TOPLINE:
An increase in outdoor temperature is associated with increased hospital visits for both alcohol- and substance-related disorders, results of a study spanning 20 years show.
METHODOLOGY:
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Evaluations of weather and climate on health have mainly focused on infectious and parasitic diseases, chronic conditions affecting cardiovascular and respiratory systems, and mental health-related mortality outcomes such as suicide and violence.
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It’s plausible that people require more hospitalizations during warmer weather as they spend more time outdoors, consume more substances, perspire more and become dehydrated, or drive while under the influence.
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From relevant databases, researchers obtained 671,625 hospital visit records for alcohol-related disorders, and 721,469 records for disorders related to other drugs (cannabis, cocaine, opioids, and sedatives), across New York State from 1995-2014, information on patient residential ZIP codes and sociodemographic information, and data on daily average temperatures, relative humidity, and pressure.
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Investigators created exposure-response curves of cumulative percentage change in hospital visit rates relative to minimal temperature (−30.1 °C [−22.2 °F]) and plotted percentage change in hospital visit rates by percentiles of temperature relative to minimal temperature.
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They used 6 days’ cumulative associations prior to hospital visit, and controlled for seasonal patterns, long-term trends, and non- or slowly varying confounders.
TAKEAWAY:
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Males accounted for most of the hospital visits, which were mainly inpatient and outside New York City. The age group with the largest proportion of hospital visits was 25-44 years, ranging from 46% of alcohol-related disorder visits to 61% of cocaine visits.
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For alcohol-related hospital visits, an increase in temperature from the period minimum (-30.1 °C [-22.2 °F]) to the 75th percentile (18.8 °C [65.8 °F]) across 0-6 lag days was associated with a cumulative 24.6% (95% CI, 14.6% – 34.6%) increase in hospital visit rates.
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For substance-related disorders, there was an association between increases in temperatures from the period minimum (-30.1 °C [-22.2 °F]) to the 50th percentile (10.4 °C [50.7 °F]) (37.7%; 95% CI, 27.2% – 48.2%).
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The relationship for substance-related disorders continued only up to a temperature threshold, possibly because once it becomes sufficiently comfortable, further temperature increases don’t result in more outdoor activity.
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Sub-analyses by females vs males, various age group, and socioeconomic status demonstrated consistent evidence of an association.
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Results of analyses only including temperatures from the day of and the day before (0-1 days) were the same as the main analysis overall.
IN PRACTICE:
“Our work highlights how hospital visits from alcohol- and substance-related disorders are currently susceptible to elevated temperatures and could also be modified by rising temperatures resulting from climate change,” the researchers write, adding public health interventions targeting these disorders in warmer weather “should be a public health priority.”
SOURCE:
The study was conducted by Robbie M. Parks, PhD, Department of Environmental Health Sciences, Mailman School of Public Health, and The Earth Institute, Columbia University, New York City, and colleagues. It was published online September 26 in the journal Communications Medicine.
LIMITATIONS:
As the most severe cases of alcohol- and substance-related disorders likely resulted in death before a hospital visit, outcome misclassification is possible. Estimated associations may have been susceptible to confounding bias. The study was confined to New York state, and associations should be further explored in different communities and climates. It also focused on individual disorders and not comorbidities, which may modify alcohol- and substance-related vulnerability to heat stress. The consequences of these findings in the context of a changing climate are unclear.
DISCLOSURES:
The study was supported by the National Institute of Environmental Health Sciences. The authors have no relevant conflicts of interest.
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