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Impact of heat on emergency hospital admission in Texas: geographic and racial/ethnic disparities

Journal of Exposure Science & Environmental Epidemiology (2023)Cite this article

Abstract

Background

Studies exploring the racial/ethnicity disparity of the impact of heat on hospital admission are notably limited, especially in Texas, a state with a diverse population and consistently ranking among the top ten U.S. states for heat-related deaths per capita from 2018 to 2020.

Objective

Our objective is to determine the correlation between elevated temperatures and emergency hospital admissions for various causes and age groups across 12 Metropolitan Statistical Areas(MSAs) in Texas. Additionally, we aim to investigate health inequalities in the five largest MSAs in Texas between 2004 and 2013.

Methods

We used MSA-level hospital admission and weather data to estimate the relationship between heat and emergency hospital admissions. We applied a Generalized Additive Model and random effects meta-analysis to calculate MSA-specific associations and overall correlation, repeating the analysis for age groups and specific causes of admission. We also investigated health disparities across racial and ethnic groups and performed a sensitivity analysis.

Results

The results showed that a 1 °C increase in temperature was associated with a 0.50% (95% CI [0.38%, 0.63%]) increase in all-cause emergency hospital admissions. Heat’s impact on hospital admissions varied among age groups and causes, with children under 6 years showing the highest effect estimate (0.64% (95% CI [0.32%,0.96%])). Statistically significant associations were found for Cardiovascular Diseases (0.27% (95% CI [0.07%,0.47%])), Ischemic Heart Diseases (0.53% (95% CI [0.15%,0.92%])), Pneumonia (0.70% (95% CI [0.25%,1.16%])), and Respiratory Diseases (0.67% (95% CI [0.18%,1.17%])). Health disparities were found among racial and ethnic groups in the five largest MSAs.

Impact statement

Studies exploring the impact of heat on hospital admission in Texas are notably limited. Our research provided a comprehensive examination of the connection between heat and emergency hospital admissions throughout Texas. Furthermore, we are the first to examine racial/ethnic disparities, identifying African American and Hispanic groups as disproportionately affected. These insights provide valuable insights for policymakers to allocate resources and implement strategies to mitigate the negative consequences of rising temperatures.

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Fig. 1: Meta-analysis for heat effect on all-cause morbidity at lag 0–1 in 12 major Texas MSAs during 2004–2013.
Fig. 2: Pooled estimates of heat effect on age-stratified and cause-specific morbidity at the MSA-level in Texas during 2004–2013.
Fig. 3: Estimates of heat effect on race-stratified morbidity for five largest MSA in Texas including Austin-Round Rock, Dallas-Plano-Irving, El Paso, Houston-The Woodlands-Sugar Land, and San Antonio-New Braunfels during 2004–2013.
Fig. 4: Estimates of heat effect on ethnicity-stratified morbidity for five largest MSA in Texas including Austin-Round Rock, Dallas-Plano-Irving, El Paso, Houston-The Woodlands-Sugar Land, and San Antonio-New Braunfels during 2004–2013.
Fig. 5: Sensitivity analysis by changing lag range and adding pollution (ozone) into the estimation mode.

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Data availability

Hospital admission dataset can be requested through Texas Department of State Health Service.

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Funding

KZ was partially funded by the American Heart Association grant (19TPA34830085).

Author information

Authors and Affiliations

  1. Department of Economics, School of Art and Science, University at Albany, State University of New York, Albany, NY, USA

    Chunyu Guo

  2. Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Erjia Ge

  3. Department of Landscape Architecture and Urban Planning, School of Architecture, Texas A&M University, College Station, TX, USA

    Sungmin Lee

  4. Department of Geography and Environmental Studies, Texas State University, San Marcos, TX, USA

    Yongmei Lu

  5. Center of Excellence in Weather & Climate Analytics, University at Albany, State University of New York, Albany, NY, USA

    Nick P. Bassill

  6. Division of Biostatistics & Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Nanhua Zhang

  7. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Nanhua Zhang

  8. Department of Plants, Soils and Climate, Utah State University, Logan, UT, USA

    Wei Zhang

  9. Ecology Center, Utah State University, Logan, UT, USA

    Wei Zhang

  10. Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong, Hong Kong

    Yi Lu

  11. Department of Architectural Engineering, The Pennsylvania State University, University Park, PA, USA

    Yuqing Hu

  12. Department of Sociology and Anthropology, University of Texas at El Paso, El Paso, TX, USA

    Jayajit Chakraborty

  13. Department of Internal Medicine, Division of Molecular Medicine, Albuquerque, University of New Mexico Health Sciences Center, Albuquerque, NM, USA

    Rebecca T. Emeny

  14. Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA

    Kai Zhang

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Contributions

CG: Methodology, Writing – original draft, visualization. KZ: Conceptualization, methodology, supervision, and writing. EG, SL, Yongmei Lu, NPB, NZ, WZ, Yi Lu, YH, JC, and RTE: Writing – review & editing.

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Correspondence to Kai Zhang.

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Guo, C., Ge, E., Lee, S. et al. Impact of heat on emergency hospital admission in Texas: geographic and racial/ethnic disparities. J Expo Sci Environ Epidemiol (2023). https://doi.org/10.1038/s41370-023-00590-6

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