Abstract：
BACKGROUND: Although ambient heat exposure is linked with diabetes mortality, the impacts of heat exposure on diabetes-related hospitalizations remain controversial. Previous research did not examine the timing of heat-diabetes associations and relation with comorbidities/risk factors.
OBJECTIVE: We examined the association between heat exposure and diabetes-related hospitalizations in the transitional and summer months and identified populations vulnerable to heat.
METHODS: We conducted a time-stratified case-crossover study. Data on diabetes hospital admissions (primary diagnosis of type 1 and type 2 diabetes, 2013-2020) were collected by the New York State (NYS) Department of Health under the state legislative mandate. We treated temperature and air pollutants as continuous variables and defined the heat exposure as per interquartile range (IQR, a measure between the 25th and 75th percentiles) increase of daily mean temperature. Conditional logistic regressions were performed to quantify the heat-diabetes associations after controlling for air pollutants and time variant variables. Multiplicative-scale interactions between heat and demographics/comorbidities/risk factors on diabetes hospitalizations were investigated.
RESULTS: Each IQR increase in temperature was associated with significantly increased risks for diabetes admissions that occurred immediately and lasted for an entire week during multi-day lags in the transitional month of May (ranges of excess risk: 3.1 %-4.8 %) but not in the summer (June-August) (ranges of excess risk: -0.3 %-1.3 %). The significant increases in the excess risk of diabetes were also found among diabetes patients with complications of neuronopathy (excess risk: 27.7 %) and hypoglycemia (excess risk: 19.1 %). Furthermore, the modification effects on the heat-diabetes association were significantly stronger in females, Medicaid enrollees, non-compliant patients, and individuals with comorbidities of atherosclerotic heart disease and old myocardial infarction.
CONCLUSIONS: Ambient heat exposure significantly increased the burden of hospital admissions for diabetes in transitional rather than summer months indicating the importance of exposure timing. Vulnerability to heat varied by demographics and heart comorbidity.
OBJECTIVE: We examined the association between heat exposure and diabetes-related hospitalizations in the transitional and summer months and identified populations vulnerable to heat.
METHODS: We conducted a time-stratified case-crossover study. Data on diabetes hospital admissions (primary diagnosis of type 1 and type 2 diabetes, 2013-2020) were collected by the New York State (NYS) Department of Health under the state legislative mandate. We treated temperature and air pollutants as continuous variables and defined the heat exposure as per interquartile range (IQR, a measure between the 25th and 75th percentiles) increase of daily mean temperature. Conditional logistic regressions were performed to quantify the heat-diabetes associations after controlling for air pollutants and time variant variables. Multiplicative-scale interactions between heat and demographics/comorbidities/risk factors on diabetes hospitalizations were investigated.
RESULTS: Each IQR increase in temperature was associated with significantly increased risks for diabetes admissions that occurred immediately and lasted for an entire week during multi-day lags in the transitional month of May (ranges of excess risk: 3.1 %-4.8 %) but not in the summer (June-August) (ranges of excess risk: -0.3 %-1.3 %). The significant increases in the excess risk of diabetes were also found among diabetes patients with complications of neuronopathy (excess risk: 27.7 %) and hypoglycemia (excess risk: 19.1 %). Furthermore, the modification effects on the heat-diabetes association were significantly stronger in females, Medicaid enrollees, non-compliant patients, and individuals with comorbidities of atherosclerotic heart disease and old myocardial infarction.
CONCLUSIONS: Ambient heat exposure significantly increased the burden of hospital admissions for diabetes in transitional rather than summer months indicating the importance of exposure timing. Vulnerability to heat varied by demographics and heart comorbidity.
摘要：
背景：尽管环境热暴露与糖尿病死亡率有关，热暴露对糖尿病相关住院的影响仍存在争议.先前的研究没有检查热-糖尿病关联的时间以及与合并症/危险因素的关系。
目的：我们研究了热暴露与过渡月份和夏季月份糖尿病相关住院之间的关系，并确定了容易受热的人群。
方法：我们进行了时间分层的病例交叉研究。糖尿病住院数据（1型和2型糖尿病的主要诊断，2013-2020年）由纽约州（NYS）卫生部根据州立法授权收集。我们将温度和空气污染物作为连续变量，并根据四分位数范围定义了热暴露(IQR，在第25个百分位数和第75个百分位数之间的度量）每日平均温度的升高。在控制空气污染物和时变变量后，进行条件逻辑回归以量化热-糖尿病关联。研究了热量与人口统计学/合并症/糖尿病住院危险因素之间的多重尺度相互作用。
结果：温度的每一次IQR升高都与糖尿病入院风险显着增加有关，糖尿病入院风险在5月的过渡月份（超额风险范围：3.1％-4.8％），但在夏季（6月至8月）则没有（超额风险范围：-0.3％-1.3％）。在患有神经病（超额风险：27.7％）和低血糖（超额风险：19.1％）并发症的糖尿病患者中，糖尿病的超额风险也显着增加。此外，女性对热-糖尿病关联的修饰作用明显更强，医疗补助注册人员，不服从的患者，以及有动脉粥样硬化性心脏病和陈旧性心肌梗塞合并症的个体。
结论：在过渡期而不是夏季，环境热暴露显著增加了糖尿病患者入院的负担，这表明暴露时间的重要性。对热的脆弱性因人口统计学和心脏合并症而异。
目的：我们研究了热暴露与过渡月份和夏季月份糖尿病相关住院之间的关系，并确定了容易受热的人群。
方法：我们进行了时间分层的病例交叉研究。糖尿病住院数据（1型和2型糖尿病的主要诊断，2013-2020年）由纽约州（NYS）卫生部根据州立法授权收集。我们将温度和空气污染物作为连续变量，并根据四分位数范围定义了热暴露(IQR，在第25个百分位数和第75个百分位数之间的度量）每日平均温度的升高。在控制空气污染物和时变变量后，进行条件逻辑回归以量化热-糖尿病关联。研究了热量与人口统计学/合并症/糖尿病住院危险因素之间的多重尺度相互作用。
结果：温度的每一次IQR升高都与糖尿病入院风险显着增加有关，糖尿病入院风险在5月的过渡月份（超额风险范围：3.1％-4.8％），但在夏季（6月至8月）则没有（超额风险范围：-0.3％-1.3％）。在患有神经病（超额风险：27.7％）和低血糖（超额风险：19.1％）并发症的糖尿病患者中，糖尿病的超额风险也显着增加。此外，女性对热-糖尿病关联的修饰作用明显更强，医疗补助注册人员，不服从的患者，以及有动脉粥样硬化性心脏病和陈旧性心肌梗塞合并症的个体。
结论：在过渡期而不是夏季，环境热暴露显著增加了糖尿病患者入院的负担，这表明暴露时间的重要性。对热的脆弱性因人口统计学和心脏合并症而异。
