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Extreme heat events may increase ESRD hospital admission, mortality risks
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Extreme heat events were associated with an increased risk for hospital admissions and mortality among patients with end-stage renal disease, according to a recently published study. Researchers also found these risks may vary by geographic location, race/ethnicity and comorbidities.
“Extreme heat events are increasing in frequency, duration and intensity, and this trend is projected to continue as part of ongoing climate change,” Amir Sapkota, PhD, of the Maryland Institute for Applied Environmental Health at the University of Maryland School of Public Health, and researchers wrote. “The evidence that climate and human health are inextricably connected has been increasing during the last decade. Prior studies on the effects of extreme heat have consistently shown an increased risk of hospital admission and mortality among the general population, particularly in urban areas. Urban communities may be disproportionately affected by extreme heat because of higher rates of poverty and more intense heat exposure due to the urban heat island effect. However, to our knowledge, few studies have investigated how extreme heat events may affect highly vulnerable populations, such as individuals living with ESRD within these urban centers.”
Researchers analyzed hospital admission and mortality records from 7,455 patients who underwent hemodialysis treatment at Fresenius Kidney Care clinics in Boston, Philadelphia or New York from January 2001 to December 2012 (mean age, 61.1 years; 57.5% were men). Patients were categorized by self-reported race/ethnicity as Hispanic, non-Hispanic black, non-Hispanic white or Asian.
To identify extreme heat events, researchers calculated calendar-day and location-specific 95th percentile maximum temperature thresholds by comparing daily meteorological data from 1960 to 1989 with daily meteorological data from 2001 through 2012. Extreme heat events were those which exceeded the thresholds.
During the study period, 2,953 deaths and 44,941 hospital admissions (mean, six per patient) occurred, with the highest mortality rate in Boston. Researchers found that, among all participants, extreme heat events were associated with increased risk of same-day hospital admission (rate ratio = 1.27) and same-day mortality (RR = 1.31).
Researchers further observed that patients in Boston had a statistically significant increased risk for hospital admission (RR = 1.15) associated with cumulative exposure to extreme heat events. This association was not found for patients in Philadelphia. In addition, cumulative exposure to extreme heat events was associated with increased risk for hospital admissions among black and white patients, but not among Hispanic or Asian patients. Finally, after stratifying by preexisting comorbidities, researchers found extreme heat events were associated with increased risk for mortality among patients who also had congestive heart failure, chronic obstructive pulmonary disease or diabetes.
“The projected increases in extreme heat events associated with climate change are a significant public health concern, as they can negatively affect vulnerable populations, such as patients with ESRD,” the researchers wrote. “The geographic heterogeneity observed among Boston, NYC and Philadelphia during the study is in agreement with previous studies that have noted such variability in the influence of climate change on local weather events. These preliminary findings highlight the need for national scale assessments to quantify the underlying geographic and demographic variability in risk of hospital admission and mortality associated with extreme heat events to better inform ESRD management in a changing climate.” – by Melissa J. Webb
Disclosures: Sapkota reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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