title: Susceptibility to Heat-Related Fluid and Electrolyte Imbalance Emergency Department Visits in Atlanta, Georgia, USA.
abstract: Identification of populations susceptible to heat effects is critical for targeted prevention and more accurate risk assessment. Fluid and electrolyte imbalance (FEI) may provide an objective indicator of heat morbidity. Data on daily ambient temperature and FEI emergency department (ED) visits were collected in Atlanta, Georgia, USA during 1993-2012. Associations of warm-season same-day temperatures and FEI ED visits were estimated using Poisson generalized linear models. Analyses explored associations between FEI ED visits and various temperature metrics (maximum, minimum, average, and diurnal change in ambient temperature, apparent temperature, and heat index) modeled using linear, quadratic, and cubic terms to allow for non-linear associations. Effect modification by potential determinants of heat susceptibility (sex; race; comorbid congestive heart failure, kidney disease, and diabetes; and neighborhood poverty and education levels) was assessed via stratification. Higher warm-season ambient temperature was significantly associated with FEI ED visits, regardless of temperature metric used. Stratified analyses suggested heat-related risks for all populations, but particularly for males. This work highlights the utility of FEI as an indicator of heat morbidity, the health threat posed by warm-season temperatures, and the importance of considering susceptible populations in heat-health research.
authors.affiliation: Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA. lheidari@gmail.com.
authors.forename: Leila
authors.initials: L
authors.lastname: Heidari
authors.affiliation: Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA. awinqui@emory.edu.
authors.forename: Andrea
authors.initials: A
authors.lastname: Winquist
authors.affiliation: Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA. mklein@emory.edu.
authors.forename: Mitchel
authors.initials: M
authors.lastname: Klein
authors.affiliation: Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA. croleni@emory.edu.
authors.forename: Cassandra
authors.initials: C
authors.lastname: O'Lenick
authors.affiliation: Department of Geography, Franklin College of Arts and Sciences, The University of Georgia, 210 Field Street, Athens, GA 30602, USA. andrewg@uga.edu.
authors.forename: Andrew
authors.initials: A
authors.lastname: Grundstein
authors.affiliation: Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA. sebelt@emory.edu.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Ebelt Sarnat
mesh_terms: D000393:Air Pollutants / Q000032:analysis; D015897:Comorbidity; D004573:Electrolytes / Q000378:metabolism*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005845:Georgia / Q000453:epidemiology; D018882:Heat Stress Disorders / Q000453:epidemiology*; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D016014:Linear Models; D008297:Male; D012621:Seasons; D012737:Sex Factors; D012959:Socioeconomic Factors
chemical_list: D000393:Air Pollutants; D004573:Electrolytes
keywords: climate change; emergency department visits; fluid and electrolyte imbalance; heat morbidity; temperature