title: Associations between extreme precipitation and gastrointestinal-related hospital admissions in Chennai, India.
abstract: BACKGROUND
  Understanding the potential links between extreme weather events and human health in India is important in the context of vulnerability and adaptation to climate change. Research exploring such linkages in India is sparse.
  
  
  OBJECTIVE
  We evaluated the association between extreme precipitation and gastrointestinal (GI) illness-related hospital admissions in Chennai, India, from 2004 to 2007.
  
  
  METHODS
  Daily hospital admissions were extracted from two government hospitals in Chennai, India, and meteorological data were retrieved from the Chennai International Airport. We evaluated the association between extreme precipitation (≥ 90th percentile) and hospital admissions using generalized additive models. Both single-day and distributed lag models were explored over a 15-day period, controlling for apparent temperature, day of week, and long-term time trends. We used a stratified analysis to explore the association across age and season.
  
  
  RESULTS
  Extreme precipitation was consistently associated with GI-related hospital admissions. The cumulative summary of risk ratios estimated for a 15-day period corresponding to an extreme event (relative to no precipitation) was 1.60 (95% CI: 1.29, 1.98) among all ages, 2.72 (95% CI: 1.25, 5.92) among the young (≤ 5 years of age), and 1.62 (95% CI: 0.97, 2.70) among the old (≥ 65 years of age). The association was stronger during the pre-monsoon season (March-May), with a cumulative risk ratio of 6.50 (95% CI: 2.22, 19.04) for all ages combined compared with other seasons.
  
  
  CONCLUSIONS
  Hospital admissions related to GI illness were positively associated with extreme precipitation in Chennai, India, with positive cumulative risk ratios for a 15-day period following an extreme event in all age groups. Projected changes in precipitation and extreme weather events suggest that climate change will have important implications for human health in India, where health disparities already exist.
  
  
  BACKGROUND
  Bush KF, O'Neill MS, Li S, Mukherjee B, Hu H, Ghosh S, Balakrishnan K. 2014. Associations between extreme precipitation and gastrointestinal-related hospital admissions in Chennai, India. Environ Health Perspect 122:249-254; http://dx.doi.org/10.1289/ehp.1306807.
authors.affiliation: Department of Environmental Health Sciences.
authors.forename: Kathleen F
authors.initials: KF
authors.lastname: Bush
authors.forename: Marie S
authors.initials: MS
authors.lastname: O'Neill
authors.forename: Shi
authors.initials: S
authors.lastname: Li
authors.forename: Bhramar
authors.initials: B
authors.lastname: Mukherjee
authors.forename: Howard
authors.initials: H
authors.lastname: Hu
authors.forename: Santu
authors.initials: S
authors.lastname: Ghosh
authors.forename: Kalpana
authors.initials: K
authors.lastname: Balakrishnan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology* / Q000209:etiology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011891:Rain; D012621:Seasons; D055815:Young Adult