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Heat and hospital admission via the emergency department for people with intellectual disability, autism, and mental disorders in South Korea: a nationwide, time-stratified, case-crossover study
The Lancet Psychiatry ( IF 64.3 ) Pub Date : 2024-04-15 , DOI: 10.1016/s2215-0366(24)00067-1
Jinah Park , Ayoung Kim , Michelle L Bell , Ho Kim , Whanhee Lee

Given the anticipated increase in ambient temperature due to climate change, the hazardous effects of heat on health have been extensively studied; however, its impact on people with intellectual disability, autism, and mental illness is largely unknown. We aimed to estimate the association between heat and hospitalisation through the emergency department (ED) among people with these mental disorders. In this nationwide study, we used data from the National Health Insurance Database (NHID) of the National Health Insurance Service, the single universal insurer in South Korea, the claims data for which is based on the ICD-10. We included individuals with identified intellectual disability, autism, and mental disorders (including schizophrenia, bipolar disorder, recurrent depressive disorder, schizoaffective disorder and persistent obsessive-compulsive disorder, Tourette's disorder, and narcolepsy) and we established two control groups of people without these disorders: one including 1 million systematically sampled individuals, and one matched to the cohort based on sex, age, and income group. Data on hospital admission via the ED were obtained from the NHID, including the primary cause of admission and corresponding medical costs, for the warm season (June–September) of the period 2006–2021. We used the Google Earth Engine with the ERA5-Land dataset to collect data on the daily mean temperature. We applied a time-stratified case-crossover design using a distributed lag non-linear model and performed a conditional logistic regression. The risk ratio was estimated as the odds ratio (OR) with calculated odds at the 99th percentile temperature compared with that at the local 75th percentile temperature. We did not include people with lived experience of mental illness in this study. Of the 456 946 people with intellectual disability, autism, or mental disorder in the NHID records, 99 845 were admitted to the ED, including 59 821 (59·9%) males and 40 024 (40·1%) females, and including 29 192 people with intellectual disability, 1428 people with autism, and 69 225 people with mental disorders. We were not able to collect data on ethnicity. The mean age at ED admission was 42·1 years (SD 17·9, range 0–102) for people with intellectual disability, 18·6 years (SD 10·4, range 1–72) for people with autism, and 50·8 years (SD 11·9, range 2–94) for people with mental disorders. The heat OR (odds at the 99th percentile 75th percentile of temperature) of ED admission was 1·23 (95% CI 1·11–1·36) for intellectual disability, 1·06 (0·68–1·63) for autism, and 1·20 (1·12–1·29) for mental disorders. People with intellectual disability, female individuals, people living in rural areas, or those with a low-income status were at increased risk of ED admission due to heat. The risk of ED admission due to genitourinary diseases was higher than that from other causes. Annual increase in medical costs attributable to heat among people with intellectual disability, autism, and mental disorders was US$ 224 970 per 100 000 person-years (95% empirical CI 139 784–305 770). People with intellectual disability, autism, and mental disorders should be included in groups considered at a high-risk for heat exposure, and heat adaptation policies should be implemented with consideration of these groups and their needs. The National Research Foundation of Korea, Korean Ministry of Environment, and Korean Ministry of Education. For the Korean translation of the abstract see Supplementary Materials section.

中文翻译:

韩国智力障碍、自闭症和精神障碍患者的高温和急诊入院:一项全国性、时间分层、病例交叉研究

鉴于气候变化预计会导致环境温度升高,人们对高温对健康的危害进行了广泛的研究;然而,它对智力障碍、自闭症和精神疾病患者的影响在很大程度上尚不清楚。我们的目的是评估这些精神障碍患者中高温与急诊科 (ED) 住院治疗之间的关联。在这项全国性研究中,我们使用了韩国唯一的全民保险公司国民健康保险公社的国民健康保险数据库 (NHID) 的数据,其索赔数据基于 ICD-10。我们纳入了已确诊的智力障碍、自闭症和精神障碍(包括精神分裂症、双相情感障碍、复发性抑郁症、分裂情感性障碍和持续性强迫症、抽动秽语症和发作性睡病)的个体,并建立了两个没有这些障碍的对照组:其中包括 100 万系统抽样个体,其中一个根据性别、年龄和收入群体与队列进行匹配。通过 ED 的入院数据从 NHID 获得,包括 2006 年至 2021 年暖季(6 月至 9 月)的入院主要原因和相应的医疗费用。我们使用 Google Earth Engine 和 ERA5-Land 数据集来收集日平均温度数据。我们使用分布式滞后非线性模型应用时间分层案例交叉设计,并执行条件逻辑回归。风险比估计为比值比 (OR),其中计算出第 99 个百分位温度下的比值与当地第 75 个百分位温度下的比值。我们的研究中没有包括有过精神疾病经历的人。在 NHID 记录中的 456 946 名智力障碍、自闭症或精神障碍患者中,有 99 845 人被送入急诊室,其中包括 59 821 名男性 (59·9%) 和 40 024 名女性 (40·1%),其中包括智力障碍患者29192人,自闭症患者1428人,精神障碍患者69225人。我们无法收集有关种族的数据。智力障碍患者入院时的平均年龄为 42·1 岁(SD 17·9,范围 0–102),自闭症患者为 18·6 岁(SD 10·4,范围 1–72),50 岁对于精神障碍患者,8 年(SD 11·9,范围 2-94)。急诊科入院的热 OR(体温第 99 个百分位和第 75 个百分位的比值)对于智力障碍为 1·23 (95% CI 1·11–1·36),对于智力障碍为 1·06 (0·68–1·63)自闭症,精神障碍 1·20 (1·12–1·29)。智力障碍者、女性、农村地区的人或低收入人群因高温而入急诊室的风险增加。因泌尿生殖系统疾病入院急诊的风险高于其他原因。智障人士因高温而导致的医疗费用逐年增加,自闭症和精神障碍的费用为每 10 万人年 224 970 美元(95% 经验 CI 139 784–305 770)。应将智力障碍、自闭症和精神障碍患者纳入热暴露高危人群,并在实施热适应政策时考虑这些人群及其需求。韩国国家研究基金会、韩国环境部和韩国教育部。有关摘要的韩语翻译,请参阅补充材料部分。
更新日期:2024-04-15
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