title: Risk factors of direct heat-related hospital admissions during the 2009 heatwave in Adelaide, Australia: a matched case-control study.
abstract: The extreme heatwave of 2009 in South Australia dramatically increased morbidity, with a 14-fold increase in direct heat-related hospitalisation in metropolitan Adelaide. Our study aimed to identify risk factors for the excess morbidity.
  
  
  
  A matched case-control study of risk factors was conducted.
  
  
  
  Patients and matched community controls were interviewed to gather data on demographics, living environment, social support, health status and behaviour changes during the heatwave.
  
  
  
  Cases were all hospital admissions with heat-related diagnoses during the 5-day heatwave in 2009. Controls were randomly selected from communities.
  
  
  
  Descriptive analyses, simple and multiple conditional logistic regressions were performed. Adjusted ORs (AORs) were estimated.
  
  
  
  In total, 143 hospital patients and 143 matched community controls were interviewed, with a mean age of 73 years (SD 21), 96% European ethnicity, 63% retired, 36% with high school or higher education, and 8% institutional living. The regression model indicated that compared with the controls, cases were more likely to have heart disease (AOR=13.56, 95% CI 1.27 to 144.86) and dementia (AOR=26.43, 95% CI 1.99 to 350.73). The protective factors included higher education level (AOR=0.48, 95% CI 0.23 to 0.99), having air-conditioner in the bedroom (AOR=0.12, 95% CI 0.02 to 0.74), having an emergency button (AOR=0.09, 95% CI 0.01 to 0.96), using refreshment (AOR=0.10, 95% CI 0.01 to 0.84), and having more social activities (AOR=0.11, 95% CI 0.02 to 0.57).
  
  
  
  Pre-existing heart disease and dementia significantly increase the risk of direct heat-related hospitalisations during heatwaves. The presence of an air-conditioner in the bedroom, more social activities, a higher education level, use of emergency buttons and refreshments reduce the risk during heatwaves.
authors.affiliation: School of Public Health, China Studies Centre, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: South Australian Department for Health and Ageing (DHA), Adelaide, South Australia, Australia.
authors.forename: Monika
authors.initials: M
authors.lastname: Nitschke
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Krackowizer
authors.affiliation: Global Health Institute, Duke University and Duke Kunshan University, Shanghai, China.
authors.forename: Keith
authors.initials: K
authors.lastname: Dear
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Dino
authors.initials: D
authors.lastname: Pisaniello
authors.affiliation: School of Biological Sciences, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: Weinstein
authors.affiliation: South Australian Department for Health and Ageing (DHA), Adelaide, South Australia, Australia.
authors.forename: Graeme
authors.initials: G
authors.lastname: Tucker
authors.affiliation: Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Sepehr
authors.initials: S
authors.lastname: Shakib
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Peng
authors.initials: P
authors.lastname: Bi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004190:Disasters; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D055874:Extreme Heat; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010343:Patient Admission / Q000706:statistics & numerical data*; D065840:Protective Factors; D012307:Risk Factors; D013021:South Australia
keywords: EPIDEMIOLOGY; PREVENTIVE MEDICINE; PUBLIC HEALTH