/1363/excel/t10.xls. Accessed 25 May 2010
  7. Clarke JF (1972) Some effects of the urban structure on heat mortality. Environ Res 5:93–104Google Scholar
  8. Davido A, Patzak A, Dart T, Sadier MP, Méraud P, Masmoudi R, Sembach N, Cao TH (2006) Risk factors for heat related death during the August 2003 heat wave in Paris, France, in patients evaluated at the emergency department of the Hôpital Européen Georges Pompidou. Emerg Med J 23:515–518CrossRefGoogle Scholar
  9. Ellis FP, Prince HP, Lovatt G, Whittington RM (1980) Mortality and morbidity in Brimingham during the 1976 heatwave. Q J Med 49:1–8Google Scholar
  10. Empereur-Bissonnet P, Salines G, Bérat B et al. (2006) Heatwave in France, July 2006: 112 excess deaths so far attributed to the heat. Euro Surveill 11:E060803.3Google Scholar
  11. Fischer PH, Brunekreef B, Lebret E (2004) Air pollution related deaths during the 2003 heat wave in the Netherlands. Atmos Environ 38:1083–1085CrossRefGoogle Scholar
  12. Fokianos K, Kedem B (2004) Partial likelihood inference for time series following generalized linear models. J Time Ser Anal 25:173–197CrossRefGoogle Scholar
  13. Gaffen DJ, Ross RJ (1998) Increased summertime heat stress in the US. Nature 396:529–530CrossRefGoogle Scholar
  14. Intergovernmental Panel on climate change (IPCC) (2007) Climate Change 2007: Synthesis Report; 4th Assessment Report (AR4). WMO, Geneva, Switzerland. http://www.ipcc.ch/publications_and_data/publications_ipcc_fourth_assessment_report_synthesis_report.htm. Accessed 15 Sep. 2010
  15. Ishigami A, Hajat S, Kovats RS, Bisanti L, Rognoni M, Russo A, Paldy A (2008) An ecological time-series study of heat-related mortality in theree European cities. Environ Health 7:5–11CrossRefGoogle Scholar
  16. Johnson H, Kovats RS, McGregor G, Stedman J, Gibbs M, Walton H, Cook L, Black E (2005) The impact of the 2003 heat wave on mortality and hospital admissions in England. Health Stat Q 25:6–11Google Scholar
  17. Jones TS, Liang AP, Kilbourne EM, Griffin MR, Patriarca PA, Wassilak SG, Mullan RJ, Herrick RF, Donnell HD Jr, Choi K, Thacker SB (1982) Morbidity and mortality associated with the July 1980 heat wave in St. Louis and Kansas City, MO. JAMA 247:3327–3331CrossRefGoogle Scholar
  18. Katsouyanni K, Pantazopoulou A, Touloumi G, Tselepidaki I, Moustris K, Asimakopoulos D, Poulopoulou G, Trichopoulos D (1993) Evidence of interaction between air pollution and high temperature in the causation of excess mortality. Arch Environ Health 48:235–242CrossRefGoogle Scholar
  19. Kenney WL (1997) Thermoregulation at rest and during exercise in healthy older adults. Exerc Sport Sci Rev 25:41–76CrossRefGoogle Scholar
  20. Kilbourne EM, Choi K, Jones TS, Thacker SB (1982) Risk factors for heatstroke. A case control study. JAMA 247:3332–3336CrossRefGoogle Scholar
  21. Kinney PL, O'Neill MS, Bell ML, Schwartz J (2008) Approaches for estimating effects of climate change on heat-related deaths: challenges and opportunities. Environ Sci Policy 11:87–96CrossRefGoogle Scholar
  22. Knowlton K, Rotkin-Ellman M, King G, Margolis HG, Smith D, Solomon G, Trent R, English P (2009) The 2006 California heat wave: impacts on hospitalizations and emergency department visits. Environ Health Perspect 117:61–67Google Scholar
  23. Kovats RS, Hajat S (2008) Heat stress and public health: a critical review. Annu Rev Public Health 29:41–55CrossRefGoogle Scholar
  24. Kovats RS, Hajat S, Wilkinson P (2004) Contrasting patterns of mortality and hospital admissions during hot weather and heat waves in Greater London, UK. Occup Environ Med 61:893–898CrossRefGoogle Scholar
  25. Luber G, Prudent N (2009) Climate change and human health. Trans Am Clin Climatol Assoc 120:113–117Google Scholar
  26. O'Neill MS (2003) Air conditioning and heat related health effects. Appl Environ Sci Public Health 1:9–12Google Scholar
  27. Semenza JC, Rubin CH, Falter KH, Selanikio JD, Flanders WD, Howe HL, Wilhelm JL (1996) Heat-related deaths during the July 1995 heat wave in Chicago. N Engl J Med 335:84–90CrossRefGoogle Scholar
  28. Semenza JC, McCullough JE, Flanders WD, McGeehin MA, Lumpkin JR (1999) Excess hospital admissions during the July 1995 heat wave in Chicago. Am J Prev Med 16:269–277CrossRefGoogle Scholar
  29. Stedman JR (2004) The predicted number of air pollution related deaths in the UK during the August 2003 heat wave. Atmos Environ 38:1087–1090CrossRefGoogle Scholar
  30. Vanhems P, Gambotti L, Fabry J (2003) Excess rate of in-hospital death in Lyons, France, during the August 2003 heat-wave. N Engl J Med 349:2077–2078CrossRefGoogle Scholar
  31. Yannas S (2001) Towards more sustainable cities. Sol Energy 70:281–294CrossRefGoogle Scholar

Copyright information

© ISB 2011

Authors and Affiliations

  • Ilya Novikov
    • 1
  • Ofra Kalter-Leibovici
    • 2
    • 3
  • Angela Chetrit
    • 2
  • Nir Stav
    • 4
  • Yoram Epstein
    • 3
    • 5
  1. 1.Unit of BiostatisticsGertner Institute for Epidemiology & Health Policy ResearchTel HashomerIsrael
  2. 2.Unit of Cardiovascular EpidemiologyGertner Institute for Epidemiology & Health Policy ResearchTel HashomerIsrael
  3. 3.Sackler Faculty of MedicineTel Aviv UniversityTel HashomerIsrael
  4. 4.National Meteorological ServicesBeit DaganIsrael
  5. 5.Heller Institute of Medical ResearchSheba Medical CenterTel HashomerIsrael

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